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Sunburn

Topic Overview

Sunlight can help our mental outlook and help us feel healthier. For people who have arthritis, the sun's warmth can help relieve some of their physical pain. Many people also think that a suntan makes a person look young and healthy. But sunlight can be harmful to the skin, causing immediate problems as well as problems that may develop years later.

A sunburn is skin damage from the sun's ultraviolet (UV) rays. Most sunburns cause mild pain and redness but affect only the outer layer of skin (first-degree burn). The red skin might hurt when you touch it. These sunburns are mild and can usually be treated at home.

Skin that is red and painful and that swells up and blisters may mean that deep skin layers and nerve endings have been damaged (second-degree burn). This type of sunburn is usually more painful and takes longer to heal.

Other problems that can be present along with sunburn include:

  • Heatstroke or other heat-related illnesses from too much sun exposure.
  • Allergic reactions to sun exposure, sunscreen products, or medicines.
  • Vision problems, such as burning pain, decreased vision, or partial or complete vision loss.

Long-term problems include:

  • An increased chance of having skin cancer.
  • An increase in the number of cold sores.
  • An increase in problems related to a health condition, such as lupus.
  • Cataracts, from not protecting your eyes from direct or indirect sunlight over many years. Cataracts are one of the leading causes of blindness.
  • Skin changes, such as premature wrinkling or brown spots.

Your skin type affects how easily you become sunburned. People with fair or freckled skin, blond or red hair, and blue eyes usually sunburn easily.

Although people with darker skin don't sunburn as easily, they can still get skin cancer. So it's important to use sun protection, no matter what your skin color is.

Your age also affects how your skin reacts to the sun. The skin of children younger than 6 and adults older than 60 is more sensitive to sunlight.

You may get a more severe sunburn depending on:

  • The time of day. You are more likely to get a sunburn between 10 in the morning and 4 in the afternoon, when the sun's rays are the strongest. You might think the chance of getting a sunburn on cloudy days is less, but the sun's damaging UV light can pass through clouds.
  • Whether you are near reflective surfaces, such as water, white sand, concrete, snow, and ice. All of these reflect the sun's rays and can cause sunburns.
  • The season of the year. The position of the sun on summer days can cause a more severe sunburn.
  • Altitude. It is easy to get sunburned at higher altitudes, because there is less of the earth's atmosphere to block the sunlight. UV exposure increases about 4% for every 1000 ft (305 m) gain in elevation.
  • How close you are to the equator (latitude). The closer you are to the equator, the more direct sunlight passes through the atmosphere. For example, the southern United States gets 1.5 times more sunlight than the northern United States.
  • The UV index of the day, which shows the risk of getting a sunburn that day.

Preventive measures and home treatment are usually all that is needed to prevent or treat a sunburn.

  • Protect your skin from the sun.
  • Do not stay in the sun too long.
  • Use sunscreens, and wear clothing that covers your skin.

If you have any health risks that may increase the seriousness of sun exposure, you should avoid being in the sun from 10 in the morning to 4 in the afternoon.

Check your symptoms to decide if and when you should see a doctor.

