Sun Burn; How to Protect Your Skin from the Sunburn

Sunburn is a form of radiation burn that affects living tissue, such as skin, that results from an overexposure to ultraviolet (UV) radiation, commonly from the sun. Common symptoms in humans and other animals include red or reddish skin that is hot to the touch, pain, general fatigue, and mild dizziness. An excess of UV radiation can be life-threatening in extreme cases. The excessive UV radiation is the leading cause of primarily non-malignant skin tumors.

Sunburn is an inflammatory response in the skin triggered by direct DNA damage by UV radiation. When the skin cells’ DNA is overly damaged by UV radiation, type I cell-death is triggered and the skin is replaced.

Sun protective measures including sunscreen and sun protective clothing is widely accepted to prevent sunburn and some types of skin cancer. Special populations including children are especially susceptible to sunburn and protective measures should be used.

Sunburn is a commonly occurring acute inflammatory process, with dermal vasodilatation and leukocyte infiltration as central features. Ultraviolet (UV) B-induced hydrolysis of membrane phospholipids releases polyunsaturated fatty acids, and their subsequent metabolism by cyclooxygenases (COXs) and lipoxygenases (LOXs) may produce potent eicosanoid mediators modulating different stages of the inflammation. Our objective was to identify candidate eicosanoids formed during the sunburn reaction in relation to its clinical and histological course. We exposed skin of healthy humans (n=32) to UVB and, for 72 h, examined expression of proinflammatory and anti-inflammatory eicosanoids using LC/ESI-MS/MS, and examined immunohistochemical expression of COX-2, 12-LOX, 15-LOX, and leukocyte markers, while quantifying clinical erythema. We show that vasodilatory prostaglandins (PGs) PGE₂, PGF_2α, and PGE₃ accompany the erythema in the first 24–48 h, associated with increased COX-2 expression at 24 h.

Causes of Sun Burn

Sunburn causes an inflammation process, including the production of prostanoids and bradykinin. 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). The pain may be caused by overproduction of a protein called CXCL5, which activates nerve fibers.

• Skin type determines the ease of sunburn. In general, people with lighter skin tone and limited capacity to develop a tan after UV radiation exposure have a greater risk of sunburn.
• The 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.

Fitzpatrick’s skin phototypes

• Type I: Pale white skin, burns easily, does not tan
• Type II: White skin, burns easily, tans with difficulty
• Type III: White skin, may burn but tans easily
• Type IV: Light brown/olive skin, hardly burns, tans easily
• Type V: Brown skin, usually does not burn, tans easily
• Type VI: Black skin, very unlikely to burn, becomes darker with UV radiation exposure

Age also affects how skin reacts to sun. Children younger than six and adults older than sixty are more sensitive to sunlight.

There are certain genetic conditions, for example, xeroderma pigmentosum, that increase a person’s susceptibility to sunburn and subsequent skin cancers. These conditions involve defects in DNA repair mechanisms which in turn decreases the ability to repair DNA that has been damaged by UV radiation.

Medications

• The risk of sunburn can be increased by pharmaceutical products that sensitize users to UV radiation. Certain antibiotics, oral contraceptives, and tranquilizers have this effect.

UV intensity

The UV Index indicates the risk of getting a sunburn at a given time and location. Contributing factors include

• The time of day. In most locations, the sun’s rays are strongest between approximately 10am and 4pm daylight saving time.
• Cloud cover. UV is partially blocked by clouds; but even on an overcast day, a significant percentage of the sun’s damaging UV radiation can pass through clouds.
• Proximity to reflective surfaces, such as water, 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 in late spring and early summer can cause a more-severe sunburn.
• Altitude. At a higher altitude it is easier to become burnt, 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.
• Proximity to the equator (latitude). Between the polar and tropical regions, the closer to the equator, the more direct sunlight passes through the atmosphere over the course of a year. For example, the southern United States gets fifty percent more sunlight than the northern United States.

Protect Your Skin from the Sun

As an FDA-regulated product, sunscreens must pass certain tests before they are sold.  But how you use this product, and what other protective measures you take, make a difference in how well you are able to protect yourself and your family from sunburn, skin cancer, early skin aging and other risks of overexposure to the sun. Some key sun safety tips include:

• Limit time in the sun, especially between the hours of 10 a.m. and 2 p.m., when the sun’s rays are most intense.
• Wear clothing to cover skin exposed to the sun, such as long-sleeved shirts, pants, sunglasses, and broad-brimmed hats.
• Use broad spectrum sunscreens with SPF values of 15 or higher regularly and as directed.
• Reapply sunscreen at least every two hours, and more often if you’re sweating or jumping in and out of the water.

