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When Sunburn Requires Medical Attention

By Chadd Kraus

The days are longer, the trees are blooming and baseball season is in full swing.  These are all signs that summer is just around the corner. Outside spring and summer activities bring with them risks of skin damage, from sunburn in the short term to skin cancer in the long term.

 As an emergency physician, I once cared for a patient who was on a rafting trip with friends and took a break on a large rock. The young man had fallen asleep on the rock in direct sunlight for several hours and sustained serious sunburn, complete with blisters over a large portion of his face, chest, arms, and legs. The sunburn was so severe that he required admission to the hospital for IV fluids and pain control. 

 Sunburn occurs from exposure of the skin to ultraviolet (UVA and UVB) radiation from the sun, tanning beds/booths, and other UV sources. Sunburn, also called solar erythema, occurs when blood vessels near the skin dilate and skin cells become inflamed and die, causing the red appearance of the skin most commonly associated with sunburn. Redness and painful skin usually develop within a few hours of sun exposure and peak at approximately one day after exposure. Blisters can develop in severe cases.

 Most cases of sunburn only require symptomatic care, such as rehydration and pain control, usually with over the counter medications such as NSAIDs (for example, ibuprofen) or acetaminophen, using mild soaps when bathing/showering, skin moisturizes and anti-itch products such as calamine lotion. Topical and oral steroids are usually not recommended. The best treatment for sunburn is prevention. Some strategies to reduce the chance of sunburn include avoiding prolonged periods in the strong, midday sun (from approximately 10AM to 4PM), covering skin with hats that cover head, neck, and ears, wearing loose clothing that covers arms and legs, choosing clothing with UV protection, and wearing appropriate sun protection factor (SPF) rated sunscreen. A higher SPF Sunscreen that protects against both UVA and UVB types of radiation (and UV protective lip balm) should be applied liberally to the exposed areas of skin. Sunscreen should be applied within 30 minutes of sun exposure and reapplied every 2 to 3 hours or after swimming, drying off with a towel, or if sweating.

 Although most sunburns require only symptomatic care, sunburns that cause blistering, are associated with nausea, vomiting, fevers, chills, or appear to be infected should be immediately evaluated by a medical professional.

 About the Author: Chadd Kraus, DO, DrPH, MPH, is an assistant professor of Clinical Emergency Medicine at The University of Missouri in Columbia.