Check Your Symptoms

Do you have a sunburn?
Yes
Sunburn
No
Sunburn
How old are you?
Less than 3 months
Less than 3 months
3 months to 11 years
3 months to 11 years
12 years or older
12 years or older
Are you male or female?
Male
Male
Female
Female
Do you think you may have a heat-related illness, like heat exhaustion or heat cramps?
Yes
Possible heat-related illness
No
Possible heat-related illness
Do you have symptoms of an allergic reaction?
Yes
Symptoms of allergic reaction
No
Symptoms of allergic reaction
Do you have symptoms of heatstroke?
Yes
Heatstroke symptoms
No
Heatstroke symptoms
Do you think you may be dehydrated?
Yes
May be dehydrated
No
May be dehydrated
Are the symptoms severe, moderate, or mild?
The symptoms in an adult or older child are different than the symptoms in a baby or toddler.
Severe
Severe dehydration
Moderate
Moderate dehydration
Mild
Mild dehydration
Are you having trouble drinking enough to replace the fluids you've lost?
Little sips of fluid usually are not enough. You need to be able to take in and keep down plenty of fluids.
Yes
Unable to maintain fluid intake
No
Able to maintain fluid intake
Is there any pain?
Yes
Pain
No
Pain
How bad is the pain on a scale of 0 to 10, if 0 is no pain and 10 is the worst pain you can imagine?
Signs of pain in an adult or child are different than signs of pain in a baby or toddler.
8 to 10: Severe pain
Severe pain
5 to 7: Moderate pain
Moderate pain
1 to 4: Mild pain
Mild pain
Are you having eye or vision problems?
Yes
Eye or vision problems
No
Eye or vision problems
Has blurred vision or vision loss lasted for more than 30 minutes?
Yes
Vision loss or blurred vision for more than 30 minutes
No
Vision loss or blurred vision for more than 30 minutes
Do you have any eye pain?
Yes
Eye pain
No
Eye pain
How bad is the pain on a scale of 0 to 10, if 0 is no pain and 10 is the worst pain you can imagine?
Signs of pain in an adult or child are different than signs of pain in a baby or toddler.
8 to 10: Severe pain
Severe eye pain
5 to 7: Moderate pain
Moderate eye pain
1 to 4: Mild pain
Mild eye pain
Has the pain lasted for more than 1 full day (24 hours)?
Yes
Mild eye pain for more than 24 hours
No
Mild eye pain for more than 24 hours
Does light make your eyes hurt?
Yes
Sensitivity to light
No
Sensitivity to light
Do you have more than a mild fever?
A mild fever is common with sunburn. Home treatment usually is all that's needed for a mild fever.
Yes
Possible fever
No
Possible fever
Do you have a severe headache or extreme fatigue?
Yes
Severe headache or fatigue
No
Severe headache or fatigue
Does your baby have a sunburn with blisters?
Yes
Baby has sunburn with blisters
No
Baby has sunburn with blisters
Are there any blisters, bleeding under the skin, or bruising in the sunburned area?
Yes
Blisters, bleeding under the skin, or bruising in sunburned area
No
Blisters, bleeding under the skin, or bruising in sunburned area
Are you worried about scarring from large blisters?
Yes
Concerns about scarring
No
Concerns about scarring
Are there any symptoms of infection?
Yes
Symptoms of infection
No
Symptoms of infection
Do you think you may have a fever?
Yes
Possible fever
No
Possible fever
Are there red streaks leading away from the area or pus draining from it?
Yes
Red streaks or pus
No
Red streaks or pus
Do you have diabetes, a weakened immune system, peripheral arterial disease, or any surgical hardware in the area?
"Hardware" includes things like artificial joints, plates or screws, catheters, and medicine pumps.
Yes
Diabetes, immune problems, peripheral arterial disease, or surgical hardware in affected area
No
Diabetes, immune problems, peripheral arterial disease, or surgical hardware in affected area
Are you taking a medicine that may cause you to sunburn easily?
Yes
Taking medicine that may increase risk of sunburn
No
Taking medicine that may increase risk of sunburn

Many things can affect how your body responds to a symptom and what kind of care you may need. These include:

  • Your age. Babies and older adults tend to get sicker quicker.
  • Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
  • Medicines you take. Certain medicines, herbal remedies, and supplements can cause symptoms or make them worse.
  • Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
  • Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

  • Try home treatment to relieve the symptoms.
  • Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.
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Symptoms of infection may include:

  • Increased pain, swelling, warmth, or redness in or around the area.
  • Red streaks leading from the area.
  • Pus draining from the area.
  • A fever.

You can get dehydrated when you lose a lot of fluids because of problems like vomiting or fever.

Symptoms of dehydration can range from mild to severe. For example:

  • You may feel tired and edgy (mild dehydration), or you may feel weak, not alert, and not able to think clearly (severe dehydration).
  • You may pass less urine than usual (mild dehydration), or you may not be passing urine at all (severe dehydration).

Severe dehydration means:

  • Your mouth and eyes may be extremely dry.
  • You may pass little or no urine for 12 or more hours.
  • You may not feel alert or be able to think clearly.
  • You may be too weak or dizzy to stand.
  • You may pass out.

