Sunburn

Topic Overview

Sunlight can help our mental outlook and help us feel healthier. For people who have arthritis, the sun's warmth can help relieve some of their physical pain. Many people also think that a suntan makes a person look young and healthy. But sunlight can be harmful to the skin, causing immediate problems as well as problems that may develop years later.

A sunburn is skin damage from the sun's ultraviolet (UV) rays. Most sunburns cause mild pain and redness but affect only the outer layer of skin (first-degree burn). The red skin might hurt when you touch it. These sunburns are mild and can usually be treated at home.

Skin that is red and painful and that swells up and blisters may mean that deep skin layers and nerve endings have been damaged (second-degree burn). This type of sunburn is usually more painful and takes longer to heal.

Other problems that can be present along with sunburn include:

  • Heatstroke or other heat-related illnesses from too much sun exposure.
  • Allergic reactions to sun exposure or to sunscreen products.
  • Vision problems, such as burning pain, decreased vision, or partial or complete vision loss.

Long-term problems include:

  • An increased chance of having skin cancer.
  • An increase in the number of cold sores.
  • An increase in problems related to a health condition, such as lupus.
  • Cataracts , from not protecting your eyes from direct or indirect sunlight over many years. Cataracts are one of the leading causes of blindness.
  • Skin changes, such as premature wrinkling or brown spots.

Your skin type affects how easily you become sunburned. People with fair or freckled skin, blond or red hair, and blue eyes usually sunburn easily. Your age also affects how your skin reacts to the sun. The skin of children younger than 6 and adults older than 60 is more sensitive to sunlight.

You may get a more severe sunburn depending on:

  • The time of day. You are more likely to get a sunburn between 10 in the morning and 4 in the afternoon, when the sun's rays are the strongest. You might think the chance of getting a sunburn on cloudy days is less, but the sun's damaging UV light can pass through clouds.
  • Whether you are near reflective surfaces, such as water, white sand, concrete, snow, and ice. All of these reflect the sun's rays and can cause sunburns.
  • The season of the year. The position of the sun on summer days can cause a more severe sunburn.
  • Altitude. It is easy to get sunburned at higher altitudes, because there is less of the earth's atmosphere to block the sunlight. UV exposure increases about 4% for every 1000 ft (305 m) gain in elevation.
  • How close you are to the equator (latitude). The closer you are to the equator, the more direct sunlight passes through the atmosphere. For example, the southern United States gets 1.5 times more sunlight than the northern United States.
  • The UV index of the day, which indicates the risk of getting a sunburn that day.

Preventive measures and home treatment are usually all that is needed to prevent or treat a sunburn.

  • Protect your skin from the sun.
  • Do not stay in the sun too long.
  • Use sunscreens, and wear clothing that covers your skin.

If you have any health risks that may increase the seriousness of sun exposure, you should avoid being in the sun from 10 in the morning to 4 in the afternoon.

Use the Check Your Symptoms section to decide if and when you should see a doctor.

Check Your Symptoms

Home Treatment

Home treatment measures may provide some relief from a mild sunburn.

  • Use cool cloths on sunburned areas.
  • Take frequent cool showers or baths.
  • Apply soothing lotions that contain aloe vera to sunburned areas. Topical steroids (such as 1% hydrocortisone cream) may also help with sunburn pain and swelling. Note: Do not use the cream on children younger than age 2 unless your doctor tells you to. Do not use in the rectal or vaginal area in children younger than age 12 unless your doctor tells you to.

A sunburn can cause a mild fever and a headache. Lie down in a cool, quiet room to relieve the headache. A headache may be caused by dehydration, so drinking fluids may help. For more information, see the topic Dehydration.

There is little you can do to stop skin from peeling after a sunburn—it is part of the healing process. Lotion may help relieve the itching.

Other home treatment measures, such as chamomile, may help relieve your sunburn symptoms.

Medicine you can buy without a prescription
Try a nonprescription medicine to help treat your fever or pain:

Talk to your child’s doctor before switching back and forth between doses of acetaminophen and ibuprofen. When you switch between two medicines, there is a chance your child will get too much medicine.

Safety tips
Be sure to follow these safety tips when you use a nonprescription medicine:
  • Carefully read and follow all directions on the medicine bottle and box.
  • Do not take more than the recommended dose.
  • Do not take a medicine if you have had an allergic reaction to it in the past.
  • If you have been told to avoid a medicine, call your doctor before you take it.
  • If you are or could be pregnant, do not take any medicine other than acetaminophen unless your doctor has told you to.
  • Do not give aspirin to anyone younger than age 20 unless your doctor tells you to.