What Happen During Sun Exposure?

Rx

How to apply and store sunscreen

• Apply 30 minutes before you go outside. This allows the sunscreen (of SPF 15 or higher) to have enough time to provide the maximum benefit.
• Use enough to cover your entire face and body (avoiding the eyes and mouth).  An average-sized adult or child needs at least one ounce of sunscreen (about the amount it takes to fill a shot glass) to evenly cover the body from head to toe.

Frequently forgotten spots

Ears, Nose, Lips, Back of neck, Hands, Tops of feet,  Along the hairline

• Know your skin. Fair-skinned people are likely to absorb more solar energy than dark-skinned people under the same conditions.
• Reapply at least every two hours, and more often if you’re swimming or sweating.

Storing your sunscreen

• To keep your sunscreen in good condition, the FDA recommends that sunscreen containers should not be exposed to direct sun. Protect the sunscreen by wrapping the containers in towels or keeping them in the shade.
• Sunscreen containers can also be kept in coolers while outside in the heat for long periods of time.  This is why all sunscreen labels must say: “Protect the product in this container from excessive heat and direct sun.”

Sunscreens for infants and children

• Sunscreens are not recommended for infants. The FDA recommends that infants be kept out of the sun during the hours of 10 a.m. and 2 p.m., and to use protective clothing if they have to be in the sun.
• Infants are at greater risk than adults of sunscreen side effects, such as a rash. The best protection for infants is to keep them out of the sun entirely. Ask a doctor before applying sunscreen to children under six months of age.

For children over the age of six months, the FDA recommends using sunscreen as directed on the Drug Facts label.

Types of sunscreen

Sunscreen comes in many forms, including

Note: FDA has not authorized the marketing of nonprescription sunscreen products in the form of wipes, towelettes, powders, body washes, or shampoos.

Understanding the sunscreen label

Broad spectrum

Not all sunscreens are broad spectrum, so it is important to look for it on the label. Broad spectrum sunscreen provides protection from the sun’s ultraviolet (UV) radiation. There are two types of UV radiation that you need to protect yourself from – UVA and UVB. Broad spectrum provides protection against both by providing a chemical barrier that absorbs or reflects UV radiation before it can damage the skin.
Sunscreens that are not broad spectrum or that lack an SPF of at least 15 must carry the warning:

Sun protection factor (SPF)

Sunscreens are made in a wide range of SPFs.

• The SPF value indicates the level of sunburn protection provided by the sunscreen product. All sunscreens are tested to measure the amount of UV radiation exposure it takes to cause sunburn when using a sunscreen compared to how much UV exposure it takes to cause a sunburn when not using a sunscreen.
• The product is then labeled with the appropriate SPF value. Higher SPF values (up to 50) provide greater sunburn protection. Because SPF values are determined from a test that measures protection against sunburn caused by UVB radiation, SPF values only indicate a sunscreen’s UVB protection.

As of June 2011, sunscreens that pass the broad spectrum test can demonstrate that they also provide UVA protection. Therefore, under the label requirements, for sunscreens labeled “Broad Spectrum SPF [value]”, they will indicate protection from both UVA and UVB radiation. To get the most protection out of sunscreen, choose one with an SPF of at least 15.

If your skin is fair, you may want a higher SPF of 30 to 50.

• There is a popular misconception that SPF relates to time of solar exposure. For example, many people believe that, if they normally get sunburned in one hour, then an SPF 15 sunscreen allows them to stay in the sun for 15 hours (e.g., 15 times longer) without getting sunburn. This is not true because SPF is not directly related to time of solar exposure but to amount of solar exposure.
• The sun is stronger in the middle of the day compared to early morning and early evening hours. That means your risk of sunburn is higher at mid-day. Solar intensity is also related to geographic location, with greater solar intensity occurring at lower latitudes.

