The purpose of today's blog, is for my daughter to get an in depth education on sunburn since she never listens to me, Dr. Mom! Not only are we both R+ F consultants and have access to the wonderful sunscreen we sell, but also (even though she is a young adult), I still constantly remind her to use sunscreen and she still doesn't. This weekend, she did get a bad burn on her legs. Allison Marie read on! Please Note: I did add my own commentary throughout this educational article.
INTRODUCTION — Sunburn is an acute, delayed, and transient inflammatory response of the skin to excessive exposure to ultraviolet radiation (UVR) from natural sunlight or artificial sources (eg, tanning beds, phototherapy devices). Both UVB and UVA can cause sunburn, but the wavelengths that are the most effective at inducing redness are in the UVB range. Sunburn is a self-limited condition. The acute manifestations usually resolve in three to seven days. However, susceptibility to sunburn is a marker of genetic susceptibility to skin cancer and is associated with an increased risk of melanoma at all ages. It is very important that those at increased susceptibility to sunburn use sun protection. Younger You Commentary: If you won't believe me, then maybe you will believe this medical summary!
EPIDEMIOLOGY — Sunburn is common. In the United States, the estimated sunburn prevalence among all adults was approximately 34 percent in 2004. Sunburn occurs more frequently among adolescents and young adults. In nation-wide surveys in the United States, approximately 70 percent of adolescents aged 11 to 18 years and 50 percent of adults aged 18 to 29 years reported at least one sunburn in the previous year. Younger You Commentary: See, they don't listen to their Mothers either!
The risk of sunburn is inversely related to latitude and is therefore greatest near the equator, where UVB intensity is highest. The time of day is also important and sunburn is more likely to occur at NOON than earlier or later in the day. Cloud cover when the sun is high offers some protection but significant quantities of UVR still reach the earth’s surface. Additional factors that increase the risk of sunburn include altitude and reflection from snow (approximately 90 percent), sand (15 to 30 percent), and water (5 to 20 percent). There is also evidence that wet skin is more susceptible to redness than dry skin. Younger You Commentary: Yes, even in the winter you need to wear sunscreen
Excessive consumption of alcohol may be a risk factor for sunburn. In a study of beachgoers in Texas, participants reporting alcohol drinking on the beach had a greater body surface area with sunburn and blisters than nondrinkers. Younger You Commentary: Yep, Passed out college kids on Spring Break!
PATHOGENESIS
Individual susceptibility — The susceptibility to sunburn is highly variable among individuals. Phenotypic characteristics that confer high susceptibility to sunburn include fair skin, blue eyes, and red or blond hair. Younger You Commentary: DEAR DAUGHTER: YOU ARE A RED HEAD! ATTENTION ALL BLONDIES AND REDHEADS !!!! Increased susceptibility to sunburn is also a marker of increased risk of melanoma and nonmelanoma skin cancer. This is serious advice!
Action spectra — The action spectrum for erythema indicates that the most effective wavelengths present in sunlight are in the UVB range. UVA also can cause erythema, but doses nearly 1000 times higher than UVB are required.
The sun is primarily a UVA source, with UVB representing only a maximum of approximately 5 percent of the UVR reaching the earth’s surface. Thus, the risk of sunburn is highest when the UVB to UVA ratio is high, as occurs between 11 AM and 3 PM in the summer months in temperate climates and particularly at latitudes approaching the equator.
CLINICAL MANIFESTATIONS — Clinical manifestations of sunburn range from mild erythema(redness) to highly painful erythema(redness) with edema, vesiculation, and blistering. Blistering indicates superficial partial-thickness or, rarely, deep partial-thickness burn.
Erythema(redness)is usually first noted 3 to 5 hours following sunlight exposure, peaks at 12 to 24 hours, and in most cases subsides at 72 hours. The skin areas that were covered or shaded are typically spared.
Increased skin sensitivity to heat and mechanical pressure are characteristic and present even in mild cases. In severe cases, systemic symptoms, including headache, fever, nausea, and vomiting, may develop.
Clinical course — The erythema typically resolves in three to seven days. Blisters heal without scarring in 7 to 10 days. Scaling, desquamation, and tanning are noted four to seven days after exposure.
In light-skinned individuals, multiple permanent brown macules, often with irregular borders, may occur after sunburn (sunburn-induced solar lentigines). Younger You Commentary: This is where Reverse Regimen is helpful for brown spots caused by sun damage
MANAGEMENT
Mild to moderate sunburn — Sunburn is a self-limiting condition that usually resolves in a few days. There are no specific therapies to reverse the skin damage and hasten the healing time. Management involves the symptomatic treatment of skin inflammation and control of pain.Younger You commentary: This is why every household should have Soothe Steps 2 and 3 to help speed up the healing process and ease the pain!
Cool compresses or soaks, calamine lotion, or aloe vera-based gels provide some relief of pain and discomfort. Bland emollients (eg, liquid paraffin/white soft paraffin 50/50) can be used on intact skin as tolerated. Ruptured blisters should be gently cleaned with mild soap and water and covered with wet dressings (eg, saline or petrolatum impregnated gauzes).