Care of blisters

Home treatment may help decrease pain, prevent infection, and help the skin heal.

Small, unbroken blisters [less than 1 in. (2.5 cm) across] usually heal on their own.

  • Do not try to break the blisters. Just leave them alone.
  • Do not cover the blisters unless something such as clothing is rubbing against them. If you do cover them, apply a loose bandage. Secure the bandage so the tape does not touch the blisters. Do not wrap tape completely around a hand, arm, foot, or leg, because it could cut off the blood supply if the limb swells. If the tape is too tight, you may develop symptoms below the level of the tape, such as numbness, tingling, pain, or cool and pale or swollen skin.
  • Avoid wearing clothes or shoes or doing activities that rub or irritate the blisters until they have healed.

Large or broken blisters usually heal without problems. Most large blisters will break on their own and then heal.

  • Wash your hands with soap and water before touching blisters. Blisters can easily become infected.
  • If you have a large blister, you may want to drain it, depending on where it is. If you decide to drain it:
    • Clean a needle with rubbing alcohol or soap and water, then use it to gently puncture the edge of the blister.
    • Press the fluid in the blister toward the hole you made.
    • Wash the blister after you have drained it, and pat it dry with clean gauze.
  • Do not remove the flap of skin covering the blister unless it tears or gets dirty or pus forms under it. If the blister has just a small puncture or break, leave the flap of skin on, and gently smooth it flat over the tender skin underneath.
  • Apply an antibiotic ointment, such as polymyxin B or bacitracin, if you are not allergic to it. The ointment will prevent the bandage from sticking to the blister and may help prevent infection. Do not use alcohol or iodine on the blister, because these may delay healing. Do not use an ointment if you know you are allergic to it.
  • Loosely apply a bandage or gauze. Secure the bandage so the tape does not touch the blister. Do not wrap tape completely around a hand, arm, foot, or leg, because it could cut off the blood supply if the limb swells. If the tape is too tight, you may develop numbness, tingling, pain, or cool and pale or swollen skin below the level of the tape.
  • If the skin under the bandage begins to itch or develops a rash, stop using the antibiotic ointment.
  • Change the bandage every day and anytime it gets wet or dirty. You can soak the bandage in cool water just before removing it to make it less painful to take off.
  • Avoid wearing clothes or shoes or doing activities that rub or irritate the blisters until they have healed.

Watch for a skin infection while your blister is healing. Signs of infection include:

  • Increased pain, swelling, redness, or warmth around the blister.
  • Red streaks extending away from the blister.
  • Drainage of pus from the blister.
  • Swollen lymph nodes in your neck, armpit, or groin.
  • Fever.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur during home treatment:

  • Vision problems continue after you get out of the sun.
  • Fever develops.
  • Dehydration develops and you are unable to drink enough to replace lost fluids.
  • Signs of skin infection in blisters develop.
  • Signs of an allergic reaction develop.
  • Symptoms become more severe or more frequent.

Prevention

Avoid sun exposure

The best way to prevent a sunburn is to avoid sun exposure.

Stay out of the midday sun (from 10 in the morning to 4 in the afternoon), which is the strongest sunlight. Find shade if you need to be outdoors. You can also calculate how much ultraviolet (UV) exposure you are getting by using the shadow rule: A shadow that is longer than you are means UV exposure is low; a shadow that is shorter than you are means the UV exposure is high.

Other ways to protect yourself from the sun include wearing protective clothing, such as:

  • Hats with wide 4 in. (10 cm) brims that cover your neck, ears, eyes, and scalp.
  • Sunglasses with UV protection.
  • Loose-fitting, tightly woven clothing that covers your arms and legs. Some outdoor stores may sell clothing treated with sun protection factor.

Do not use tanning booths to get a tan. Artificial tanning devices can cause skin damage and increase the risk of skin cancer.

Preventing sun exposure in children

You should start protecting your child from the sun when he or she is a baby. Because children spend a lot of time outdoors playing, they get most of their lifetime sun exposure in their first 18 years.

