CONDITIONS

What Is Sunburn

A “sexy summer glow” is something we’ve grown up thinking is desirable, and it can feel good to soak up some rays, especially after a long winter. However, sunburn is no light matter (if you’ll pardon the pun). A tan, which you may or may not think looks nice, is actually your body’s way of attempting to protect itself from the damaging effects of the sun’s UV rays. Sunburns increase your risk of skin damage that, in turn, can lead to deadly cancers. And that’s not to mention the aging effects of sun damaging your skin, from sunspots and dry skin patches, to premature wrinkles.

It’s unlikely that you don’t know the basic mechanics of sunburn—it’s the sun, literally burning your skin! But did you know that, despite all of the increased awareness and public education in the last couple of decades or so, at least one in three adults and a whopping 70 percent of children admit they’ve gotten sunburned in the past year.

According to the American Academy of Dermatology (AAD), more than 3.5 million skin cancers, in more than 2 million people, are diagnosed every single year— and many of these skin cancers could have been prevented with protection from the sun’s rays.

What Causes Sunburn

When it comes to sunburn, perhaps the most important thing to know is that it’s not just about spending all day at the beach under a blazing hot sun. In fact, it only takes 15 minutes of sun exposure for the sun’s ultraviolet (UV) rays to damage your skin.

And, not only this can happen on hot, sunny days, but you can still get burned when it’s gloomy or cold: while clouds may stop the heat and some of the light from brightening up your day, they do NOT stop all of the UV rays that cause skin damage. Finally, skin damage can happen when you haven’t been in the sun at all! That’s right, we’re talking about exposing yourself to artificial sources of UV light, including tanning beds and sun lamps.

What’s actually happening below the surface of your skin? And why is sunburn so dangerous?

First things first… UV radiation, or ultraviolet light, is a wavelength of sunlight. And while you can’t see it, because it’s in a range too short for the human eye to see, it’s there, all around us. The sun gives off three different kinds of ultraviolet light, or radiation:

  • Ultraviolet A (UVA)
  • Ultraviolet B (UVB)
  • Ultraviolet C (UVC)

Unless you’re planning to head into outer space sometime soon, you only have to worry about the first two kinds of UV radiation as UVC light doesn’t reach the Earth’s surface. However, UVA and UVB light can not only easily reach you—whether you’re taking a walk in the park on a cloudy day or lying on the beach in the summer—that light can penetrate your skin. And, whether or not you get visible signs of a burn, below the surface, UVA and UVB radiation can actually alter your DNA. Not only does this prematurely age your skin, over time, this DNA damage can lead to potentially lethal skin cancers, like melanoma.

Sunlamps and tanning beds also give off UV light—generally more powerful than the rays emitted by the sun– and therefore can cause sunburn, skin damage, and skin cancer.

So, what happens when UV light reaches your skin?

The dark pigment in your skin that gives you your normal skin color is called melanin. When your skin is exposed to UV rays, your body works to protect itself from this radiation by speeding up the creation of melanin. That’s what causes your skin to get darker, or to tan. In other words, a suntan is your body’s method of preventing sunburn and skin damage. However, this protection is limited, because your body is limited in the amount of melanin it can produce – this is genetically determined. Many people simply can’t produce enough melanin to protect their skin well enough from the sun, so, eventually, UV light causes the skin to burn.

Risk Factors For Sunburn

How soon a sunburn begins to develop and the severity of that burn depends on several factors:

