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Sunburn

Definition


Disease: Sunburn Sunburn
Category: Dermatological diseases
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Disease Definition:

Within a few hours after sun exposure, a person may notice having red and painful skin that feels hot to the touch. This means that they have a condition known as sunburn, which may take from several days to weeks in order to fade.

The risk of developing skin related diseases and complications will increase due to intense sun exposure. Some of those complications may be skin cancer (including melanoma), liver spots, dry and wrinkled skin and actinic keratoses.

There are several home remedies and treatments that can alleviate the pain of sunburn and speed recovery. However, by protecting the skin when going outside, one can prevent sunburn and the skin conditions that are caused by it.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Some of the signs and symptoms of sunburn may be:

-    Swelling
-    Red or pink skin
-    Skin that feels warm or hot to the touch
-    Small fluid-filled blisters that may break
-    Tenderness or pain
-    In case the sunburn covers a large area, the person may experience fever, headache and fatigue.

The sun could burn any part of the body, including the eyes, which are especially sensitive to UV light and may feel painful, the lips, earlobes and scalp.

It may take a day or more in order to know the full extent of the sunburn, but usually, the signs and symptoms start showing within a few hours of being exposed to the sun.

The body usually heals the sunburn itself by peeling the top layer of the skin, which may take more than a couple of days, depending on the severity of the condition. The skin may have a strange pattern and color for a short period of time after the peeling process.

In case the sunburned person notices any signs and symptoms of infection, he/she should see a doctor. Some of those symptoms may be:

-    Increasing swelling
-    Red streaks that lead away from the open blister. These streaks may extend in a line upward along the arm or leg
-    Increasing tenderness and pain
-    Yellow drainage from an open blister

In addition to the symptoms mentioned above, a sunburned person should also see a doctor in case the sunburn doesn't respond to self-care methods within a few days; is accompanied by nausea, chills, extreme pain, confusion and fever; or if the sunburn covers a large portion of the body and is blistering.

Causes:

The ultraviolet radiation is a wavelength of sunlight that is in too short of a range to be seen by the human eye. The three wavelength bands of the UV light are:

-    UVA (ultraviolet A)
-    UVB (ultraviolet B)
-    UVC (ultraviolet C)

Only the UVA and UVB rays reach the earth.

Being exposed to too much UV light causes sunburn. Sunburn could also be caused by commercial tanning lamps and beds, because they also produce UV light.

The skin's production of melanin increases when a person is exposed to UV light. Being the dark pigment in the epidermis, melanin gives the skin its normal color. The darker color of the tan is created by the extra melanin that is produced for the purpose of protecting the deeper layers of the skin. This means that the suntan is the result of the skin's attempt to prevent sunburn and other skin damage caused by the UV rays. The UV light will ultimately cause the skin to burn, which in turn causes pain, swelling and redness, especially in people who can't produce enough melanin to protect their skin, because the production of melanin is determined genetically.

About 90% of UV rays pass through clouds, which means that a person can get sunburn on cloudy days too. Water, ice, sand, snow and other reflective surfaces can reflect UV lights causing sunburn similar to direct sunlight.


Because people with darker skin have more melanin, which provides them protection from sunburn but not from UV-induced skin damage, dark skinned people are less likely to experience sunburn than are people with fair skin.

The number, distribution and type of pigment-producing cells called melanocytes in the skin determine the skin color. There are six types of skin, ranging from very little pigment to very darkly pigmented.

The darkness of the skin and the skin type will determine how easily someone burns:

-    Type 1 skin has a pale white color and never tans because it always burns
-    Type 2 skin has a white color that burns easily and tans minimally
-    Type 3 skin also has a white color that tans slowly and burns minimally
-    Type 4 skin has a light brown or olive color that burns minimally and tans easily
-    Type 5  skin has a brown color that tans easily and darkly and burns only in some rare cases
-    Type 6 skin has a dark brown or black color that is deeply pigmented, always tans, and burns only in some rare cases.

The energy of the sun will penetrate deeply into the skin and damage the DNA of the skin cells, no matter what the type of the skin is. Melanoma is one of the types of skin cancer that may be caused by this damage. The fingers, palms or other more lightly pigmented areas of the body may be the areas where people with type 5 or 6 skin may develop skin cancer.

