Sunburn is an inflammation of the skin that is caused by overexposure to ultraviolet (UV) radiation from the sun. Anyone who is exposed to sun can get a sun burn, which is reddish patch on the areas of exposure. The time spent in the sun varies to cause a sun burn. Although overexpsoure seldom cause death ( Sun poisoning) but it can be debilitating.

Can sunburn cause permanent damage?

• Yes. Sunburn early in life increases the risk of developing skin cancer later on. 

• Repeated overexposure to ultraviolet rays can also, scar, freckle, dry out, and wrinkle the skin prematurely. 

• In addition, frequent overexposure to ultraviolet rays can increase the risk of developing eye cataract and macular degeneration leading cause of blindness

Ultraviolet rays

The sun discharges three types of ultraviolet radiation:

• Ultraviolet A (UV-A)
• Ultraviolet B (UV-B)
• Ultraviolet C (UV-C)

Only UV-A and UV-B reach earth. (UV-C does not penetrate the earth's upper atmosphere)

UV-B as the most likely form of UV radiation to damage the skin and cause skin cancer, recent studies suggest that UV-A can also be dangerous

Tanning lamps also produce UV-A and/or UV-B. These artificial rays affect the skin in the same way as do UV-A and UV-B from the sun

UV rays are most intense at noon and the hours immediately before and after (between 10 a.m. and 3 p.m.), particularly in the late spring, summer, and early autumn

Risk factors

• Pigment disorders (such as albinism)
• Fair skin
• Blond or red hair, and possibly freckles
• Systemic lupus erythematosus- The "butterfly" rash (or malar rash) of lupus over the cheeks and nose is extremely sensitive to UV rays
• Porphyrias
• Vitiligo
• Xeroderma pigmentosum

Symptoms

• Skin becomes red, tender and hot
• Touching or rubbing the skin causes pain
• Because heat triggers fluid loss, a sunburn victim can also become dehydrated
• For several days after exposure, the skin may swell, blister, and peel
• Some sufferers develop welts or rashes

Symptoms of severe sunburn (sun poisoning)

Severe cases of sunburn require emergency treatment

• Fever
• Nausea
• Chills
• Dizziness
• Rapid pulse
• Rapid breathing
• Dehydration
• Shock with loss of consciousness

First-aid measures should be taken with sunburn

• Apply dampened cloths or compresses to reduce the heat and lessen the pain
• Soak in a bathtub of plain, soap-free water (soap can irritate the burn)
• Gently pat the skin dry afterward - do not rub it
• Apply a soothing cream or lotion
• In a case of severe sun burns the patient should contact their Emergency Department
• The affected person should not drink cold water, which can trigger chills
• If compresses are applied, they should be dipped in cool or tepid water, not cold water
• Moisturizing measures with creams or Aloe Vera gel may also help with symptoms of sunburn
• If the discomfort is significant, take a painkiller such as Paracetamol or Ibuprofen can be taken

Medical treatment

NSAIDS- like Ibuprofen, Naprosyn, and diclofenac in oral or topical form will reduce the redness if applied before or immediately after UVB exposure. This benefit may be diminished after 24 hours.

Topical steroid creams were also studied, but these did not show any significant improvement.

Applying Aloe Vera gel to the skin has also not been beneficial in treating the actual sunburn. This, again, may be beneficial in treating the symptoms.

Topical anesthetics (benzocaine) may help with symptoms of sunburn; however, very little clinical data is available to substantiate their effectiveness.

Oral or topical antioxidants (vitamins A, C, and E, and green tea) may theoretically protect the skin against sunburn. Clinical data is not sufficient to support their use instead of or in addition to, traditional sunscreen.

Why does the skin tan after exposure to UV rays?

• The skin contains a pigment called melanin. It colors the skin, imparting the variety of skin tones we all recognize
• Melanin blocks at least some of the UV rays from penetrating the skin
• After repeated or prolonged exposure to UV rays, the skin produces more melanin
• Consequently, the skin darkens, or tans, which in turn protects the skin to a certain degree

Cancer caused by UV rays

• Malignant melanoma
• Basal and squamous cell carcinomas
• Squamous cell carcinoma

How can sunburn and skin cancer be prevented?

Limit the amount of time of sun exposure and avoiding the peak sunshine hours of late morning to early mid-day, generally 10 a.m. to 4 p.m.

Wear protective clothing such as a broad-brimmed hat (at least 6 inches), long- legged pants, and shirts with sleeves that cover the arms.

Use a protective sunscreen to minimize the penetration of UV rays. Sunscreens with a skin protection factor (SPF) of at least 15 are recommended for everyone exposed to the sun.

Sunscreens

Sunscreens protect the skin by absorbing or reflecting the UV radiation. It is important to realize that many available sunscreens protects mainly against UVB and may not adequately protect against long standing UVA exposure.

Physical sunscreens

Physical sunscreens act by reflecting and scattering the UV rays (A and B) and thus, limiting their exposure to the skin.

They include chemicals such as zinc oxide, titanium dioxide, ferric chloride, ichthamnol, and talc.

Chemical sunscreens

Chemical sunscreens work by absorbing the light prior to reaching the skin.

More recently, newer sunscreens have been developed to also absorb UVA such as avobenzone, Mexoryl, dibenzoylmethanes, anthranilates, benzophenones, triazoles, and some camphor derivatives.

What is the best way to apply sunscreen?

• It advised to apply sunscreen 15 to 30 minutes before expected sun exposure
• Reapplication of sunscreen every 1-2 hours is also generally advised
• SPF 15 sunscreen is the minimum requirement for most individuals
• Stronger sunscreens are recommended for people who easily burn in the sun and have longer exposure time in the sun. Water exposure may wash off the sunscreen, so it should be reapplied after the body dries up.