It hurts!

SUNBURN

A sunburn is the reddening, inflammation, and, in severe cases, blistering and peeling of the skin caused by overexposure to the ultraviolet rays of the sun.

• Sunburns before the age of 20 are associated with more melanocytic and atypical melanocytic nevi, whereas in adulthood, sunburns tend to cause the development of actinic keratoses.
• Severe sunburns are linked to the development of BCC, SCC and melanoma.
• Being in the shade (and not using sunscreen) can still lead to sunburn.
• Factors associated with visits to the ER for sunburn in one study included psychiatric illness, alcohol use and homelessness.

Clinical

The skin becomes erythematous and tender in the areas of photo-exposure. Blisters may form. Later, desquamation occurs.

Treatment

• Vitamin D
• Steroids, oral or topical.
• Sunscreen to prevent the next time!

In one intriguing double-blind, placebo-controlled study, 200,000 International Units of Vitamin D3 given 1 hour after UV exposure (up to 3 MED) significantly reduced skin inflammation in humans. No toxicity of vitamin D or calcium was seen. None of the subjects were taking Vitamin D before the study.

If the patient is seen within 24 to 48 hours after the sun exposure, a short course of oral corticosteroids may be helpful. Otherwise, cool wet compresses may be soothing. The topical anesthetics are usually not effective and may rarely cause an allergic contact dermatitis. The patient should be educated about the long term risks of repeated sun exposure (e.g. wrinkling, photodamage, basal cell carcinoma, squamous cell carcinoma and melanoma).

Prevention

240 mg BID of Polypodium Leucotomos extract [PLE] reduced the likelihood of sunburn in healthy adults in a RDBPCT. It also increased the minimal erythema dose. Similar findings were shown in a study that had subjects take 240 mg of PLE 2 hours and 1 hour before UV exposure. Of note, Heliocare is currently the preferred product available OTC in the US that contains PLE.

Sunburn Purpura

Sunburn purpura remains a rare phenomenon in which a petechial or purpuric rash develops acutely after intense sun exposure.

Additional Pictures

Desquamation is very common after a sunburn.

RegionalDerm

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