Articles written by me on Self-care and Palliative Medicine
On Self-Care & Palliative Medicine

Burning Issues

With Spring now in full force in Middle Tennessee, more and more people are shedding layers of clothing to enjoy the warmth and sunshine. . .and summer is just around the corner. Most of us will be spending much more time outside and will be wearing fewer and smaller items of clothing–a perfect set up for sunburn or permanent ultraviolet damage to skin unless appropriate precautions are taken. There are some basic burning issues that should be addressed to help all of us keep healthy and youthful skin.

Even though there is an increased risk of sunburn in fair skinned, red or blond-haired individuals, skin of any color can be damaged by the sun’s rays. Though suntans are meticulously maintained by many individuals, a suntan itself is a warning. . .it tells you that your skin has been burned. The increase in pigmentation is a protective mechanism which the skin uses in an effort to protect itself from further ultraviolet damage. Microscopic changes in sunburned skin can be detected within 30 minutes of sun exposure, but the characteristic redness develops after 2–6 hours and peaks at 12–24 hours. The skin becomes painful and swollen; and in severe cases, fever, chills, blistering and even nausea and vomiting can occur. Depending on the severity of the sunburn, delayed scaling or even peeling of the outer skin layer can occur 4–7 days after a severe sunburn.

One can become sunburned without sitting directly under a hot, blazing sun. Ultraviolet rays penetrate hazy atmosphere and clouds; though clouds block brightness, they may still allow up to 80% of ultraviolet light to reach the skin. Also, remember that water, sand and snow may reflect sun rays and cause sunburn. (Badly sunburned snow skiers can attest to the fact that cold temperatures and winter months do not protect an individual from burning). Certain medications such as antibiotics, oral contraceptives, some diuretics, and even over the counter Benadryl can increase the skin’s sensitivity to ultraviolet light. Time of day is important; 65% of ultraviolet radiation reaches the earth between 10 a.m. and 2 p.m. daily. Compared with white skinned individuals, moderately pigmented races require 3–5 times more UVR to cause reddened skin; blacks require up to 30 times more. Other interesting factors: Ultraviolet B radiation (290-320 nm) is more potent than Ultraviolet A (320-400 nm) in producing sunburn and is the principal cause of sunburn (about 85%). Ultraviolet radiation penetrates moist skin more effectively than dry skin–so better hydration is actually an increased risk for sunburn. And UVR increases 4% for every 1000 ft. rise in elevation.

So, what to do to protect yourself from sunburn? Avoid the sun’s rays between 10 a.m. and 2 p.m. if possible. Wear protective clothing and sun glasses. Loose, long-sleeved cotton shirts and hats with at least a 4-inch brim offer protection. Wear sun glasses that have at least 99% protection against both UVA and UVB sunlight–a form of acute conjunctivitis can occur in sunburned eyes, and long term ultraviolet exposure can lead to discoloration of the lens and cataract formation. Straw hats do not provide adequate protection. Interestingly, bright colors and white (common choices for warm weather clothing) will reflect sun onto your face increasing the risk of burn). And, of course, wear sun screen. Apply a sun screen with an SPF of 15 or higher 15 minutes before you go into sunlight–even on cloudy days, and reapply it after swimming or sweating. And, remember to use a sun screen on your lips as well. If you’re in intense sunlight, you might consider using a total sunblock (such as zinc oxide) on your lips, nose, and ears. Remember, baby oil, mineral oil, and cocoa butter offer no protection since they filter no UV light.

If preventive measures fail, and you do get sunburned, cool moist compresses on the skin can reduce heat and pain. Aspirin, tylenol and Aleve or ibuprofen products can also help with the pain and fever reduction. Sunburn sprays may help to relieve pain but should be used with caution since allergic reactions to Benzocaine and lidocaine are not uncommon. Hydrocortisone cream can be helpful in relieving inflammation, but be careful with any topical agents if there are open blisters or sores with a severe burn. And, remember that the healing process usually takes 48 to 72 hours, and no sunbathing at all should be done during this time period. In the most severe cases, sunburns may need to be treated with prescription steroids.

I hope the above information has answered some of your burning questions. Enjoy the Spring and Summer sun, but protect yourself from misery and skin damage with appropriate precautions. Remember, too, that long term risks of sun-damaged skin include premature aging and wrinkling of the skin, age spots, and skin cancer. Protect your skin, and you can gloat later on as your well-tanned friends are mistaken for your older siblings or perhaps your parents by well-intentioned strangers.

Stephen L. Hines, M.D.
April 2000

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