Sunscreen ingredients

Every drug has active ingredients and inactive ingredients.  In the case of sunscreen, active ingredients are the ones that are protecting your skin from the sun’s harmful UV rays.  Inactive ingredients are all other ingredients that are not active ingredients, such as water or oil that may be used in formulating sunscreens. Below is a list of acceptable active ingredients in products that are labeled as a sunscreen-

• Aminobenzoic acid
• Avobenzone
• Cinoxate
• Dioxybenzone
• Homosalate
• Menthyl anthranilate
• Octocrylene
• Octyl Methoxycinnamate
• Octyl salicylate
• Oxybenzone
• Padimate O
• Phenylbenzimidazole sulfonic acid
• Sulisobenzone
• Titanium dioxide
• Trolamine salicylate
• Zinc oxide

Sunscreen expiration dates

FDA regulations require all sunscreens and other nonprescription drugs to have an expiration date unless stability testing conducted by the manufacturer has shown that the product will remain stable for at least three years.  That means, a sunscreen product that doesn’t have an expiration date should be considered expired three years after purchase.

To make sure that your sunscreen is providing the sun protection promised in its labeling, the FDA recommends that you do not use sunscreen products that have passed their expiration date (if there is one), or that have no expiration date and were not purchased within the last three years.  Expired sunscreens should be discarded because there is no assurance that they remain safe and fully effective.

Sunscreens from other countries

In Europe and in some other countries, sunscreens are regulated as cosmetics, not as drugs, and are subject to different marketing requirements. Any sunscreen sold in the United States is regulated as a drug because it makes a drug claim – to help prevent sunburn or to decrease the risks of skin cancer and early skin aging caused by the sun.

Fun in the sun can be had all year long — hiking, winter skiing, swimming, or just enjoying the warmth of the sun. However, when taking certain medicines, life in the sun can sometimes be less than fun.

Some medicines contain ingredients that may cause photosensitivity — a chemically induced change in the skin. Photosensitivity makes a person sensitive to sunlight and can cause sunburn-like symptoms, a rash or other unwanted side effects. It can be triggered by products applied to the skin or medicines taken by mouth or injected.

There are two types of photosensitivity – photoallergy and phototoxicity.

Photoallergy is an allergic reaction of the skin and may not occur until several days after sun exposure. Phototoxicity, which is more common, is an irritation of the skin and can occur within a few hours of sun exposure. Both types of photosensitivity occur after exposure to ultraviolet light – either natural sunlight or artificial light, such as a tanning booth.

There are certain types of medicines that can cause sensitivity to the sun. Some of these include:

• Antibiotics (ciprofloxacin, doxycycline, levofloxacin, ofloxacin, tetracycline, trimethoprim)
• Antifungals (flucytosine, griseofulvin, voriconazole)
• Antihistamines (cetirizine, diphenhydramine, loratadine, promethazine, cyproheptadine)
• Cholesterol-lowering drugs (simvastatin, atorvastatin, lovastatin, pravastatin)
• Diuretics (thiazide diuretics: hydrochlorothiazide, chlorthalidone, chlorothiazide.; other diuretics: furosemide and triamterene)
• Non-steroidal anti-inflammatory drugs (ibuprofen, naproxen, celecoxib, piroxicam, ketoprofen)
• Oral contraceptives and estrogens
• Phenothiazines (tranquilizers, anti-emetics: examples, chlorpromazine, fluphenazine, promethazine, thioridazine, prochlorperazine)
• Psoralens (methoxsalen, trioxsalen)
• Retinoids (acitretin, isotretinoin)
• Sulfonamides (acetazolamide, sulfadiazine, sulfamethizole, sulfamethoxazole, sulfapyridine, sulfasalazine, sulfisoxazole)
• Sulfonylureas for type 2 diabetes (glipizide, glyburide)
• Alpha-hydroxy acids in cosmetics

Not all people who take or use the medicines mentioned will have a reaction. Also, if you experience a reaction on one occasion, it does not mean that you are guaranteed to have a reaction if you use the product again.

If you have concerns about developing a reaction, try to reduce your risk:

• When outside, seek shade, especially between 10 a.m. and 2 p.m. – some organizations recommend as late as 4:00 p.m. Keep in mind that the sun’s rays may be stronger when reflected off water, sand and snow.
• Wear long-sleeved shirts, pants, sunglasses, and broad-brimmed hats to limit sun exposure.
• Use a broad sunscreen regularly and as directed. Broad-spectrum sunscreens provide protection against ultraviolet A (UVA) and ultraviolet B (UVB) radiation. An SPF 15 is the minimum number needed to provide measurable protection; however, a sunscreen with an SPF value of 30 or higher is recommended. Rarely, some sunscreen ingredients can cause photosensitivity themselves.

