Sunburn

Overexposure to the sun is by far the leading cause of skin damage, with consequences ranging from mild sunburn to premature aging and even skin cancer. Most sunburns are classified as first-degree, meaning they are limited to the epidermis, the top layer of the skin. More severe, second-degree burns extend into the dermis, the inner layer of skin. Although very painful, these burns eventually heal as the skin renews itself. Third-degree sunburns, which damage both layers of skin as well as the underlying nerves and subcutaneous tissue, are rare. They occur mainly in babies or young children, who have thin, delicate skin that is especially vulnerable to the sun.

Sun can harm skin the year-round in both bright and overcast weather, but the amount of damage depends upon the intensity of ultraviolet, or UV, radiation. In the northern hemisphere, UV radiation is highest in the summer between 10 a.m. and 2 p.m.

Ultraviolet radiation has two components: the shorter UVB rays, which are responsible for most sunburns, and the longer UVA rays, which are involved more in suntanning. Both types cause skin damage as well as promote skin cancer. Over-exposure to UV rays also encourages actinic keratoses; these are scaly lesions that may be precancerous.

The tanning process is the body's way of protecting the skin from the sun's damage. Pigment-producing cells send an increasing amount of melanin to the skin's surface to block the harmful incoming rays. Thus, fair-skinned, blue-eyed people who do not readily tan are the most vulnerable to sunburn. Those with dark skin are also susceptible, but their heavier layer of melanin helps protect them against sunburn.

While an occasional mild sunburn may seem harmless, research indicates that any prolonged exposure to the sun causes irreversible damage and increases the risk of cancer. Especially dangerous are blistering sunburns suffered in childhood; even one or two at an early age can more than double the risk of developing melanoma, the deadliest of the skin cancers.

Diagnostic Studies and Procedures

A sunburn is easily diagnosed simply by observing the characteristic skin reddening, blistering, and peeling.

Medical Treatments

A severe sunburn that covers a large area of the body or produces fever, chills, and nausea within 12 hours of exposure, should be treated by a doctor. Oral prednisone may be prescribed to alleviate inflammation and swelling, especially if a rash develops. Penicillin or another broad-spectrum antibiotic may be advisable to prevent or treat a secondary infection from blistering. Aspirin or ibuprofen can relieve pain and inflammation. A mild tranquilizer may be prescribed if loss of sleep and itching become a problem.

Alternative Therapies

Herbal Medicine. To ease the discomfort of mild sunburn, herbalists suggest applying a cool compress of apple cider vinegar. The juice of a freshly cut aloe plant may also alleviate pain and speed healing. However, do not apply this or any other preparation to severely blistered skin; to do so risks infection.

Meditation. Deep-breathing exercises can help overcome the desire to scratch itchy, peeling skin.

Self-Treatment

Mild sunburn may be relieved with a cool shower or cold-water compresses, or by sitting in a tub of cool water to which a cup of cornstarch has been added.
Doctors advise against self-care with ointments or lotions that contain the anesthetic benzocaine. They recommend ice packs wrapped in cloth to alleviate severe pain or itching (applying ice directly to skin can increase damage), and staying out of the sun until skin is completely healed.

Of course, prevention is the best approach to sunburn. Dermatologists stress that there is no such thing as a healthy-tan. Any time spent outdoors during the day, even if no tan results, exposes the skin to potentially harmful ultraviolet rays. This includes cloudy days, when 80 percent of UV radiation reaches the earth. Remember, too, that water and sand reflect the sun's rays, thus increasing exposure.

Many dermatologists now recommend daily use of protective clothing and a sunscreen on exposed skin all year round. Some makeups contain sunscreens, but most do not provide complete protection. Also, sunscreens vary in the amount of protection they provide. Look for one with a sun protection factor, or SPF, of at least 15 or more. Also look for a brand that protects against both UVA and UVB rays. Many sunscreens contain para-aminobenzoic acid (PABA), to which some people are allergic. They can substitute sunscreens that contain benzophenone.

If you are especially sun-sensitive, you may need a sunblock, which prevents any UV rays from penetrating the skin. The most familiar sunblock is zinc oxide, the opaque white salve that some lifeguards use to cover their noses and lips. Similar protection for all parts of the face and body is now available in less visible preparations made with micronized titanium dioxide.

Do not apply sunscreens to babies under six months; instead, shield them from the sun. After six months, an alcohol-free sunscreen may be used.

Other Causes of Sunburns

Artificial lights that emit ultraviolet rays can cause sunburns and other skin damage. This is especially true of equipment used in tanning parlors, which may give off 200 times more UVA than natural sunlight. Also, many drugs, including antihypertensives, antibiotics, steroids, acne medications, and anticancer drugs, make skin extra sensitive to the sun, as does pregnancy and such diseases as lupus.