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Sunburn: Prevention is the Best Treatment

By Jock Simon, M.D., Attending Physician at 75th St. & 126th St. Medical, Ocean Pines Medical & Doctors Weight Control & Wellness centers, Ocean City, MD.

Sunburn is caused by ultraviolet radiation B (UVB), encompassing that portion of the electromagnetic spectrum with wavelengths ranging from 290-320 nm. Solar damage to the skin results in painful reddish discoloration and, sometimes, swelling and blistering; this stage is then followed by peeling. Ultraviolet B radiation remains the main culprit in initiating solar damage to the skin and is ultimately responsible for premature aging and for many forms of skin cancer; it possesses high energy photons that are primarily responsible for sunburn and cutaneous carcinogenesis. Ultraviolet radiation A (320-400nm) minimally contributes to sunburn erythema. Ninety percent of UVB and all UVC (200-290nm.) is absorbed by the stratospheric ozone layer and does not reach the earth's surface, whereas UVA is unaffected by the ozone barrier.

The propensity for solar damage depends upon several factors:

  • A person's skin type: the human population varies widely in its susceptibility to sunburn erythema, fair-skinned, blue-eyed individuals tending to be at greatest risk to sunburn.
  • The cumulative exposure to ultraviolet light.
  • The intensity of exposure: UVB irradiance is maximal during midday.
  • The age at the time of exposure: childhood is an especially vulnerable period.

Sunburns are particularly harmful, and great emphasis should be placed on preventing burns. Natural protection is provided by the stratum corneum, the outer layer of the epidermis, as well as by the skin pigment melanin. To minimize sun-induced injury, avoid sun exposure between 11 A.M. and 3 P.M., the times when UVB radiation is at its highest peak; start with short exposures of 20 minutes or so in the morning or late afternoon. Wear appropriate clothing that allows adequate but comfortable protection; also, wear a hat.

Suncreens are topical agents that protect the skin from ultraviolet light. A sunscreen with a sun protective factor (SPF) of 15 or greater is recommended under most conditions. Various preparations are being increasingly used with the growing awareness of the harmful effects of sunlight exposure, particularly the increasing incidence of skin cancer. Chemical sunscreens such as para-aminobenzoic acid (PABA) selectively absorb UV radiation in the spectral range of 290 to 320nm.; they are incorporated into cosmetically acceptable lotion and cream bases. Physical suncreens that scatter UV radiation such as zinc oxide or titanium dioxide are also available.

Sunburn is best treated with cool wet compresses. Topical corticosteroids and anesthetic preparations containing lidocaine provide some relief in managing moderate sunburn. Benzocaine used in some sunburn formulas is a photosensitizer and should be avoided. Oral nonsteroidal agents i.e, aspirin, ibuprofen, are beneficial in suppressing prostaglandin formation in the skin. A rapidly tapered course of oral corticosteroids, at a dose of 1mg per kg of prednisone, within a few hours of sun exposure may abort a potentially intense reaction.

A severe blistering sunburn is similar to a second-degree thermal burn in which fluid management and meticulous wound care to circumvent infection are of paramount importance. However, the optimal way to treat sunburn is to prevent it from occurring by wearing appropriate clothing, limiting sun exposure, and by application of sunscreen preparations.

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