| Sunburn | |
|---|---|
 | |
| A sunburnt neck | |
| Specialty | Dermatology |
| Complications | Skin cancer |
| Risk factors | Working outdoors, skin unprotected by clothes orsunscreen,skin type, age |
| Prevention | Use ofsunscreen,sun protective clothing |
| Treatment | Avoiding further exposure to the sun. Cool, frequent baths or showers for pain relief. Anti-inflammatory medications such as ibuprofen or aspirin can also help with pain. Drinking water to stay hydrated. |
Sunburn is a form ofradiation burn that affectsliving tissue, such asskin, that results from an overexposure toultraviolet (UV) radiation, usually from theSun. Common symptoms in humans and other animals includered or reddish skin that is hot to the touch orpainful, generalfatigue, and milddizziness. Other symptoms includeblistering,peeling skin, swelling, itching, and nausea. Excessive UV radiation is the leading cause of (primarily)non-malignantskin tumors,[1][2] which in extreme cases can be life-threatening. Sunburn is aninflammatory response in the tissue triggered bydirect DNA damage by UV radiation. When thecells'DNA is overly damaged by UV radiation,type I cell-death is triggered and the tissue is replaced.[3]
Sun protective measures likesunscreen andsun protective clothing are widely accepted to prevent sunburn and some types ofskin cancer.[4] Special populations, including children, are especially susceptible to sunburn and protective measures should be used to prevent damage.[5]
Typically, there is initial redness, followed by varying degrees of pain, the severity of which correlates with the duration and intensity of sun exposure.[citation needed]
Other symptoms can includeblistering, swelling (edema), itching (pruritus),peeling skin,rash,nausea,fever,chills, and fainting (syncope). Also, heat is produced from capillaries close to the skin surface, therefore the affected area feels warm to touch. Sunburns may be classified as superficial or partial-thicknessburns. Blistering is a sign of second-degree sunburn.[6]
Minor sunburns typically cause nothing more than slight redness and tenderness to the affected areas. In more serious cases, blistering can occur. Extreme sunburns can be painful to the point of debilitation and may require hospital care.[7]
Sunburn can occur in less than 15 minutes in response to sun exposure and in seconds when exposed to non-shielded welding arcs or other sources of intense ultraviolet light. Nevertheless, the inflicted harm is often not immediately obvious.[citation needed]
After sun exposure, the skin may turn red in as little as 30 minutes, but sunburn usually takes 2 to 6 hours. Pain is usually strongest 6 to 48 hours after exposure. The burn continues to develop for 1 to 3 days, occasionally followed by peeling skin after 3 to 8 days. Some peeling and itching may continue for several weeks.[citation needed]
Ultraviolet radiation causes sunburns and increases the risk of three types of skin cancer:melanoma,basal-cell carcinoma andsquamous-cell carcinoma.[1][2][8] Of greatest concern is that the melanoma risk increases dose-dependently proportional to the number of a person's lifetime cumulative episodes of sunburn.[9] An estimated 1/3 of melanomas in the United States and Australia could be prevented with regular sunscreen use.[10]
Sunburn is caused byUV radiation from the Sun but may also result from artificial sources, such astanning lamps,welding arcs, orultraviolet germicidal irradiation.
UVB damagesmRNA[11] This triggers a fast pathway that leads to inflamination of the skin and sunburn. mRNA damage initially triggers a response inribosomes though a protein known asZAK-alpha in a ribotoxic stress response. This response acts as a cell surveillance system. Following this detection of RNA damage leads to inflammatory signaling and recruitment of immune cells. This, not DNA damage (which is slower to detect) results in UVB skin inflammation and acute sunburn.[12]
DNA isdamaged by UVB light. This damage is mainly the formation of athymine dimer. The body recognizes such UVB damage on mRNA,[12] which then triggers several defense mechanisms, including DNA repair to revert the damage,apoptosis and peeling to remove irreparably damaged skin cells, and increased melanin production to prevent future damage.[3]
Melanin readily absorbs UV wavelength light, acting as a photoprotectant. By preventing UV photons from disrupting chemical bonds, melanin inhibits both the direct alteration of DNA, as well as the generation offree radicals, to prevent them from indirectly damaging DNA. However, humanmelanocytes contain over 2,000genomic sites that are highly sensitive toUV, and such sites can be up to 170-fold more sensitive to UV induction of cyclobutanepyrimidine dimers than the average site[13] These sensitive sites often occur at biologically significant locations neargenes.
