Sun burn

Definition

Sunburn, also called solar erythema or in Latin Dermatitis solaris , is defined as a 1st degree superficial skin burn or an acute inflammation of the skin. Sunburn appears after a few hours of exposure to the sun and can take several days to several weeks to disappear.1.

Sunburn is a burn caused by radiation. Clinically, there is a strong inflammatory component. In fact, researchers observed in a mouse study published in 2013 in the scientific journal PNAS (DOI: 10.1073/pnas.1312933110 ) that ultraviolet rays from UVB sunlight damaged a small RNA molecule in keratinocytes (cells in the surface layer of the skin that synthesizes keratin). This modified RNA molecule triggered a chain reaction that could lead to skin inflammation. Hence the interest in treatment, mainly against pain, with the use of anti-inflammatories usually in the form of a cream (more information below in Treatments🇧🇷 It is important to know that inflammation is necessary for healing, it is one of the phases of healing. Therefore, anti-inflammatory drugs should only be used in case of severe pain.

Sunburn has two phases:
1.  The epidermis turns red (there is a burning sensation, reminiscent of inflammation).
2.  The epidermis begins to peel. If there is detachment of the epidermis (blisters), it is a 2nd degree burn .

Albinism (influence of melanin)
People with albinism, with reduced or no melanin production, have a significantly higher risk of suffering from sunburn and skin cancer.

Index

Causes

The most frequent cause of sunburn is, of course, excessive and/or poorly protected exposure to the sun’s ultraviolet rays (UVA and UVB), which is an invisible light. UVB rays are in fact the main cause of sunburn.

Some people are more at risk than others, such as children (who have very sensitive skin) and people with fair skin (blondes or redheads), as they generally have less melanin (a molecule that protects the skin against sun exposure).

It is important to know that the intensity of the sun can increase by 30% on the beach or in the mountains, due to the increased reflection of UV rays on sand, water and snow. It is therefore necessary to further extend protection in these places. It is also necessary to protect yourself even on cloudy days, as UV rays pass through clouds and can cause burns. Inadequate or unrenewed sun protection also increases the risk of sunburn.

Another way to get sunburned is through tanning beds and tanning booths, which use UV rays to produce a tan.

Certain medications, especially tetracyclines (doxycycline, minocycline), a class of antibiotics frequently used in acne problems, can favor the appearance of sunburns, as they make the skin more sensitive. We are talking about photosensitivity. If you are being treated with one of these substances, avoid exposure to the sun or with an SPF greater than 25.

Other medications also make the skin more sensitive to sunburn, but cases are rare: non-steroidal anti-inflammatory drugs (example:  ibuprofen ), quinolones, furosemide, hydrochlorothiazide (HCTZ) and phenothiazines.

Symptoms

After very intense exposure to the sun, the skin (more precisely the epidermis) becomes red, painful, burning and itching may occur. In severe cases, the patient may blister – that is, a 2nd degree burn – and suffer from heatstroke. Fever, fatigue, and headaches can sometimes be present.
Unlike other burns, sunburn symptoms are not immediate, redness usually appears between 3 to 5 hours after sun exposure, with the worst period after 12 to 24 hours. This first phase usually lasts two or three days, after which the redness disappears and the skin begins to dry out and flake off.

Symptoms of severe burns include: severe pain, blistering and heat stroke. Heatstroke can cause fever, headache, nausea, vomiting, mental confusion, blurred vision, and fainting. If you experience any of these symptoms, seek emergency medical attention (emergency room).

It is important to note that although tanning is in fashion these days, overexposure to the sun damages and greatly ages the skin.

In the long term, after a lot of sun exposure, it is possible to develop skin cancer, including melanoma, a serious type of skin cancer that is difficult to treat. In addition, sun exposure can also increase the risk of developing cataracts (when the eye film becomes cloudy, which can lead to blindness). Therefore, you should avoid getting too much sun, especially at the most dangerous times, between 10 am and 4 pm.

It is strongly recommended to use glasses with adequate protection (anti-UV).

Complications

Despite a tanned body being fashionable and popular these days, repeated exposure to the sun leads to excessive aging of the skin.

Getting sunburned, especially in childhood, can promote the long-term development of skin cancer (notably melanoma). According to a May 2014 Harvard study of more than 100,000 women, those who had at least 5 sunburns between the ages of 15 and 20 had an 80% higher risk of developing melanoma a few years later.

Eye problems such as the appearance of cataracts, premature aging with the formation of wrinkles are also complications of repeated sunburn.

Sunburn should always be avoided.

Treatments

The treatment of sunburn consists of protecting or treating the skin before (1), during (2) or after (3) exposure to the sun.

1.  Before exposure (and prevention), it is important to smear your skin with sunscreen (with a higher protection factor, if you are part of the risk group). You should choose sunscreens that contain mineral agents like zinc oxide or titanium dioxide.2 . Chemical agents or molecules such as avobenzone, oxybenzone (this molecule seems to accumulate particularly in the blood), otorylene, homosalate, octisalate and octinoxate, 6 agents widely used in creams or sunscreens, should be avoided if possible, particularly due to the lack of studies that confirm a complete absence of health risks (eg hormonal disorders, risks to the unborn child in pregnant women). These chemical agents would tend to pass from the skin into the blood stream and accumulate in the blood and body with possible health risks.

2.  The protector must be reapplied 15 to 30 minutes before exposure to the sun and every two hours. It is also important to avoid exposing yourself to the sun during periods when ultraviolet rays are strongest (between 10am and 4pm).

