The pain, redness and occasional blistering that you experience when you have a sunburn happens because you exposed your skin to more sun than it was designed to handle.
The burn tells you that you have both damaged DNA and damaged skin cells, and for these there is no fix.
You can relieve the symptoms of inflammation a little with proper care, but you can’t do anything to undo the DNA and cell damage.
This means that the most important form of treatment for a sunburn is prevention; once the UV rays start damaging your skin, a complex inflammatory process has already begun that ends in redness and discomfort…. and there’s no going back.
This is part 3 of my Sunburn Series. Together they create a complete picture of what sun does to your skin. The first post is titled: What Is A Sunburn? The second post is: What is A Tan? In this third and final post I try to give you some suggestions for how to care for your skin if you’re unlucky enough to get a sunburn. I also give you advice for preventing another sunburn in the future.
The treatment that I’m outlining below is simply an attempt to ease the inflammation and discomfort, it does not fix the DNA and cell damage-that’s an unfortunate lifetime souvenir.
4 Simple steps that can relieve the discomfort of a sunburn:
The best thing to help lessen the redness and discomfort is to start taking aspirin or a indomethacin (a prescription medicine requiring your doctor’s supervision). These help fight some forms of inflammation, but they need to be taken prior to or immediately after the sun exposure before the redness has gotten really bad. (I’m not going to give dosing recommendations as this is a medical treatment and requires your doctor’s supervision, the info here is purely educational.)- Topical prescription cortisone creams applied to the red skin within 6 hours can provide a little relief too. Again, this requires your personal doctor’s supervision and many cortisone creams are only for use on specific areas of your skin; this info is educational only!
- Moisturizers should be applied within 3 minutes after toweling off from a cool water bath or shower to keep skin soothed and hydrated, but peeling will still most likely occur in about a week.
- Pure aloe vera gel can sooth inflamed skin. Never use one with a topical anesthetic ingredient, such as benzocaine or lidocaine, because they can cause an allergic skin rash.
What to avoid when you have a sunburn:
Sunburned skin is more vulnerable to irritation than normal skin. Its barrier strength is damaged because it’s swollen and the protective outer dead skin cell layer is peeling. This means that it’s porous and fragile and needs the be ‘babied’. If you don’t baby it you may cause even more injury. The redness and pain may last longer and you may be at greater risk for uneven skin color when you finally heal. This means:
- Sunburned skin should not be rubbed, peeled, exposed to harsh products (like some acne medicines, alpha hydroxy acid anti-aging products, retinol or tretinoin).
- Sunburned skin should also not be re-exposed to the sun until it is entirely healed. This is because the outer protective dead skin cell layer is damaged so more harmful UV rays will pass into it.
How long should you keep sunburned skin out of the sun?
This question makes me crazy and anyone who knows me can imagine that I need to be sedated to answer it. I never recommend sun exposure of skin capable of sunburning. (I just read this to my husband who gasped!) I also know that not everyone is going to follow my advice to the letter, so I’ll give you a longer answer.
The durability of skin after a sunburn depends on the extent of the burn. Part of what protects skin from the sun is a healthy dead skin cell layer (called the stratum corneum). This peels after about a week and then it takes the skin at least another 2 weeks to rebuild it. So the soonest your skin could be back to normal is about 3 weeks. If the sunburn was severe it could take even longer. Unfortunately, there’s no good news, or quick fix, for a sunburn. Prevention is really important.
What are the long term effects of a sunburn?
Sunburned skin often develops ‘sunburn freckles’ as a permanent reminder of the damage that occurred. The more often you get sunburned, the more freckles you get. Sometimes it only takes one really bad burn to cause the freckles. When I see these ‘sunburn freckles’ on a skin exam I know to be extra worried about finding a skin cancer on that area of skin.
Sunburns increase your risk of getting melanoma, the potentially deadly (aka big ‘C’) type of skin cancer. Even one blistering sunburn before the age of 18 doubles your risk!
How to protect your skin from sunburn, including protecting your sunburned skin from more sun exposure!
Wear a broad spectrum sunscreen with an SPF 30 or higher. Know the difference between SFP and UVA sun protection when you shop for sunscreen and know how to properly apply sunscreen so that it works. I give you the sunscreen facts below.
Cover as much skin as possible with sun protective clothing when you’re in the sun, don’t just rely on sunscreen. Remember, not all clothing is good at blocking the sun. You need to know what type of fabric works and what doesn’t. Play it safe and use either official sun protection garments or wash Sun Guard into the fabric of clothing to make it sun protective. I explain how to make sun protective clothing using Sun Guard in my post: Are Your Summer Clothes Good Enough To Be Sun Protective Clothing?
Wear a hat to create shade over your face. It needs to have a full brim of at least 3 inches to really shade your face. (Not a baseball style hat!) You still need a good sunscreen on your face too to protect you from reflected light. Remember, your hat also needs to cover the top of your head so forget the visors and mesh-topped hats. I talk more about what constitutes a good sun protection hat in my post: Great Sun Hats: What Works and What Doesn’t.
Wear UV blocking sunglasses too.
Seek the shade and avoid being in the direct sun as much as possible between 10am and 3pm.