Moderate dehydration means:

  • You may be a lot more thirsty than usual.
  • Your mouth and eyes may be drier than usual.
  • You may pass little or no urine for 8 or more hours.
  • You may feel dizzy when you stand or sit up.

Mild dehydration means:

  • You may be more thirsty than usual.
  • You may pass less urine than usual.

Severe dehydration means:

  • The baby may be very sleepy and hard to wake up.
  • The baby may have a very dry mouth and very dry eyes (no tears).
  • The baby may have no wet diapers in 12 or more hours.

Moderate dehydration means:

  • The baby may have no wet diapers in 6 hours.
  • The baby may have a dry mouth and dry eyes (fewer tears than usual).

Mild dehydration means:

  • The baby may pass a little less urine than usual.

If you're not sure if a fever is high, moderate, or mild, think about these issues:

With a high fever:

  • You feel very hot.
  • It is likely one of the highest fevers you've ever had. High fevers are not that common, especially in adults.

With a moderate fever:

  • You feel warm or hot.
  • You know you have a fever.

With a mild fever:

  • You may feel a little warm.
  • You think you might have a fever, but you're not sure.

Pain in adults and older children

  • Severe pain (8 to 10): The pain is so bad that you can't stand it for more than a few hours, can't sleep, and can't do anything else except focus on the pain.
  • Moderate pain (5 to 7): The pain is bad enough to disrupt your normal activities and your sleep, but you can tolerate it for hours or days. Moderate can also mean pain that comes and goes even if it's severe when it's there.
  • Mild pain (1 to 4): You notice the pain, but it is not bad enough to disrupt your sleep or activities.

Pain in children under 3 years

It can be hard to tell how much pain a baby or toddler is in.

  • Severe pain (8 to 10): The pain is so bad that the baby cannot sleep, cannot get comfortable, and cries constantly no matter what you do. The baby may kick, make fists, or grimace.
  • Moderate pain (5 to 7): The baby is very fussy, clings to you a lot, and may have trouble sleeping but responds when you try to comfort him or her.
  • Mild pain (1 to 4): The baby is a little fussy and clings to you a little but responds when you try to comfort him or her.

Certain health conditions and medicines weaken the immune system's ability to fight off infection and illness. Some examples in adults are:

  • Diseases such as diabetes, cancer, heart disease, and HIV/AIDS.
  • Long-term alcohol and drug problems.
  • Steroid medicines, which may be used to treat a variety of conditions.
  • Chemotherapy and radiation therapy for cancer.
  • Other medicines used to treat autoimmune disease.
  • Medicines taken after organ transplant.
  • Not having a spleen.

Many prescription and nonprescription medicines can cause the skin to sunburn more easily. A few common examples are:

  • Some antibiotics.
  • Aspirin, ibuprofen (such as Advil or Motrin), and naproxen (such as Aleve).
  • Skin products that contain vitamin A or alpha hydroxy acids (AHA).
  • Some acne medicines.
  • Some diabetes medicines that you take by mouth.

Symptoms of an allergic reaction may include:

  • A rash, or raised, red areas called hives.
  • Itching.
  • Swelling.
  • Trouble breathing.

Symptoms of heatstroke may include:

  • Feeling or acting very confused, restless, or anxious.
  • Trouble breathing.
  • Sweating heavily, or not sweating at all (sweating may have stopped).
  • Skin that is red, hot, and dry, even in the armpits.
  • Passing out.
  • Seizure.
  • Nausea and vomiting.

Heatstroke occurs when the body can't control its own temperature and body temperature continues to rise.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

  • Call your doctor now to discuss the symptoms and arrange for care.
  • If you cannot reach your doctor or you don't have one, seek care in the next hour.
  • You do not need to call an ambulance unless:
    • You cannot travel safely either by driving yourself or by having someone else drive you.
    • You are in an area where heavy traffic or other problems may slow you down.
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Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

  • Call your doctor today to discuss the symptoms and arrange for care.
  • If you cannot reach your doctor or you don't have one, seek care today.
  • If it is evening, watch the symptoms and seek care in the morning.
  • If the symptoms get worse, seek care sooner.
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Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

Heat-Related Illnesses
Allergic Reaction

Home Treatment

Home treatment measures may provide some relief from a mild sunburn.