Sunburn causes aninflammation process that includes the production ofprostanoids andbradykinin. These chemical compounds increase sensitivity to heat by reducing the threshold of heat receptor (TRPV1) activation from 109 °F (43 °C) to 85 °F (29 °C).[14] The pain may be caused by the overproduction of a protein calledCXCL5, which activates nerve fibers.[15]
Skin type determines the ease of sunburn. People with lighter skin tones and limited capacity to develop a tan after UV radiation exposure have a greater risk of sunburn. Fitzpatrick's Skin phototypes classification describes the normal variations of skin responses to UV radiation. Persons with type I skin have the greatest capacity to sunburn, and type VI have the least capacity to burn. However, all skin types can develop sunburn.[16]
Fitzpatrick's skin phototypes:
Age also affects how skin reacts to the sun. Children younger than six and adults older than sixty are more sensitive to sunlight.[18]
Certain genetic conditions, for example,xeroderma pigmentosum, increase a person's susceptibility to sunburn and subsequent skin cancers. These conditions involve defects in DNA repair mechanisms which decrease the ability to repair DNA damaged by UV radiation.[19]
The risk of sunburn can be increased bypharmaceutical products that sensitize users to UV radiation. Certainantibiotics, oralcontraceptives,antidepressants,acne medications, andtranquillizers have this effect.[20]
TheUV Index indicates the risk of sunburn at a given time and location. Contributing factors include:[18]
Because of variations in the intensity of UV radiation passing through the atmosphere, the risk of sunburn increases with proximity to thetropic latitudes, located between 23.5° north and south latitude. All else being equal (e.g., cloud cover,ozone layer,terrain, etc.), each location within the tropic orpolar regions receives approximately the same amount of UV radiation over a year. In thetemperate zones between 23.5° and 66.5°, UV radiation varies substantially by latitude and season. The higher the latitude, the lower the intensity of the UV rays. Sun intensity in the northern hemisphere is greatest during May, June and July—and in the southern hemisphere, November, December and January. On a minute-by-minute basis, the amount of UV radiation depends on the Sun's angle. Ultraviolet radiation is easily determined by the heightratio of any object to the size of itsshadow. Height is measured parallel to the Earth's gravitational field and the projected shadow is measured on a flat, level surface. For objects wider than skulls or poles, the height and length are best measured relative to the same occluding edge. The most significant risk is atsolar noon when shadows are at their minimum, and the Sun's radiation passes most directly through the atmosphere. Regardless of one's latitude (assuming no other variables), equal shadow lengths mean equal amounts of UV radiation.[citation needed]
The skin and eyes are most sensitive to damage by UV at 265–275 nm wavelength, which is in the lower UVC band that is rarely encountered except from artificial sources like welding arcs. Longer wavelengths of UV radiation cause most sunburn because those wavelengths are more prevalent in ground-level sunlight.[citation needed]
In recent decades, the incidence and severity of sunburn have increased worldwide, partly because of chemical damage to the atmosphere's ozone layer. Between the 1970s and the 2000s, average stratospheric ozone decreased by approximately 4%, contributing an approximate 4% increase to the average UV intensity at the Earth's surface.Ozone depletion and the seasonal "ozone hole" have led to much larger changes in some locations, especially in the southern hemisphere.[24]
Suntans, which naturally develop in some individuals as a protective mechanism against the sun, are viewed by most in the Western world as desirable.[25] Tanning has led to an increased exposure to UV radiation from both the natural sun andtanning lamps. Suntans can provide a modestsun protection factor (SPF) of 3, meaning that tanned skin would tolerate up to three times the UV exposure as pale skin.[26]
Sunburns associated with indoor tanning can be severe.[27]
The World Health Organization, American Academy of Dermatology, and theSkin Cancer Foundation have recommended avoiding artificial UV sources such as tanning beds. Suntans are not recommended as a form of sun protection.[28][29][30]
The differential diagnosis of sunburn includes other skin pathology induced by UV radiation, including photoallergic reactions, phototoxic reactions to topical or systemic medications, and other dermatologic disorders that are aggravated by exposure to sunlight. Considerations for diagnosis include duration and intensity of UV exposure, topical or systemic medication use, history of dermatologic disease, and nutritional status.