  • Keep babies younger than 6 months of age out of the sun. Use sunscreen on children older than 6 months.
  • Teach children the ABCs of how to protect their skin from getting sunburned.
    • A = Away. Stay away from the sun in the middle of the day (from 10 in the morning to 4 in the afternoon).
    • B = Block. Use a sunscreen with a sun protection factor (SPF) of 15 or higher to protect babies' and children's very sensitive skin.
    • C = Cover up. Wear clothing that covers the skin, hats with wide brims, and sunglasses with UV protection. Even children 1 year old should wear sunglasses with UV protection.
    • S = Speak out. Teach others to protect their skin from sun damage.

Sunscreen protection

If you can't avoid being in the sun, use a sunscreen to help protect your skin while you are in the sun.

  • Use a sunscreen that has a sun protection factor (SPF) of at least 15 or higher. Sunscreens that say "broad-spectrum" can protect the skin from ultraviolet A and B (UVA and UVB) rays. Sunscreens come in lotions, gels, creams, and ointments.
  • Apply the sunscreen at least 30 minutes before going in the sun.
  • Apply sunscreen to all the skin that will be exposed to the sun, including the nose, ears, neck, scalp, and lips. Sunscreen needs to be applied evenly over the skin and in the amount recommended on the label. Most sunscreens are not completely effective, because they are not applied correctly. It usually takes about 1 fl oz (30 mL) to cover an adult's body.
  • Apply sunscreen every 2 to 3 hours while in the sun and after swimming or sweating a lot. The SPF value decreases if a person sweats heavily or is in water, because water on the skin reduces the amount of protection the sunscreen provides. Sunscreen effectiveness is also affected by the wind, humidity, and altitude.
  • Use lip balm or cream that has sun protection factor (SPF) of 15 or higher to protect your lips from getting sunburned or developing cold sores.

Some sunscreens say they are water-resistant or waterproof and can protect for about 40 minutes in the sun if a person is doing a water activity. Apply sunscreen more often if you are in water. Wet skin can burn easily, so it is important to protect your skin even if you do not feel that you are getting sunburned. Wearing a T-shirt while swimming does not protect your skin unless sunscreen has also been applied to your skin under the T-shirt.

The following tips about sunscreen will help you use it more effectively:

  • Older adults should always use a sunscreen with an SPF of at least 15 to protect their very sensitive skin.
  • If you have sensitive skin that burns easily, use a sunscreen with an SPF of at least 15.
  • If you have dry skin, use a cream or lotion sunscreen.
  • If you have oily skin or you work in dusty or sandy conditions, use a gel, which dries on the skin without leaving a film.
  • If your skin is sensitive to skin products, use a sunscreen that is free of chemicals and alcohol.
  • If you have had a skin reaction (allergic reaction) to a sunscreen, look for one that is free of para-aminobenzoic acid (PABA), preservatives, and perfumes. These ingredients may cause skin reactions.
  • If you are going to be in very intense sunlight for a long period of time, consider using a physical sunscreen (sunblock), such as zinc oxide, which will stop all sunlight from reaching the skin.
  • If you need to use sunscreen and insect repellent with DEET, do not use a product that combines the two. You can apply sunscreen first and then apply the insect repellent with DEET, but the sunscreen needs to be reapplied every 2 hours.

For information on sun exposure and vitamin D, see Getting Enough Vitamin D.

Preparing For Your Appointment

To prepare for your appointment, see the topic Making the Most of Your Appointment.

You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:

  • What are your main symptoms?
  • How long have you had your symptoms?
  • Do you have blisters?
  • What amount of time did you spend in the sun? Were you at a high altitude?
  • Did you use sunscreen or sunblock, and what SPF was used?
  • Have you had this problem before? If so, do you know what caused the problem at that time? How was it treated?
  • What activities make your symptoms better or worse?
  • What prescription or nonprescription medicines do you take?
  • What home treatment measures have you tried? Did they help?
  • What nonprescription medicines have you tried? Did they help?
  • Do you have any health risks?

Other Places To Get Help

Online Resource

U.S. Environmental Protection Agency SunWise Program
Web Address: www.epa.gov/sunwise
 

The U.S. Environmental Protection Agency (EPA) created the SunWise program to teach children and caregivers about the UV index and safe sun exposure.


Related Information

Credits

Author Jan Nissl, RN, BS
Editor Susan Van Houten, RN, BSN, MBA
Associate Editor Tracy Landauer
Primary Medical Reviewer H. Michael O'Connor, MD - Emergency Medicine
Specialist Medical Reviewer Martin Gabica, MD - Family Medicine
Last Updated December 21, 2009

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