  • Use cool cloths on sunburned areas.
  • Take frequent cool showers or baths.
  • Apply soothing lotions that contain aloe vera to sunburned areas. Topical steroids (such as 1% hydrocortisone cream) may also help with sunburn pain and swelling. Note: Do not use the cream on children younger than age 2 unless your doctor tells you to. Do not use in the rectal or vaginal area in children younger than age 12 unless your doctor tells you to.

A sunburn can cause a mild fever and a headache. Lie down in a cool, quiet room to relieve the headache. A headache may be caused by dehydration, so drinking fluids may help. For more information, see the topic Dehydration.

There is little you can do to stop skin from peeling after a sunburn-it is part of the healing process. Lotion may help relieve the itching.

Other home treatment measures, such as chamomile, may help relieve your sunburn symptoms.

Medicine you can buy without a prescription

Try a nonprescription medicine to help treat your fever or pain:

Talk to your child's doctor before switching back and forth between doses of acetaminophen and ibuprofen. When you switch between two medicines, there is a chance your child will get too much medicine.
Safety tips

Be sure to follow these safety tips when you use a nonprescription medicine:

  • Carefully read and follow all directions on the medicine bottle and box.
  • Do not take more than the recommended dose.
  • Do not take a medicine if you have had an allergic reaction to it in the past.
  • If you have been told to avoid a medicine, call your doctor before you take it.
  • If you are or could be pregnant, do not take any medicine other than acetaminophen unless your doctor has told you to.
  • Do not give aspirin to anyone younger than age 20 unless your doctor tells you to.

Care of blisters

Home treatment may help decrease pain, prevent infection, and help the skin heal.

  • A small, unbroken blister about the size of a pea, even a blood blister, will usually heal on its own. Use a loose bandage to protect it. Avoid the activity that caused the blister.
  • If a small blister is on a weight-bearing area like the bottom of the foot, protect it with a doughnut-shaped moleskin pad. Leave the area over the blister open.
  • If a blister is large and painful, it may be best to drain it. Here is a safe method:
    • Wipe a needle with rubbing alcohol.
    • Gently puncture the edge of the blister.
    • Press the fluid in the blister toward the hole so it can drain out.
    • If you have a condition such as diabetes, HIV, cancer, or heart disease, you do not want to drain a blister because of the risk of infection.
  • After you have opened a blister, or if it has torn open:
    • Gently wash the area with clean water. Do not use alcohol, iodine, or any other cleanser.
    • Don't remove the flap of skin over a blister unless it's very dirty or torn or there is pus under it. Gently smooth the flap over the tender skin.
    • You may cover the blister with a thin layer of petroleum jelly, such as Vaseline, and a nonstick bandage.
    • Apply more petroleum jelly and replace the bandage as needed.

Watch for a skin infection while your blister is healing. Signs of infection include:

  • Increased pain, swelling, redness, or warmth around the blister.
  • Red streaks extending away from the blister.
  • Drainage of pus from the blister.
  • Fever.

Symptoms to watch for during home treatment

Call your doctor if any of the following occur during home treatment:

  • Vision problems continue after you get out of the sun.
  • Fever develops.
  • Dehydration develops and you are unable to drink enough to replace lost fluids.
  • Signs of skin infection in blisters develop.
  • Symptoms become more severe or more frequent.

Prevention

Protecting your skin

Use the following tips to protect your skin from the sun. You may decrease your chances of developing skin cancer and help prevent wrinkles.

Avoid sun exposure

The best way to prevent a sunburn is to avoid sun exposure.

Stay out of the midday sun (from 10 in the morning to 4 in the afternoon), which is the strongest sunlight. Find shade if you need to be outdoors. You can also calculate how much ultraviolet (UV) exposure you are getting by using the shadow rule: A shadow that is longer than you are means UV exposure is low; a shadow that is shorter than you are means the UV exposure is high.

Other ways to protect yourself from the sun include wearing protective clothing, such as:

  • Hats with wide 4 in. (10 cm) brims that cover your neck, ears, eyes, and scalp.
  • Sunglasses with UV ray protection, to prevent eye damage.
  • Loose-fitting, tightly woven clothing that covers your arms and legs.
  • Clothing made with sun protective fabric. These clothes have a special label that tells you how effective they are in protecting your skin from ultraviolet rays.