  • Your skin type. If you have fair skin, freckles, blond hair, and/or blue eyes, your skin will burn more easily and more quickly. However, it’s important to know that, even if you have darker skin, you can still burn, still get sun damage, and still get skin cancer.
  • The intensity of the sun. This is dependent on a few factors:
    • The time of day. The sun’s rays are the strongest between the hours of 10 a.m. and 4 p.m. This is true whether the sky is clear or cloudy!
    • The season of the year. The sun’s position on summer days can cause a more severe sunburn.
    • Your altitude. At higher altitudes, there is less of the Earth’s atmosphere to block the sun’s light. For every 1000 ft. gain in elevation, UV exposure increases about four percent.
    • Your latitude. The closer to the Equator you are, the more exposure to direct sunlight you’ll get. For example, in the southern United States, one-and-a-half times more sunlight passes through the atmosphere than in the northern United States!
    • The V. index of the day. The U.V. index is a forecast of the expected risk of overexposure to UV radiation from the sun. (According to the Environmental Protection Agency (EPA), Ozone depletion, as well as seasonal and weather variations, cause different amounts of UV radiation to reach the Earth at any given time.)
  • Whether you’re near reflective surfaces. Surfaces like water, white sand, concrete, snow, and ice reflect the sun’s rays and can cause sunburns, even if you’re not directly in the sun!
  • How long you’ve been exposed to the sun
  • Your age. Children younger than 6 and adults older than 60 have skin that’s more sensitive to sunlight.

Additionally, these are behavioral risk factors that can increase the likelihood you’ll suffer from sunburn:

  • Photosensitizing medications: Some drugs may make you make you more likely to burn, such as antibiotics from the tetracycline or fluoroquinolone classes.
  • Mixing outdoor recreation and drinking alcohol: You may be less likely to remember to use sunscreen and other sun protection if you’ve been drinking alcohol.
  • Working outdoors
  • Having a history of sunburn

But did you know that you can’t always immediately see signs of sun damage?

Symptoms of Sunburn

You can often see the results of a sunburn soon after burning your skin and, often, you can feel those painful results, too!

With a first degree burn, where only the top layer of skin is affected:

  • Your skin may turn pink or red.
  • Your skin may feel warm or hot to the touch.
  • Your skin may feel irritated, sore, or tender (especially if you try to take a hot shower – ouch!)
  • It’s even possible to experience flu-like symptoms, such as feeling feverish along with chills, nausea, headache, and a sensation of weakness.

In more severe cases, you can get what’s considered a second degree burn. If you’ve gotten a severe sunburn, you can develop swelling and even blisters (yes, just like the blisters you get when you accidentally touch a hot pan handle or an open flame). This may mean that deep skin layers and nerve endings have been damaged.

After a few days, your skin can start to feel itchy, and begin peeling. Why? Because your body is working to rid itself of those sun-damaged skin cells.

Prognosis

In a nutshell: Indoor tanning exposes your skin to the same UV radiation you’d get by laying out under the sun. It’s just as dangerous and damaging to your skin.

It is absolutely possible to get a “sunburn” from indoor tanning, and it’s actually a common occurrence. A recent study amongst female college students revealed that:

  • 1 in 5 tanning sessions resulted in red skin or sunburn.
  • About two-thirds of the study participants had at least one episode of sunburn or skin redness from an indoor tanning visit; about half reported two or more episodes, and slightly more than one-third of them reported red skin or sunburn three or more times.

According to the Skin Cancer Foundation, indoor tanning increases your chance of melanoma by 74%. And, the more time a person has spent tanning indoors, the higher the risk.

In addition to melanoma (the deadliest type of skin cancer), indoor tanning can cause basal cell carcinoma, and squamous cell carcinoma. Exposure to ultraviolet (UV) radiation also can cause cataracts and cancers of the eye (ocular melanoma).  Just like exposure to the sun, indoor tanning also causes premature aging (photoaging), like wrinkles and sunspots, and can change you skin texture.

Complications

Repeated instances of sunburn can lead to a variety of complications, including infection, eye damage, premature aging (photoaging), and skin cancer, which can be deadly. According to the Center for Disease Control and Prevention (CDC), skin cancer is the most common form of cancer in the United States!

Infection. If you’ve gotten blisters from a second-degree sunburn, these blisters can rupture, leaving you at risk of infection. If you notice any of these signs of infection, you should see a doctor: pain, redness, swelling, and an oozing of the blister.

Eye damage. UV light can damage the retina, lens or cornea or your eyes. Sun damage to the lens can lead to cataracts, which is a clouding of the lens. Sunburned eyes may feel gritty or painful. “Snow blindness” is a sunburn of the cornea.