Because people who live in sunny, warm and high altitude climates are exposed to more sunlight than those who live in colder climates, their risk of experiencing sunburn is increased.

Other people who are exposed to more radiation and so have greater chances of experiencing sunburn and skin damage are those who live at higher elevations, where the sun is extremely strong.

Complications

Complications:

The risk of developing certain complications and diseases that are related to skin will be increased due to intense sun exposure. Skin cancer, infection and premature aging of the skin may be some of those complications.


INFECTION
In case someone notices pain, swelling, redness or oozing, which are some of the symptoms of infection, they should see a doctor. The risk of developing an infection increases if someone has ruptured blisters.


PHOTOAGING
Skin changes caused by the sun are called photoaging.
A person may look older than he/she actually is because sun exposure and repeated sunburns accelerate the aging process of the skin. Photoaging may cause:

-    Freckles, which usually appear on the face and shoulders
-    Dry, rough skin
-    Deep wrinkles
-    White macules on the lower arms and legs
-    Fine red veins on the ears, nose and cheeks
-    Thinner and more translucent-looking skin
-    A decrease in the strength and elasticity of the skin due to the weakening of connective tissues.
-    Large brown lesions or macules on the face, arms, back of hands, upper back and chest (liver spots or solar lentigines).


ACTINIC KERATOSES
In the sun-exposed areas of the skin, actinic keratoses (also called solar keratoses) appear as rough and scaly areas. They are considered precancerous because they usually evolve into skin cancer. They may be whitish, pink or flesh-colored to brown or dark brown colored patches. These actinic keratoses usually appear on the face, ears, lower arms and backs of the hands of people whose fair skin has been damaged by the sun.


SKIN CANCER
The DNA of the skin cells may be damaged by intense sun exposure, leading to skin cancer. The arms and hands, scalp, face, neck, lips, chest, ears, on the legs in women and other areas that are more exposed to the sun are the areas where skin cancer develops.

Some types of melanoma may develop in areas that have been exposed to the sun for long periods. Also known as lentigo maligna, these will start as dark flat spots that become larger and darker. In other cases, an existing mole may change or a new, suspicious-looking mole may develop. Other types of skin cancer may appear as a small growth or as a sore that bleeds, crusts over, heals and then reopens.

In case someone notices a sore that doesn't heal, a change in the appearance or texture of a mole, a new skin growth or a bothersome change in the skin, they should see a doctor.


EYE DAMAGE
The retina, which is the thin layer of tissue that lines the back inner wall of the eyeball, may be damaged by UV light. The sun may also burn the eyes, damaging the lens, which is the clear structure inside the eye. Cataracts, the condition marked by the progressive clouding of the lens, may also be caused by sunburn.

Treatments:

Even though treatment for sunburn may reduce pain, swelling and discomfort, however, it won't heal or prevent damage to the skin. Applying a cool compress, applying an aloe vera lotion and taking an over-the-counter (OTC) anti-inflammatory medication are some of the self-care measures that may be helpful. Based on the severity of the burn, sunburn may resolve on its own within several days.

A person may be prescribed some of the medications mentioned below in case their sunburn is very severe or if self-care measures don't help:

NSAIDs:
In case these nonsteroidal anti-inflammatory medications are given as soon as symptoms appear, they may be quite helpful in relieving pain, swelling and inflammation. All of the types of NSAIDs may irritate the stomach and intestine. Additionally, over-the-counter (OTC) NSAIDs are less potent than prescription ones.

Corticosteroid medications:
Because corticosteroids stop being effective beyond 24 to 48 hours after the sunburn, they aren't prescribed very often. However, when given in time, they can increase the rate at which the skin heals, as well as reducing pain and swelling. One example is prednisone.

Prognosis:

Not available

Expert's opinion

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Dr. Samer Al-Jneidy

Dr. Samer Al-Jneidy Pediatrician

Dr. Tahsin Martini

Dr. Tahsin Martini Degree status: M.D. in Ophthalmology

Dr. Hani Najjar

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Dr. Faisal Dibsi

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Yaser Habrawi , F.R.C.S.Ed

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