Sunburn

Sunburn is skin damage caused by ultraviolet (UV) rays. Too much exposure to UV light can make your skin red and painful. This may later lead to peeling or blistering. 

Sources of UV light include: 

  • sunlight
  • tanning beds
  • phototherapy lamps - these are used in light therapy to treat conditions such as jaundice in newborn babies (yellowing of the skin)

Sunburn often occurs when the sun's rays are intense. However, there is also a risk of getting burned by the sun in other weather conditions. For example, light reflecting off snow can also cause sunburn. A cloudy sky or breeze may make you feel cooler, but sunlight can still get through and damage your skin.

Melanin

Melanin is a pigment that is produced when your skin is exposed to sunlight. It absorbs the UV radiation found in sunlight to help protect your skin. This results in your skin becoming darker, which is a sign that it has been damaged by UV rays.

Melanin stops you burning so easily but it does not prevent the other harmful effects of UV radiation, such as cancer and premature ageing.

Who is at risk of sunburn?

Everyone who is exposed to UV light is at risk of getting sunburn. However, the less melanin you have, the less protected you are against the effects of UV light.

For example, if you have fair skin or red hair, or if you have not been in the sun much, your melanin levels will be low, which means that your risk of burning more quickly rises.

Outlook

Mild sunburn usually goes away around four to seven days after exposure to UV rays. However, frequently exposing your skin to UV rays for long periods of time increases your risk of developing various skin problems, such as:

  • prickly heat - an itchy, red rash that occurs when you sweat more than usual 
  • early ageing of the skin and wrinkling
  • solar keratoses - rough, scaly spots on the skin due to damage from UV light exposure 
  • skin cancer 

The long-term consequences of UV exposure can be prevented by using a good-quality sunscreen. Sunscreen is available from pharmacies and supermarkets, and comes in a number of different strengths.

Sun safety

There are a number of ways that you can prevent sunburn and stay safe while you are out in the sun. For example, you should:

  • wear clothing to protect your skin from UV rays, such as a long-sleeve shirt, trousers and a wide-brimmed hat
  • wear good-quality sunglasses to protect your eyes from UVA and UVB rays
  • keep babies and children out of direct sunlight
  • use sunscreen that has a minimum sun protection factor (SPF) of 15 (use a higher SPF for fair and sensitive skin), and reapply it frequently (see below for more information)
  • seek advice immediately from your GP if you notice changes to any of your moles – for example, a change in their size, colour or texture

Most people do not apply enough sunscreen to their skin. For sunscreen to be effective, it is very important that you apply a generous amount to your skin before going out in the sun. Reapply it regularly (at least every two to three hours) and after going in the water.

Vitamin D

It is important to remember that while spending prolonged periods of time in the sun can cause sunburn and skin damage, spending a small amount of time in the sun can be beneficial as it provides your body with vitamin D.

Vitamin D helps to control the amount of calcium and phosphate in the body, which is needed to keep bones and teeth healthy.

A vitamin D deficiency (having too little) can prevent your body from absorbing calcium and phosphate. This can result in conditions such as rickets (bone deformities) in children and osteomalacia (weak bones) in adults.

Most people can get the vitamin D they need by eating a healthy, balanced diet and getting a little sun. However, some people may need to take vitamin D supplements. These groups include:

  • those who are 65 years old and over
  • children up to 1 year- To ensure that ALL babies get enough vitamin D they should be given 5 micrograms (5μg) of vitamin D3 every day from birth to 12 months, whether breastfed or formula fed or taking solid foods.
  • all pregnant and breastfeeding women 
  • people who are unable to go out in the sun, such as those with health conditions that keep them housebound for long periods
  • people from ethnic minorities with darker skin whose bodies produce less vitamin D – for example, those of African-Caribbean and South Asian origin

The symptoms of sunburn vary from person to person and depend on:

  • the length of exposure to UV rays
  • the person's skin type (paler skin is more likely to burn than darker skin)

Sunburn symptoms include: 

  • red, sore skin (erythema) 
  • skin that is warm and tender to the touch
  • flaking and peeling skin after a number of days (usually four to seven days after exposure)

Dark skin can also burn and become damaged if exposed to enough UV light. However, as dark skin contains more melanin (pigment) it can tolerate sunlight without burning for longer than paler skin.

