Health Reference / Children's Health / Sunburn

Sunburn

Date Posted: February 23, 2000

DEFINITION

Sunburn is due to overexposure of the skin to the ultraviolet rays of the sun or a sunlamp. Most people have been sunburned many times. Vacations can quickly turn into painful experiences when the power of the sun is overlooked. Unfortunately, the symptoms of sunburn do not begin until 2 to 4 hours after the sun's damage has been done. The peak reaction of redness, pain, and swelling is not seen for 24 hours. Minor sunburn is a first-degree burn that turns the skin pink or red. Prolonged sun exposure can cause blistering and a second-degree burn. Sunburn never causes a third-degree burn or scarring.

Increased leisure time can lead to increased sun damage. Repeated sun exposure and suntans cause premature aging of the skin (wrinkling, sagging, and brown sunspots). Repeated sunburns increase the risk of skin cancer in the damaged area. Each blistering sunburn doubles the risk of developing malignant melanoma, which is the most serious type of skin cancer.

HOME CARE

Pain Relief. The sensation of pain and heat will probably last for 48 hours.

Ibuprofen products started early and continued for 2 days can reduce the discomfort.
Nonprescription 1% hydrocortisone cream or moisturizing creams applied 3 times each day may also cut down on swelling and pain, but only if used early. (Avoid petroleum jelly or other ointments because they keep heat and sweat from escaping.)
The symptoms can also be helped by cool baths or wet compresses several times daily.
Showers are usually too painful.
Peeling will usually occur in about a week. Apply a moisturizing cream.
Offer extra water to replace the fluid lost into the swelling of sunburned skin and to prevent dehydration and dizziness.
For broken blisters, trim off the dead skin with a small scissors and apply an antibiotic ointment. Wash off and reapply the antibiotic ointment twice daily for 3 days.

Common Mistakes in Treatment of Sunburn. Avoid applying ointments or butter to a sunburn; they are painful to remove and not helpful. Don't buy any first aid creams or sprays for burns. They often contain benzocame that can cause an allergic rash. Don't confuse sunscreens that block the sun's burning rays with suntan lotions or oils that mainly lubricate the skin.

PREVENTION OF SUNBURNS

The best way to prevent skin cancer is to prevent sunburn. Although skin cancer occurs in adults, it is caused by the sun exposure and sunburns that occurred during childhood. Every time you apply sunscreen to your child, you are preventing skin cancer down the line.

Apply sunscreen anytime your child is going to be outside for more than 30 minutes per day.
For teenagers who are determined to acquire a suntan, teach them the limits of sun exposure without a sunscreen.
After I hour of sun exposure, always apply a sunscreen.
Protect high-risk children. About 15% of white people have skin that never tans but only burns. These fair-skinned children need to be extremely careful about the sun throughout their lives. The big risk factors for sunburn are red hair, blond hair, blue eyes, green eyes, freckles, or excessive moles. These children are also at increased risk for skin cancer They need to be instructed repeatedly to use a sunscreen throughout the summer even for brief exposure and to avoid the sun whenever possible.
Protect infants. The skin of infants is thinner and more sensitive to the sun. Therefore, babies under 6 months of age should be kept out of direct Sunlight. Keep them in the shade whenever possible. If sun exposure must occur, sunscreens, longer clothing, and a hat with a brim are essential. Don't apply sunscreen to areas where the infant may lick it off.
Try to keep sun exposure to small amounts early in the season until a tan builds up. (Caution: Although people with a suntan can tolerate a little more sun, they can still get a serious sunburn.) Start with 15 or 20 minutes per day and increase by 5 minutes per day. Decrease daily exposure time if the skin becomes reddened. Because of the 2- to 4-hour delay before sunburn starts, don't expect symptoms to tell you when it's time to get out of the sun.
Avoid the hours of 10:00 AM to 3:00 PM, when the sun's rays are most intense. Even if it's not hot outside, avoid the mid-day Sun. Find other activities for your children during these hours.
Don't let overcast days give you a false sense of security. Over 70% of the sun's rays still get through the clouds. Over 30% of the sun's rays can also penetrate loosely woven fabrics (for instance, a T-shirt).
Sun exposure increases by 4% for each 1000 feet of elevation. A sunburn can occur quickly when hiking above the timberline.
Water, sand, or snow increases sun exposure. The shade from a hat or umbrella won't protect you from reflected rays.
Also protect your child's eyes. Years of exposure to ultraviolet OJV) light increase the risk of cataracts. Buy sunglasses with UV protection.
Set a good example. Did you apply your sunscreen? Are you wearing a baseball cap to protect your face?

Sunscreens. There are good sunscreens on the market that prevent sunburn but still permit gradual tanning to occur. Choose a broad-spectrum sunscreen that screens Out both ultraviolet A and B (UVA and UVB) rays. The sun protection factor (SPF) or filtering power of the product determines what percent of the UV rays gets through to the skin. An SPF of 15 allows only 1/15 (7%) of the sun's rays to get through and thereby extends safe sun exposure from 20 minutes to 5 hours without sunburning. For practical purposes, an SPF higher than 15 is rarely needed because sun exposure beyond 5 hours is unusual. Fair-skinned whites (with red or blond hair) may need a sunscreen with an SPF of 30. The simplest approach is to use an SPF of 15 or greater on all children.

Apply the sunscreen 30 minutes before exposure to the sun to give it time to penetrate the skin. Give special attention to the areas most likely to become sunburned, such as your child's nose, ears, cheeks, and shoulders. Most products need to be reapplied every 3 to 4 hours, as well as immediately after swimming or profuse sweating. A "waterproof" sunscreen stays on for about 30 minutes in water. Do not towel off after swimming. Most people apply too little (the average adult requires I ounce of sunscreen per application).

To prevent sunburned lips, apply a lip coating that also contains para-aminobcnzoic acid (PABA). If your child's nose or some other area has been repeatedly burned during the summer, protect it completely from all the sun's rays with zinc oxide ointment.

CALL OUR OFFICE IMMEDIATELY if

An unexplained fever over 102„aF (38.9„aC) occurs.
The sunburn looks infected (yellow pus, spreading redness, red streaks).
Your child starts acting very sick.

During regular hours if

You have other questions or concerns.

Instructions for Pediatric Patients, 2nd Edition, 01999 by WB Saunders Company. Written by Barton D. Schmitt, MD, pediatrician and author of Your Child's Health, Bantam Books, a book for parents.