Photoaging. Premature aging of the skin from repeated sun exposure and sun damage is called photoaging. Photoaging makes you look older than you really are. The results of photoaging include:

  • A loss of your skin’s strength and elasticity, caused by the weakening of connective tissues
  • Deep wrinkles
  • Rough, dry skin
  • Fine red veins on your cheeks, nose, and/or ears
  • Freckles, which mostly appear on your face and shoulders
  • Dark or discolored spots, called macules or solar lentigines, on your face, arms, chest, upper back, and the back of your hands

Precancerous skin lesions. Appearing as rough, scaly patches in areas that have been damaged by the sun, precancerous skin may be whitish, pink, tan, or brown. Also called also called actinic keratoses (AKs) and solar keratosis, these precancerous lesions are usually found on the sun-exposed areas of the head, face, neck and hands of fair-skinned people. These patches can evolve into skin cancer. If you suspect you have a precancerous skin lesion, it’s very important to see your doctor.

Skin cancer. Repeated exposure to the sun or to UV rays can damage the DNA of your skin cells, and increases your risk of deadly skin cancers like basal cell carcinoma, squamous cell carcinoma, and melanoma. Sunburns in children and teens can increase the likelihood of developing melanoma later in life. Skin cancer, which primarily develops on the areas of the body most often exposed to the sun (scalp, face, lips, ears, neck, chest, arms, hands and legs), can appear as a small growth or a sore that easily bleeds. It may bleed, bleed, crusts over, heal and then reopen. With the deadly cancer melanoma, a new, suspicious-looking mole may develop or an existing mole may change in appearance. There’s a type of melanoma called lentigo maligna that starts as a flat, tan spot. This spot, which develops in areas of long-term sun exposure, slowly darkens and enlarges over time.

See your doctor if you notice ANYTHING suspicious about an existing mole (such as a change in texture or appearance). You should also see a doctor if you notice a new mole develop, if you have a sore that won’t heal, or if you notice a new skin growth.

Prevention

The good new is: sunburn is very easy to prevent! It’s all about avoiding exposure to UV light, whether by literally staying indoors, or protecting your skin when you are outdoors.  (Or, of course, steering clear of tanning beds.)

  • Avoid Mid-Day Sun.  Sunlight is the strongest during “midday,” which means 10 a.m. to 4 p.m., so if at all possible, it’s best to stay indoors or under the protection of something like an awning.
  • Seek Shade. Seek shade when you’re outdoors, whether under an umbrella, tree, or other source of shelter. Remember though—reflective surfaces can cause sunburn, so if you’re under an umbrella, but lying on a white sand beach, or next to a pool, you can still be exposed to UV rays.

Which brings us to …

  • Wear Protective Clothing. Loose-fitting pants or long skirts, and long-sleeved tops made of tightly woven material provide the best protection against sunburn. Now, that might not sound appealing in the summer heat, so if it’s not practical to wear something with so much coverage, the CDC recommends trying at least to wear a T-shirt or a beach cover-up.

Keep in mind:

  • A wet t-shirt offers less protection than a dry one.
  • Darker colors provide greater protection than lighter colors.
  • A typical T-shirt has an SPF rating lower than 15, so you should use other types of protection as well.

You can also look for clothing that is manufactured to provide protection against UV rays! Clothing that is certified under international standards should come with information on its ultraviolet protection factor.

  • Wear a Hat. The best choice is a wide-brimmed hat (with a brim of at least 4 inches), which provides coverage of your neck, ears, eyes, and scalp.
  • Wear Protective Sunglasses. According to the CDC, most sunglasses sold in the United States offer protection against UV rays, though you should always check the label. Sunglasses not only protect your eyes from UV rays and reduce the risk of cataracts, but they also protect the extremely delicate skin around your eyes. Wraparound sunglasses offer the most protection, because UV light can’t sneak in the side.

Sunscreen: What you need to know!

And of course, last but certainly not least…

Use Sunscreen! 

How does sunscreen work?  Sunscreen is made with chemicals that that interact with the skin to protect it from UV rays. Most work by absorbing, reflecting, or scattering sunlight. Since all products don’t use the same ingredients, if you have an allergic reaction to one product, you can try another one, or consult a doctor for a recommendation!