For the treatment of skin pain and inflammation, we suggest oral nonsteroidal antiinflammatory drugs (NSAIDs). We generally use ibuprofen at a dose of 400 to 800 mg per dose three to four times per day in adults and children >12 years and 4 to 10 mg/kg per dose every six to eight hours in children 6 months to 12 years. Treatment should be initiated as soon as the first symptoms become apparent and continued for 24 to 48 hours.
Do not use topical corticosteroids for the treatment of sunburn. Although they are frequently used in clinical practice, there is little evidence that they are beneficial in reducing the symptoms and healing time of sunburn.
Patients with severe sunburn — Patients with extensive blistering sunburn, severe pain, and systemic symptoms (eg, fever, headache, vomiting, dehydration) may require hospitalization for fluid replacement and parenteral analgesia.
Blistered areas should be gently cleaned with mild soap and water and covered with sterile dressings. Topical antimicrobials or antibiotics (eg, silver sulfadiazine or mupirocin 2% ointment) may be used to prevent bacterial superinfection.
There is no evidence that oral corticosteroids are useful in severe sunburn. In a small study, participants received prednisone 80 mg or placebo immediately after UVB irradiation and for the following three days. Prednisone was not more effective than placebo in reducing erythema, edema, and pain of the irradiated sites.
PREVENTION — Prevention of sunburn involves sun avoidance, wearing protective clothing, and liberal use of broad spectrum sunscreens. Younger you Commentary: Hello, prevention is key....use the darn sunscreen and one of the best ones you can get is our SPF 30 Sunscreen by Rodan + Fields!! It is important that clinicians counsel patients with sun-sensitive skin types about sun protection, because susceptibility to sunburn is a marker of genetic susceptibility to skin cancer and is associated with an increased risk of melanoma at all ages.
●Individuals should be advised to seek shade or reduce exposure particularly in the summer months and between 10:00 AM and 4:00 PM, when sunlight intensity is greatest. Infants younger than six months should be kept out of direct sunlight.
●Protective clothing such as long sleeves and broad brim hats should be worn while outdoors. Fabrics that are tightly woven, thick, or dark-colored are useful for protection. Clothing developed for photosensitive individuals is commercially available from specialty companies.
●For infants younger than six months, the American Academy of Pediatrics recommends avoidance of sun exposure and the use of clothing (eg, lightweight pants, long-sleeved shirts, brimmed hats). A minimal amount of sunscreen with an SPF of ≥15 may be applied to small areas (eg, face, back of hands) when adequate clothing and shade are not available.
●Intentional tanning by using UVA tanning beds does not protect against the risk of sunburn. Although suberythemal repetitive exposures to UVA induce a visible increase in skin pigmentation (immediate tanning, due to oxidation and redistribution of existing melanin), they do not increase melanin production and provide little or no photoprotection against subsequent UV exposures.
Source: UpToDate
EPIDEMIOLOGY — Sunburn is common. In the United States, the estimated sunburn prevalence among all adults was approximately 34 percent in 2004. Sunburn occurs more frequently among adolescents and young adults. In nation-wide surveys in the United States, approximately 70 percent of adolescents aged 11 to 18 years and 50 percent of adults aged 18 to 29 years reported at least one sunburn in the previous year. Younger You Commentary: See, they don't listen to their Mothers either!
The risk of sunburn is inversely related to latitude and is therefore greatest near the equator, where UVB intensity is highest. The time of day is also important and sunburn is more likely to occur at NOON than earlier or later in the day. Cloud cover when the sun is high offers some protection but significant quantities of UVR still reach the earth’s surface. Additional factors that increase the risk of sunburn include altitude and reflection from snow (approximately 90 percent), sand (15 to 30 percent), and water (5 to 20 percent). There is also evidence that wet skin is more susceptible to redness than dry skin. Younger You Commentary: Yes, even in the winter you need to wear sunscreen
Excessive consumption of alcohol may be a risk factor for sunburn. In a study of beachgoers in Texas, participants reporting alcohol drinking on the beach had a greater body surface area with sunburn and blisters than nondrinkers. Younger You Commentary: Yep, Passed out college kids on Spring Break!
PATHOGENESIS
Individual susceptibility — The susceptibility to sunburn is highly variable among individuals. Phenotypic characteristics that confer high susceptibility to sunburn include fair skin, blue eyes, and red or blond hair. Younger You Commentary: DEAR DAUGHTER: YOU ARE A RED HEAD! ATTENTION ALL BLONDIES AND REDHEADS !!!! Increased susceptibility to sunburn is also a marker of increased risk of melanoma and nonmelanoma skin cancer. This is serious advice!
Action spectra — The action spectrum for erythema indicates that the most effective wavelengths present in sunlight are in the UVB range. UVA also can cause erythema, but doses nearly 1000 times higher than UVB are required.