The symptoms of sunburn are not always immediately obvious. Symptoms usually begin three to five hours after exposure to the sun's rays. They usually peak between 12 and 24 hours after being in the sun.

Severe sunburn

Severe cases of sunburn can cause:

  • blistering 
  • swelling of the skin (oedema) 
  • chills 
  • a high temperature (fever) of 38ºC (100.4ºF) or above 
  • a general feeling of discomfort (malaise) 

You may also have symptoms of heatstroke, such as:

  • dizziness
  • headaches
  • nausea (feeling sick)

Sunburn is caused by overexposure to sunlight, which contains ultraviolet radiation (UV rays).

Ultraviolet rays

The sun produces three different types of UV rays:

  • UVA rays - these are less potent that UVB rays but penetrate deeper into the skin, damaging the middle layer (dermis) which contains tissues that give the skin its elasticity. Prolonged exposure to UVA rays can age the skin prematurely.  
  • UVB rays - these UV rays are absorbed by the top layer of skin (epidermis). The epidermis releases chemicals that cause the pain, swelling and redness associated with sunburn. 
  • UVC rays are filtered by the earth's atmosphere, which means that protection against this type of radiation is not required.

UVA and UVB are the two types of ultraviolet rays that cause sunburn. Sunburn can also be caused by exposure to other sources of UV light, such as tanning beds and phototherapy lamps. These lamps are often used in light therapy to treat conditions such as jaundice (yellowing of the skin) in newborn babies.

Exposure to UVA and UVB rays increases your risk of developing skin cancer. Therefore, sunburn is a warning sign that you are putting yourself at risk and damaging your skin.

Risk factors

You are more at risk of getting sunburn if you:

  • are in a country that is close to the equator, such as Ecuador in South America or Uganda in Africa
  • are under six years old or over 60
  • have pale, white skin and blonde or red hair 
  • are at a high altitude - for example, climbing or skiing
  • spend prolonged periods of time outdoors in a sunny climate, particularly when there are clear skies
  • are near snow, ice or water where the sun's rays can reflect onto your skin

If you have sunburn, you should avoid direct sunlight by covering up the affected areas of skin and staying in the shade until the sunburn has healed.

Applying sunscreen is an effective way of preventing sunburn.

Additional advice for treating sunburn is outlined below.

Water

Cool the skin by sponging it with lukewarm water or by having a cool shower or bath. Applying a cold compress, such as a cold flannel, to the area affected will also cool your skin.

Drinking plenty of fluids will also help you to cool down and will replace water that is lost through sweating. It will also help to prevent dehydration (when the normal water content in your body is reduced, causing thirst and light-headedness).

Avoid drinking alcohol because it will dehydrate you even more.

Emollients

Emollients are treatments that are applied directly to the skin (topical treatments). Moisturising creams and ointments are examples of emollients.

For mild sunburn, apply a moisturising lotion or aftersun cream, available at pharmacies. Aftersun cream will cool your skin and moisturising it, helping to relieve the feeling of tightness.

Moisturisers that contain aloe vera will also help to soothe your skin. Calamine lotion can relieve any itching or soreness.

Hydrocortisone cream

Sunburn may also be treated by applying hydrocortisone cream to the affected area. This type of cream contains a corticosteroid and is rubbed directly onto the sunburned area of skin to reduce pain and inflammation (swelling).

Hydrocortisone cream should not be used on children who are under two years old.

Do not apply it to certain parts of the body, including:

  • the face
  • genitals
  • broken or infected skin

Seek advice from your pharmacist before you start using hydrocortisone cream to treat sunburn.

Painkillers

Painkillers can help to relieve the pain and reduce the inflammation that is caused by sunburn.

Paracetamol can be used to treat pain and control fever. Ibuprofen is a type of non-steroidal anti-inflammatory drug (NSAID), which can relieve pain, reduce inflammation and lower a high temperature.

Aspirin should not be given to children who are under 16 years old. 