Rx

If you have questions about your medications and the possibility of photosensitivity, contact your health-care professional or pharmacists. Taking a few precautions can help limit your risk of photosensitivity and keep the sun shining on your fun.

Home Treatments of Sun Burn

• Place a cool compress on sunburned skin for immediate sunburn relief.
• Use lotions that contain Aloe Vera to soothe and moisturize sunburnt skin. Some aloe products contain lidocaine, an anesthetic that can help relieve sunburn pain. Aloe Vera is also a good moisturizer for peeling skin.
• Hydrate – Drink lots of water, juice, or sports drinks. Your skin is dry and dehydrated. Replacing lost body fluids will help your skin heal from sunburn more quickly.
• Apply a cool compress containing Burow’s solution (such as Domeboro Powder Packets -1 pct in 1 pint of water) to comfort and soothe a sunburn.
• Topical over-the-counter (OTC) 1% hydrocortisone cream may help relieve sunburn symptoms like pain, itch, and swelling.
• Take OTC pain relievers such as ibuprofen (Advil, Motrin) or naproxen(Aleve) to help relieve sunburn pain and inflammation.
• Apply cool, not cold, milk with a clean cloth to your sunburned skin. The milk will create a protein film that helps ease sunburn discomfort.
• Like milk, yogurt applied to sunburned skin also can be soothing.
• Vitamin E is an antioxidant and can help decrease inflammation caused by sunburn. Use Vitamin E oil on the skin, or take a regular dose of the supplement. Vitamin E oil also can be rubbed onto peeling skin.
• Apply freshly brewed tea after it has cooled to sunburnt skin using a clean cloth. The tannic acid in black tea reportedly helps draw heat from sunburned skin and also aids in restoring the pH balance. Add mint to the tea for a more cooling effect.
• Apply tea bags soaked in cold water to sunburned eyelids to soothe the burn and reduce inflammation.
• Cucumbers have natural antioxidant and analgesic properties. Chill cucumbers, then mash in a blender to create a paste and apply to affected sunburned areas including the face. Cucumber also can be soothing for peeling skin following a sunburn.
• Boil and mash some peeled potatoes, let cool, and apply as a dressing to sunburned areas. It is believed that the starch in the potatoes helps draw out heat, which can reduce pain and speed healing.
• Cornstarch also can be mixed with water to form a paste that can be applied to the skin to help soothe the sunburn.
• Witch hazel, when applied to the skin, can help reduce inflammation, and can help relieve sunburn.
• If your lips are sunburned, apply petroleum jelly or Aquaphor ointment to keep them moisturized.
• Essential oils such as lavender or Helichrysum can be applied in small amounts to the skin to soothe sunburn.
• If you feel hot from your sunburn, keep your house cool. Turn down the A/C and use fans to help blow cool air over the skin.
• If your skin is peeling following a bad sunburn, avoid picking at it or peeling it further.
• If you have blisters, this is a sign of a severe sunburn. It is best to cover them to prevent tearing and leave them alone until they heal.
• If you are taking any medications that make your skin more sensitive to the sun (such as tetracyclines, thiazides, sulfonamides, phenothiazines,oral contraceptives, diuretics, drugs for diabetes) contact your doctor to see if there are different medications you can take that will make you less likely to get sunburned. Do not stop taking any prescribed medication without first consulting your doctor.
• Once the initial sunburn has calmed down, coconut oil can be used as a skin moisturizer. Do not use coconut oil as sunscreen! Coconut oil does not provide any sun protection factor (SPF) or provide any UV protection, so you are more likely to get sunburned if you use coconut oil in place of sunblock with SPF.
• Go inside or in the shade, and stay out of the sun until your sunburn fades. Exposure to more sunlight will only make things worse.
• The best remedy against sunburn is prevention. Always use sunscreen with SPF 30 or higher, wear protective clothing and sunglasses, and avoid direct sun exposure.

Take a cool shower or bath to cool your sunburned skin. Check out these natural bath therapies to soothe sunburn pain and other symptoms.

• Add one cup of apple cider vinegar to a bath to help balance the pH (acid or alkalinity) of sunburned skin, and promote healing.
• Soak in an oatmeal bath. This is especially helpful for itchy sunburned skin.
• Add some lavender or chamomile essential oil to the bath to help relieve some of the stinging and pain.
• Add 2 cups of baking soda to the bath to help ease irritation and redness from sunburn.
• Avoid soap or perfumes in the bath water as these can be drying on already dry and sunburned skin.

References

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