Additionally, since sunburn is a type ofradiation burn,[32][33] it can initially hide a severe exposure toradioactivity. Excess radiation exposure may result inacute radiation syndrome or other radiation-induced illnesses, especially in sunny conditions. For instance, the difference between theerythema caused by sunburn and other radiation burns is not immediately obvious. Symptoms common toheat illness and the prodromic stage of acute radiation syndrome like nausea, vomiting, fever, weakness/fatigue, dizziness or seizure can add to further diagnostic confusion.[34]
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The most effective way to prevent sunburn is to reduce the amount of UV radiation reaching the skin. The World Health Organization, American Academy of Dermatology, and Skin Cancer Foundation recommend the following measures to prevent excessive UV exposure and skin cancer:[35][36][37]
The strength of sunlight is published in many locations as aUV Index. Sunlight is generally strongest when the Sun is close to the highest point in the sky. Due to time zones and daylight saving time, this is not necessarily at 12 pm, but often one to two hours later. Seeking shade using umbrellas and canopies can reduce UV exposure, but does not block all UV rays. The WHO recommends following the shadow rule: "Watch your shadow – Short shadow, seek shade!"[35]
Commercial preparations that block UV light are known assunscreens or sunblocks. They have asun protection factor (SPF) rating based on the sunblock's ability to suppress sunburn: The higher the SPF rating, the lower the amount of direct DNA damage. The stated protection factors are correct only if 2 mg of sunscreen is applied per square cm of exposed skin translates into about 28 mL (1 oz) to cover the whole body of an adult male. The recommended dose is much more than many people use in practice.[38] Sunscreens function as chemicals such asoxybenzone anddioxybenzone (organic sunscreens) or opaque materials such aszinc oxide ortitanium oxide (inorganic sunscreens) that mainly absorb UV radiation. Chemical and mineral sunscreens vary in the wavelengths of UV radiation blocked. Broad-spectrum sunscreens contain filters that protect against UVA radiation as well as UVB. Although UVA radiation does not primarily cause sunburn, it contributes toskin aging and increases skin cancer risk.[citation needed]
Sunscreen is effective and thus recommended for preventingmelanoma[39] andsquamous cell carcinoma.[40] There is little evidence that it is effective in preventingbasal cell carcinoma.[41] Typical use of sunscreen does not usually result invitamin D deficiency, but extensive usage may.[42]
Research has shown that the best sunscreen protection is achieved by application 15 to 30 minutes before exposure, followed by one reapplication 15 to 30 minutes after exposure begins. Further reapplication is necessary after activities such as swimming, sweating, and rubbing.[43] Recommendations are product dependent varying from 80 minutes in water to hours based on the indications and protection shown on the label. The American Academy of Dermatology recommends the following criteria in selecting a sunscreen:[44]
The eyes are also sensitive to sun exposure at about the same UV wavelengths as skin;snow blindness is sunburn of the cornea. Wrap-aroundsunglasses or the use by spectacle-wearers ofglasses that block UV light reduce harmful radiation. UV light has been implicated in the development of age-relatedmacular degeneration,[45]pterygium[46] andcataracts.[47] Concentrated clusters of melanin, commonly known asfreckles, are often found within the iris.
The tender skin of theeyelids can also become sunburned and can be especially irritating.[citation needed]
Thelips can become chapped (cheilitis) by sun exposure. Sunscreen on the lips does not have a pleasant taste and might be removed by saliva. Somelip balms (ChapSticks) have SPF ratings and contain sunscreens.[citation needed]
The skin of the feet is often tender and protected, so sudden prolonged exposure to UV radiation can be particularly painful and damaging to the top of the foot. Protective measures include sunscreen, socks, or swimwear that covers the foot.
Dietary factors influence susceptibility to sunburn, recovery from sunburn, and risk of secondary complications. Several dietaryantioxidants, including essential vitamins, are effective in protecting against sunburn and skin damage associated with ultraviolet radiation, in both human and animal studies. Supplementation withVitamin C andVitamin E was shown in one study to reduce the amount of sunburn after a controlled amount of UV exposure.[48]A review of scientific literature through 2007 found thatbeta carotene (Vitamin A) supplementation had a protective effect against sunburn. The effects of beta carotene were only evident in the long-term, with studies of supplementation for periods less than ten weeks in duration failing to show any effects.[49] There is also evidence that common foods may have some protective ability against sunburn if taken for a period before exposure.[50][51]
Babies and children are particularly susceptible to UV damage which increases their risk of both melanoma and non-melanoma skin cancers later in life. Children should not sunburn at any age, and protective measures can reduce their future risk of skin cancer.[52]
The WHO recommends that artificial UV exposure, including tanning beds, should be avoided as no safe dose has been established.[53] Special protective clothing (for example, welding helmets/shields) should be worn when exposed to any artificial source of occupational UV. Such sources can produce UVC, an extremely carcinogenic wavelength of UV, which ordinarily is not present in normal sunlight, having been filtered out by the atmosphere.[citation needed]
The primary measure of treatment is avoiding furtherexposure to the sun. The best treatment for most sunburns is time; most sunburns heal completely within a few weeks.
TheAmerican Academy of Dermatology recommends the following for the treatment of sunburn:[54]
Non-steroidal anti-inflammatory drugs (NSAIDs; such asibuprofen ornaproxen), andaspirin may decrease redness and pain.[55][56] Localanesthetics such asbenzocaine, however, are contraindicated.[57] Schwellnus et al. state thattopical steroids (such ashydrocortisone cream) do not help with sunburns,[56] although theAmerican Academy of Dermatology says they can be used on especially sore areas.[57] Whilelidocaine cream (a local anesthetic) is often used as a sunburn treatment, there is little evidence for the effectiveness of such use.[58]
A home treatment that may help the discomfort is using cool and wet cloths on the sunburned areas.[56] Applying soothing lotions that containaloe vera to sunburned areas was supported by multiple studies.[59][60] However, others have found aloe vera to have no effect.[56] Note that aloe vera cannot protect people from new or further sunburn.[61] Another home treatment is using amoisturizer that containssoy.[57] Furthermore, sunburn draws fluid to the skin's surface and away from the rest of the body. Drinking extra water is recommended to help preventdehydration.[57]
Up to 80% of solar UV radiation can penetrate light cloud cover.
Clear skies allow virtually 100% of UV to pass through, scattered clouds transmit 89%, broken clouds transmit 73%, and overcast skies transmit 31%.
A UVB-induced tan provides minimal sun protection, equivalent to an SPF of about 3.
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