SPF

Sunscreens are rated with a number that indicated their effectiveness against blocking harmful UV rays. The higher the number, the more effective they are. According to the AAD, a sunscreen with SPF 30 (which is their minimum recommendation) blocks 97 percent of the sun’s rays. While higher number SPFs block slightly more of the sun’s rays, it’s important to know that: NO sunscreen can block 100% of the sun’s rays.

High-number SPFs last the same amount of time as low-number SPFs. That’s why all sunscreens should be applied approximately every two hours when outdoors, even on cloudy days, and after swimming or sweating. 


Application

Just as a base rule, the CDC recommends applying a broad-spectrum sunscreen before you go outside, even on slightly cloudy or cool days.  Many skincare brands offer daily moisturizer with SPF – it’s great to get into the habit of wearing SPF on a daily basis!

When it comes to application, the AAD recommends you:

  • Remember, “one ounce—enough to fill a shot glass.” This is about the amount that dermatologists feel is needed to cover the exposed areas of your body. But, it’s important to adjust the amount of sunscreen you apply depending on your body size. Most people only apply 25-50 percent of the recommended amount of sunscreen!
  • Generously coat ALL exposed areas of skin
  • Apply sunscreen to your dry skin 15 minutes BEFORE you go outside
  • Reapply every two hours, or after you go swimming or perspire heavily. It’s a good idea to check the directions on the bottle, but remember…
  • Don’t think your sunscreen is “water proof!” Sunscreen manufacturers now are banned from claiming that a sunscreen is “waterproof” or “sweat proof,” as the FDA has determined that those terms are misleading! They can, however, be labeled as “Water Resistant” — up to 40 minutes or 80 minutes. This means that sunscreen provides some protection while swimming or sweating, up to the time listed on the label.
  • Don’t forget about your lips. Skin cancer can form on your lips, so make sure to use a lip balm with SPF, or sunscreen made especially for your lips.

Types of Sunscreen

There are many types of sunscreen, from sprays to lotions. It’s really up to a personal preference, which may vary for different parts of your body. The ADD offers some recommendations:

  • Creams –best for dry skin and the face.
  • Gels – good for hairy area (such as the scalp or male chest).
  • Sticks – good to use around the eyes.
  • Sprays – sometimes preferred by parents, since they can be easier to apply to children! A spray can also be handy for men to apply to a balding scalp. However, it’s important that you make sure that your are using enough spray sunscreen. The entire surface area of your exposed skin must be covered, thoroughly. Also, make sure you don’t these products, or apply near heat, open flame or while smoking. Also, the AAD says it’s important to note that current FDA regulations on testing and standardization do not pertain to spray sunscreens, though the FDA does continue to evaluate spray sunscreens products to ensure safety and effectiveness.
  • There also are sunscreens made for specific purposes, such as for sensitive skin and babies.
  • Regardless of which sunscreen you choose, be sure to apply it generously to achieve the UV protection indicated on the product label.

How Long Does Sunscreen Last?

Since the AAD recommends applying sunscreen on a daily basis, a bottle of sunscreen should not last very long. However, you may have different bottle and containers of sunscreens, some of which you use more often than others. If you’ve got an older bottle, follow these guidelines:

  • It’s required by the FDA that all sunscreens retain their original strength for at least three years.
  • If your bottle of sunscreen has an expiration date, and it has passed, throw it out.
  • If you buy a sunscreen that does not have an expiration date, write the date you bought the sunscreen on the bottle, so you’ll know when to throw it out.
  • There are also visible signs that a sunscreen may no longer be good., such as any obvious changes in the product’s color or consistency.

The American Academy of Dermatology recommends everyone use sunscreen that offers the following:

  • Broad-spectrum protection (protects against UVA and UVB rays).
  • Sun Protection Factor (SPF) 30 or greater. (The FDA recommends using at least SPF 15 on a daily basis, but the AAD believes a minimum of SPF 30 is necessary).
  • Water resistance.

