Sunburn

Author: Vanessa Ngan, Staff Writer, 2005.

Synonyms:

Solar erythema, Erythema solare, Solar dermatitis

Categories:

Reaction to external agent

Subcategories:

Sunburn from sun or artificial UV source, Sunburn cells, Role of UVA and UVB, Skin phototypes, MED, Minimal erythema dose, Risk factors for sunburn, Signs and symptoms of sunburn, Peeling after sunburn, Treatment of sunburn, Prevention of sunburn, Consequences of sunburn

ICD-10:

L55

ICD-11:

EJ40, EJ41.Y, EJ40.0, EJ40.1

SNOMED CT:

403194002, 402606002, 251354007, 164421006

What is sunburn?

Sunburn is erythema and oedema from excessive exposure to the sun’s rays, more specifically the ultraviolet (UV) radiation emitted from the sun. Sunburn may also occur from exposure to other UV light sources such as solaria or tanning salons.

At a cellular level, sunburn is associated with microscopic changes in the skin. There is the formation of UV induced sunburn cells and a reduction in Langerhans cells and mast cells, which play an essential part of the body's immune defence system.

What causes sunburn?

To better understand the causes of sunburn we need to take a look at some basic principles of the electromagnetic (light) spectrum. This spectrum is divided according to wavelength into the ultraviolet (< 400 nm), visible (400–760 nm), and infrared (> 760 nm). The ultraviolet (UV) spectrum is divided into three broad areas:

Ultraviolet A (UV-A) = 320–400 nm
Ultraviolet B (UV-B) = 290–320 nm
Ultraviolet C (UV-C) = < 290 nm.

UV-C radiation is filtered out or absorbed in the outer atmosphere so does not pose a problem to humans. UV-A and UV-B radiation are the primary causes of sunburn. The skin reacts differently to each waveband.

Reactions to UV-A and UV-B radiation

UV-A	UV-B
Less potent than UV-B but is the wavelength that reaches the surface of the earth most (about 90% at midday) Penetrates the middle skin layer (dermis) and subcutaneous fat causing damage to the site where new skin cells are created Long-term exposure causes injury to the dermis resulting in ageing skin	Much more potent at causing erythema About 90% is absorbed by the surface skin layer (epidermis) Epidermis responds by releasing chemicals that cause the reddening and swelling characteristic of the early signs of sunburn Repeated exposure causes injury to the epidermis resulting in ageing skin

Who is at risk of sunburn?

Skin phototyping categorises people into one of six groups based on baseline skin colour and the tendency to tan and burn when exposed to UV radiation.

Skin Phototype	Typical Features	Tanning ability	MED (mJ/cm²)
I	Pale white skin, blue/hazel eyes, blond/red hair	Always burn do not tan	15-30
II	Fair skin, blue eyes	Burn easily, tan poorly	25-40
III	Darker white skin	Tan after the initial burn	30-50
IV	Light brown skin	Burn minimally, tan easily	40-60
V	Brown skin	Rarely burn, tan darkly easily	60-90
VI	Dark brown or black skin	Never burn always tan darkly	90-150

People with type I skin phototyping are at much greater risk of sunburn than their type VI counterparts. The amount of UV radiation, measured in energy per unit area, to produce erythema at an exposed site is called the minimal erythema dose (MED), and this is significantly lower in people with a low skin phototype grading.

Other factors that increase the incidence of sunburn include:

Regions situated closer to the equator
Areas at high altitude – UV radiation increases 4% for every 300m increase in elevation
Skin exposure between 10 am, and 2 pm – 65% of UV radiation reaches the earth between these times
Clear skies: clouds and environmental pollution reduce UV radiation
Environmental reflection – UV radiation is 80% reflected by snow and ice

What are the signs and symptoms of sunburn?

The signs and symptoms of sunburn differ according to the skin phototype and length of exposure to UV radiation. Fifteen minutes of midday sun exposure may cause sunburn in a white skin person, while a darker skinned person may tolerate the exposure for hours.

Signs and symptoms usually occur after 2-6 hours of exposure and peak at 12-24 hours; they may include:

Erythema (redness)
Oedema (swelling)
Tenderness and irritation
Skin feels hot to touch
Pain
Blistering (severe cases)
Chills and fever (severe cases)

In severe cases of sunburn, severe skin burning may result in second-degree burns, dehydration, electrolyte imbalances, secondary infection, shock or even death.

Acute sunburn

Around 4-7 days after exposure skin may start to peel and flake off.

Peeling after sunburn

What is the treatment?

The treatment of sunburn is to provide relief of the discomfort it can cause with the use of analgesics (pain-killers), cool baths, aloe vera lotions and moisturisers.

However, sunburn is better prevented than treated. Sun protection is your best defence against sunburn and other damaging effects of UV radiation.

Avoid sun exposure, especially between 10 am to 2 pm
Wear protective clothing, including wide-brimmed hats
Regularly apply sunscreen with a Sun Protection Factor (SPF) of 50+

An oral food supplement containing Polypodium leucotomas may provide additional oral photoprotection and reduce sunburn.

If you are inadvertently exposed and expect to be sunburned, you may lessen the severity of the burn with the following measures:

Take two aspirin immediately and then two every four hours
Apply a topical steroid to exposed areas twice daily for two or three days

What are the long-term consequences?

It is now clearly apparent that the long-term consequences of overexposure to the sun or other sources of UV radiation are significant. One blistering sunburn at least doubles the likelihood of developing skin cancer later.