The sun is primarily a UVA source, with UVB representing only a maximum of approximately 5 percent of the UVR reaching the earth’s surface. Thus, the risk of sunburn is highest when the UVB to UVA ratio is high, as occurs between 11 AM and 3 PM in the summer months in temperate climates and particularly at latitudes approaching the equator.
CLINICAL MANIFESTATIONS — Clinical manifestations of sunburn range from mild erythema(redness) to highly painful erythema(redness) with edema, vesiculation, and blistering. Blistering indicates superficial partial-thickness or, rarely, deep partial-thickness burn.
Erythema(redness)is usually first noted 3 to 5 hours following sunlight exposure, peaks at 12 to 24 hours, and in most cases subsides at 72 hours. The skin areas that were covered or shaded are typically spared.
Increased skin sensitivity to heat and mechanical pressure are characteristic and present even in mild cases. In severe cases, systemic symptoms, including headache, fever, nausea, and vomiting, may develop.
Clinical course — The erythema typically resolves in three to seven days. Blisters heal without scarring in 7 to 10 days. Scaling, desquamation, and tanning are noted four to seven days after exposure.
In light-skinned individuals, multiple permanent brown macules, often with irregular borders, may occur after sunburn (sunburn-induced solar lentigines). Younger You Commentary: This is where Reverse Regimen is helpful for brown spots caused by sun damage
MANAGEMENT
Mild to moderate sunburn — Sunburn is a self-limiting condition that usually resolves in a few days. There are no specific therapies to reverse the skin damage and hasten the healing time. Management involves the symptomatic treatment of skin inflammation and control of pain.Younger You commentary: This is why every household should have Soothe Steps 2 and 3 to help speed up the healing process and ease the pain!
Cool compresses or soaks, calamine lotion, or aloe vera-based gels provide some relief of pain and discomfort. Bland emollients (eg, liquid paraffin/white soft paraffin 50/50) can be used on intact skin as tolerated. Ruptured blisters should be gently cleaned with mild soap and water and covered with wet dressings (eg, saline or petrolatum impregnated gauzes).
For the treatment of skin pain and inflammation, we suggest oral nonsteroidal antiinflammatory drugs (NSAIDs). We generally use ibuprofen at a dose of 400 to 800 mg per dose three to four times per day in adults and children >12 years and 4 to 10 mg/kg per dose every six to eight hours in children 6 months to 12 years. Treatment should be initiated as soon as the first symptoms become apparent and continued for 24 to 48 hours.
Do not use topical corticosteroids for the treatment of sunburn. Although they are frequently used in clinical practice, there is little evidence that they are beneficial in reducing the symptoms and healing time of sunburn.
Patients with severe sunburn — Patients with extensive blistering sunburn, severe pain, and systemic symptoms (eg, fever, headache, vomiting, dehydration) may require hospitalization for fluid replacement and parenteral analgesia.
Blistered areas should be gently cleaned with mild soap and water and covered with sterile dressings. Topical antimicrobials or antibiotics (eg, silver sulfadiazine or mupirocin 2% ointment) may be used to prevent bacterial superinfection.
There is no evidence that oral corticosteroids are useful in severe sunburn. In a small study, participants received prednisone 80 mg or placebo immediately after UVB irradiation and for the following three days. Prednisone was not more effective than placebo in reducing erythema, edema, and pain of the irradiated sites.
PREVENTION — Prevention of sunburn involves sun avoidance, wearing protective clothing, and liberal use of broad spectrum sunscreens. Younger you Commentary: Hello, prevention is key....use the darn sunscreen and one of the best ones you can get is our SPF 30 Sunscreen by Rodan + Fields!! It is important that clinicians counsel patients with sun-sensitive skin types about sun protection, because susceptibility to sunburn is a marker of genetic susceptibility to skin cancer and is associated with an increased risk of melanoma at all ages.
●Individuals should be advised to seek shade or reduce exposure particularly in the summer months and between 10:00 AM and 4:00 PM, when sunlight intensity is greatest. Infants younger than six months should be kept out of direct sunlight.
●Protective clothing such as long sleeves and broad brim hats should be worn while outdoors. Fabrics that are tightly woven, thick, or dark-colored are useful for protection. Clothing developed for photosensitive individuals is commercially available from specialty companies.
●For infants younger than six months, the American Academy of Pediatrics recommends avoidance of sun exposure and the use of clothing (eg, lightweight pants, long-sleeved shirts, brimmed hats). A minimal amount of sunscreen with an SPF of ≥15 may be applied to small areas (eg, face, back of hands) when adequate clothing and shade are not available.
●Intentional tanning by using UVA tanning beds does not protect against the risk of sunburn. Although suberythemal repetitive exposures to UVA induce a visible increase in skin pigmentation (immediate tanning, due to oxidation and redistribution of existing melanin), they do not increase melanin production and provide little or no photoprotection against subsequent UV exposures.
Source: UpToDate
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