Physical Sunblock

Physical sunscreen, otherwise known as sunblock, such as zinc oxide, will stop all sunlight from reaching the skin. However, sunblock is very thick and opaque, and will not absorb into your skin. They can be messy and hard to wash off, so are often not a first choice for the average consumer.  They can be great though, for children (some come in bright colors, which is fun for kids), people with very sensitive skin, or to protect a scar from discoloring in the sun.


Cosmetics

Many skin-care and beauty products contain some of the same chemicals that are used in sunscreen, but unless they are labeled with an SPF, they don’t provide any protection from the sun. If they are labeled SPF 15 or higher, just keep in mind that the amount of sunscreen required to provide a full coverage and protection is quite a lot. If you are not using the full amount required to provide adequate protection, don’t use cosmetics with SPF as your only source of protection.

Common Treatment

Sunburn treatment cannot heal your skin or prevent damage to it, but you can address the symptoms of sunburn, such as pain, swelling and discomfort.

There are at-home treatments to help with the discomfort of a mild sunburn:

  • Cool your skin with cool, damp cloths can be applied to sunburned areas, or a cool bath may help.
  • Soothing lotions, containing aloe vera, can be applied to sunburned skin
  • Over the counter topical steroids, such as 1 percent hydrocortisone cream, can be applied to your skin to help with swelling and pain. NOTE: These creams should not be used on a child younger than 2, unless a doctor tell you to. Nor should they be used in the rectal or vaginal area in children under 12, unless directed to do so by a doctor.
  • Laying down in a cool, dark room can help with mild fever and headaches.
  • Drink fluids, this will help with a headache that is the result of dehydration.
  • If blisters form, do not break them. Blisters are a protective layer, containing your natural body fluid (serum). Breaking blisters slows the healing process and increases the risk of infection. You can lightly cover your blisters with gauze, if needed. If they break on their own, gently clean the area with mild soap and water, then apply antibacterial cream and cover the area with a wet dressing.
  • Treat your peeling skin gently. Within a few days, the sunburned area of your skin might begin to peel, as your body works to rid itself of the damaged skin. You can continue to use moisturizing cream when your skin is peeling.
  • Protect yourself from further sun exposure. It’s important to protect your damaged, sensitive skin from further sun damage.

If at-home care isn’t working, our doctor may prescribe:

Pain medication. Over-the-counter and prescription pain relievers can help control both the pain and swelling of sunburn. They are especially effective when taken soon after sun exposure. Your doctor may recommend ibuprofen or naproxen. There are some types of pain relievers that can be applied to your skin as gels.

Medications that control itching. Corticosteroids can be applied to your skin to help with itching as your burned skin heals. This kind of medication is often combined with pain relievers.

When To Contact A Doctor

A mild sunburn does not usually require a visit to the doctor.  However, if you have a severe burn, or your symptoms don’t subside after a few days, you should see a doctor. Most likely, you will see your primary care physician first, and then you may be referred to a dermatologist.

See medical advice if you are experiencing:

  • Large areas of blistering
  • High fever
  • Extreme pain
  • Headache or confusion
  • Lightheadedness or vision changes
  • Severe swelling
  • Signs of infection, such as:
    • Having open blisters that are draining pus
    • Having areas of redness or red streaks spreading or moving away from open blisters

You should also see a doctor as soon as possible if you notice any signs of skin cancer or pre-cancerous lesions.

Questions For A Doctor

Before you go see your doctor:

Make a list the medications you’re taking — including vitamins, herbs and over-the-counter drugs. (Remember, some drugs increase your sensitivity to UV light!)

Be prepared to answer the following questions:

  • What are your symptoms?
  • How long have you had those symptoms?
  • Do you have any 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 home treatment measures have you tried? Did they help?
  • What nonprescription medicines have you tried? Did they help?
  • Do you have any health risks?

Resources

For more information on The U.V. Index and checking it for your area in the United States, visit The Environmental Protection Agency’s website.

For a comprehensive sunscreen FAQ:

For information about melanoma, including how to perform self-checks on your skin, visit the American Melanoma Foundation.

American Academy of Dermatology

Skin Cancer Foundation