3.  If, despite the precautions mentioned in 1. and 2., you still have a burn, it may be necessary to treat it with hydrocortisone-based creams. This is a very effective anti-inflammatory (see also: definition of sunburn to understand why anti-inflammatories are used). Betamethasone, a synthetic glucocorticoid, can also be used externally for sunburn. The effectiveness of corticosteroids for sunburn is controversial. For example, a 2008 study published in the Archives of Dermatology (DOI: 10.1001/archderm.144.5.620) showed that treatment with topical corticosteroids of moderate or high potency did not result in a clinically useful decrease in the acute sunburn reaction when applied 6 or 23 hours after UV exposure.
Other creams, lotions or sprays for sunburn can also be used, these usually contain aloe, a soothing medicine or diclofenac (anti-inflammatory).
Nurse Charlotte Wautelet, a burn specialist who works in Switzerland and reviewed this article in August 2022 for the website Create health.com.br, is also not in favor of using corticosteroids externally as a first-choice treatment.

4.  Cold compresses, such as wet cloths soaked in cold water, help to relieve the warm feeling of the skin. Taking a bath in cold or hot water is also recommended. It is also possible to add about 1 quarter of a cup of baking soda to this bath, it is particularly recommended if the extent of sunburn is great.

5.   If the pain is very intense, it may be necessary to take tranquilizers, analgesics ( paracetamol ) or non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen . These medications are most helpful when taken as soon as pain appears, after 24 hours the benefits begin to wane.

6.  As sunburn leaves the skin very dry, it is also advisable to apply a moisturizing cream every night (for example, based on urea, a moisturizing molecule).

If you have a severe sunburn, look for the emergency medical service (emergency room), so that they can assess whether treatment is possible or if more care is needed.

Herbal medicine

Phytotherapy for sunburn:– In case of sunburn, the use of ointments or lotions based on  aloe vera gel (aloe vera) can be very useful as a healing, disinfectant and moisturizer.
– Calendula and arnica , in the form of a cream or ointment, can act by relieving the pain associated with sunburn.Essential Oils Essential
oils such as lavender and chamomile have anti-inflammatory properties and can be effective in treating sunburn. For example, you can prepare a sunburn spray by mixing about 250 ml of water with 16 drops of lavender essential oil. In place of lavender, you can also use chamomile or peppermint.🇧🇷 The last plant, rich in menthol, helps to cool the skin. Before applying, be sure to mix well. Use several times a day by applying this mixture directly to sunburn, however avoid the eye area. Use several times a day by applying this mixture directly to sunburn, but avoid the eye area and mucous membranes. Do not expose yourself to the sun afterwards.

Tips & Prevention

– When a fever develops or the ruptured blisters become infected, it is necessary to consult a professional specialized in the field of burns.

– Take cool baths or showers to cool burned skin. It is not necessary to cool the rest of the body. Stop at the first sign of systemic cooling (eg shivering). Cold water cools the burn, but it also has a natural analgesic and anti-inflammatory effect.
It is also possible to apply a clean towel soaked in cold water to the affected area, cold compresses can also help.
Avoid using ice cubes or ice (including ice packs), as the temperature difference is usually very large and can injure the skin and even the nerves.

– Cover the skin with lotions containing vitamin E or aloe vera (aloe vera) to take good care of it.

– Avoid cosmetics, perfumes and other medications that can cause side effects on the skin (allergy) during exposure to the sun, as is the case with certain antibiotics such as tetracyclines used against acne.

– It is very important to protect yourself well from the sun (sunscreen, sunglasses, wear caps or hats, anti-UV clothing). Apply sunscreen about 20 minutes before sun exposure. In the Treatments section above, also discover the most suitable sunscreens (based on mineral and not chemical agents). As seen in the Treatments section above, sun exposure should be avoided during the most intense hours (between 11am and 3pm, some sources like the Mayo Clinic talk about avoiding sun exposure between 10am and 4pm3 ). All these measures are essential to avoid sunburn. However, the application of sunscreen is increasingly controversial in the scientific community.

– The heat, often associated with sunburn, naturally promotes dehydration, and it is essential to drink plenty of fluids to prevent and treat sunburn. Prefer water and avoid soft drinks.

– Do not pierce blisters ( blisters in English) caused by sunburn. If the blisters are present over a large area of ​​the body, i.e. the equivalent of 3 palms of the person’s own hands, or in a risk area (intimate area, hands, neck, joint), consult a health professional. It is important to know that blisters act as a protective layer, in particular, limiting infections mainly.
Blister care:
If needed, especially if blisters break on their own4 , disinfect blisters without alcohol, then apply cream based on silver sulfadiazine (e.g. in Dermazine®) which has an antibacterial effect or a mixture of sodium hyaluronate/silver sulfadiazine (not available in Brazil) and place paraffin-lined cotton gauze dressing (eg Jelonet®), a gauze and a final dressing without sticking to the sunburned area. Use a bandage, if necessary, to avoid chafing. In case of purulent discharge or uncontrolled pain, consult a professional specialist in burns.

– Remember that there is no such thing as a healthy tan.

– Treat peeling skin gently as suggested by the Mayo Clinic . Peeling is simply the body’s way of getting rid of the top layer of damaged skin. While your skin is peeling, keep using moisturizer and avoid sun exposure.

Jeanne Kenney
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I’m a stylist trainer, a content creator, and an entrepreneur passion. Virgo sign and Pisces ascendant, I move easily between my dreams, the crazy world I want, and my feet on the ground to carry out my projects.

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