Severe sunburn

Severe cases of sunburn may require special burn cream and burn dressings. Ask your pharmacist for advice. You may need to have your burns dressed by a nurse at your GP surgery.

Very severe sunburn cases may require treatment at your local accident and emergency department.

If a baby or small child has been sunburned, or if blisters or a fever develop, seek medical advice from your GP.

Inflammation
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.

A number of long-term complications can develop as a result of prolonged exposure to ultraviolet (UV) rays. They include:

  • premature ageing of the skin and wrinkling (caused by UVA rays)
  • solar keratoses - rough, scaly spots on the skin 
  • skin infection - severe blistering from sunburn can cause infection if bacteria enters breaks in the skin
  • photokeratitis - prolonged exposure to intense sunlight can cause the eyes to become painfully sensitive, known as photokeratitis or snow blindness; it can be prevented by wearing sunglasses or goggles with UV filters
  • skin cancer - people who have been exposed to a lot of ultraviolet light have a higher risk of developing skin cancer (see below)

Skin cancer

Exposure to UV rays increases your chances of developing skin cancer. To reduce your risk of developing skin cancer, do everything you can to avoid UV exposure and prevent UV rays damaging your skin. Seek shade when the sun is at its hottest. Protect your skin by wearing loose, close weave, long-sleeved garments and a wide-brimmed hat.

Regularly applying sunscreen when you are out in the sun and being aware of the risk factors for skin cancer (see box, right) will also help you to avoid developing this serious and potentially life-threatening condition.

Most types of skin cancers are caused by long-term exposure to the sun. There are a number of risk factors that can increase your risk of developing skin cancer as a result of prolonged exposure to the sun. People with an increased risk are: 

  • those with very fair skin that burns easily
  • those who have had several cases of sunburn during childhood
  • those with a family history of skin cancer
  • those with lots of moles on their body (over 50)
  • those who are being treated with immunosuppressant medication

Immunosuppressant medication is medication that suppresses your immune system (the body’s natural defence against illness and infection).

You can effectively reduce your risk of developing skin cancer by protecting your skin by using sunscreen.

To prevent getting sunburn, avoid strong sunlight whenever possible, particularly if you are fair skinned, and cover up with loose clothing and a hat.

When purchasing sunglasses, look for a pair that has ultraviolet (UV) filters.

If possible, avoid going out when the sun is at its strongest. The sun is often at its strongest around midday (12pm).

Weather reports that give you the sun index (UV index) will indicate how strong the sun will be at a particular time of day.

Sunscreen

Be aware that there are many different types of sunscreen, and some are better quality than others. When buying sunscreen, choose one with a sun protection factor (SPF) that is suitable for your skin type and protects against both UVA and UVB rays.

SPF factor

Only buy suncreen with and SPF number. This is a number that indicates the level of protection that the sunscreen provides against UVB rays.

The level of protection from UVA rays is shown on the packaging as a star rating. The number of stars indicates the ratio of protection that the lotion provides when comparing UVA and UVB rays. Therefore, you should select a sunscreen that protects against both types of rays. These sunscreens are called broad-spectrum sunscreens.

However, when buying sunscreen abroad it is a good idea to ask the pharmacist or salesperson for advice about a particular product's effectiveness.

Applying sunscreen

As sunscreen is available in a number of different formats, including lotions, sprays and gels, you should check the instructions on the packaging for advice about how to apply it.

Below is some general advice about applying sunscreen. 

  • Apply a generous amount of sunscreen with an SPF of at least 15 before you go out in the sun. Apply it about half an hour before going out so that it has time to absorb into your skin and dry.
  • It is very important to use a generous amount of sunscreen. Research shows that many people do not use enough sunscreen to provide adequate protection. When applying sunscreen, pay particular attention to the skin near to the edges of clothing, such as straps and necklines, as these areas can easily be missed.
  • Reapply sunscreen regularly (at least every two to three hours) as it can rub off on towels, sand or after going in the water. Even water-resistant sunscreens should be reapplied after you come out of the water as it can be rubbed off when drying yourself with a towel.
  • Use a stick application with a high SPF for exposed areas, such as your nose, ears and lips because these areas tend to burn more easily.
  • For further tips check the SunSmart Code

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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