Preventing sun exposure in children

You should start protecting your child from the sun when he or she is a baby.

  • It's safest to keep babies younger than 6 months out of the sun.
  • Teach children the ABCs of how to protect their skin from getting sunburned.
    • A = Away. Stay away from the sun as much as possible from 10 in the morning until 4 in the afternoon. Find shade if you need to be outdoors.
    • B = Block. Use a sunscreen with a sun protection factor (SPF) of 30 or higher to protect babies' and children's very sensitive skin.
    • C = Cover up. Wear clothing that covers the skin, hats with wide brims, and sunglasses with UV protection. Even children 1 year old should wear sunglasses with UV protection.

Sunscreen protection

If you can't avoid being in the sun, use a sunscreen to help protect your skin while you are in the sun.

Be sure to read the information on the sunscreen label about the SPF factor listed on the label and how much protection it gives your skin. Follow the directions on the label for applying the sunscreen so it is most effective in protecting your skin from the sun's ultraviolet rays.

Choosing a sunscreen

  • Sunscreens come in lotions, gels, creams, ointments, and sprays. Use a sunscreen that:
  • Use lip balm or cream that has SPF of 30 or higher to protect your lips from getting sunburned.
  • Take extra care to protect your skin when you're near water, at higher elevations, or in tropical climates.

Sunscreens labeled "water-resistant" are made to protect people while they are swimming or sweating. The label will say if the sunscreen will protect you for 40 minutes or 80 minutes.

Applying a sunscreen

  • Apply the sunscreen at least 15 to 30 minutes before going in the sun.
  • Apply sunscreen to all the skin that will be exposed to the sun, including the nose, ears, neck, scalp, and lips. Sunscreen needs to be applied evenly over the skin and in the amount recommended on the label. Most sunscreens are not completely effective because they are not applied correctly. It usually takes about 1 fl oz (30 mL) to cover an adult's body.
  • Apply sunscreen every 2 to 3 hours while in the sun and after swimming or sweating a lot. The SPF value decreases if a person sweats heavily or is in water, because water on the skin reduces the amount of protection the sunscreen provides.

Other sunscreen tips

Remember that skin that is healing from a sunburn is sensitive to more damage from the sun, so be sure to prevent more sunburn in those areas. The following tips about sunscreen will help you use it more effectively:

  • If your skin is sensitive to skin products or you have had a skin reaction (allergic reaction) to a sunscreen, use a sunscreen that is free of chemicals, para-aminobenzoic acid (PABA), preservatives, perfumes, and alcohol.
  • If you are going to have high exposure to the sun, consider using a physical sunscreen, such as zinc oxide, which will stop most of the sunlight from reaching the skin.
  • If you need to use sunscreen and insect repellent with DEET, do not use a product that combines the two. You can apply sunscreen first and then apply the insect repellent with DEET, but the sunscreen needs to be reapplied every 2 hours.

Do not use tanning booths to get a tan. Artificial tanning devices can cause skin damage and increase the risk of skin cancer. If you want your skin to look tan, try a sunless tanning cream or spray that makes your skin look tan. And keep using sunscreen when you are in the sun.

For information on sun exposure and vitamin D, see Getting Enough Vitamin D.

Preparing For Your Appointment

You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:

  • What are your main symptoms?
  • How long have you had your symptoms?
  • Do you have 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 prescription or nonprescription medicines do you take?
  • 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?

Credits

ByHealthwise Staff
Primary Medical Reviewer Patrice Burgess, MD, FAAFP - Family Medicine
Adam Husney, MD - Family Medicine
Kathleen Romito, MD - Family Medicine
E. Gregory Thompson, MD - Internal Medicine
William H. Blahd, Jr., MD, FACEP - Emergency Medicine

Current as ofNovember 20, 2017

Current as of: November 20, 2017

Author: Healthwise Staff

Medical Review: Patrice Burgess, MD, FAAFP - Family Medicine & Adam Husney, MD - Family Medicine & Kathleen Romito, MD - Family Medicine & E. Gregory Thompson, MD - Internal Medicine & William H. Blahd, Jr., MD, FACEP - Emergency Medicine