Sunscreen Facts From The Dermatologist:
The SPF tells you how well the product blocks UVB.
- UVB is the main sunburn ray.
- You want to use a sunscreen with an SPF over 30. An SPF any higher than 40 or 50 that doesn’t give you much more protection and is actually misleading.
- If you want more info on UVB, see my post titled How High Of An SPF Does Your Sunscreen Need To Have?
Your sunscreen needs to block ALL of the UVA rays.
- A product can claim UVA protection but really not block all the rays.
- The SPF does not tell you anything about UVA protection.
- I think mineral sunscreens block UVA the best and that’s why I only recommend sunscreens that contain 5% or more micro zinc oxide. Zinc oxide blocks ever single light wave in the entire UVA spectrum. You also need to know that sunscreen ingredients don’t last on your skin or even in the sunscreen bottle and this micro zinc oxide is the longest lasting and most reliable ingredient. For that reason, products with micro zinc oxide are more trustworthy in my opinion and I never personally rely on anything else. If there are other sunscreen ingredients in a product, that’s fine, but look for at least 5% micro (nano-sized) zinc oxide.
Apply your sunscreen correctly.
How you apply sunscreen is hugely important to whether it works well or not! We know that people do not put enough on, miss spots and don’t reapply often enough. Read my advice: How To Apply Sunscreen and Have Healthy Fabulous Skin Forever.
Don’t use old sunscreen!
Sunscreen doesn’t keep forever so buy a new tube or bottle every year at least. Heat and age affect how long your sunscreen will stay active and since you probably don’t remember where last years bottle has been, start fresh every season. I explain what I mean in my post titled If You Want A Sunburn Use Last Year’s Sunscreen
Reference: Andrews’ Diseases of The Skin, 11th Edition, William D. James, MD, Timothy Berger, MD and Dirk MD Elston, MD, Saunders 2011, pages 24-25.
Photos: Thanks and Gratitude to Allan Donque and Collin Grady
Dr. Bailey, do you have any pictures of what a blistering sunburn looks like? I used to peel as a kid, and if I could compare what a blistering sunburn looks like with what I recall my shoulders looked like, I would know if I have to worry about an increased risk of melanoma. Thanks for an informative blog!
Hello Martha,
I don’t unfortunately. A blistering burn is fluid filled peeling, especially before the normal 7 day sunburn peeling phase. It’s always safe to err on the side of caution and for anyone with a history of sunburns that means getting regular skin exams. In my practice, I recommend that everyone with a history of sunbelt living or sun exposure (just about everyone) who is over the age of 40 get an annual skin exam.
Hello, Dr. Bailey.
Does even last years ZnO lose potency over time?
I understand that even ZnO does breakdown over time, both sitting in the product and on your skin exposed to sun. It just does it more slowly than other sunscreen actives. That’s why it too needs reapplication and it’s also why I always recommend purchasing new sunscreen every year. There should also be an expiration date on a product to know how long it has been in a warehouse and store shelf before you purchase it.
Even though there are so many warnings about the danger of the sun, people tend to ignore it. They love lying on the beach and the glow of a tan. Usually it takes a scary wake up call, such as a friend or family member being diagnosed with skin cancer for people to “get it”.
I think this is a great article on a very important topic!
I would like to qualify the comments regarding zinc oxide being the very best in UVA protection. This is true in so far as ingredients widely being used in the USA.
I have a UVA photohypersensitivity condition and for a long time I believed zinc oxide was the best way to block the handful effects of UVA — unfortunately it did help but not sufficiently to prevent reactions in me. I get reactions from even moderate exposure (for example through glass, fabric)
From my extensive reading (read: obsession, too much time indoors) I can now surmise that some of the new generation ingredients available to Canadian and European consumers such as Mexoryl and Tinosorb which have very good if not superior UVA blocking properties. Unfortunately of these only Mexoryl SX is approved for use in the USA and is not widely used.
One can see from looking at this paper showing the absorption spectra of z-cote (one of the more commonly found micronized zinc oxides) that the protection falls off sharply in the long wave UVA range, giving some protection throughout the spectrum but not proportionately not very much in the wavelengths approaching 400 nanometers. This is typically the hardest part of the spectrum to protect against.
http://www.ifcinternational.net/INGLES/MAT_CIENTIFICO/ARTICULOS/17.pdf
From my own experience I have loved zinc oxide for it’s soothing properties on irritated skin, its stability, and its gentleness. I did find, however, that when comparing sunscreens split face to prevent UVA reactions I had hands down greater success with a stable sunscreen formulated with lots of Mexoryl XL — much to my surprise! It was hard not to notice what a difference it made, as the reactions I get can be pretty dramatic.
For this reason, I hope that users with UVA concerns in the USA will have access to these newer filters soon. I continue to be a fan of zinc oxide but I am personally convinced that it does not work well enough for my needs — at least not when compared with worldwide options.
You have given this a lot of careful thought and you are absolutely right in noting how complex sunscreen sun protection is. Mexoryl SX is an excellent sunscreen and it will be wonderful when we have it in the US as a non-mineral sunscreen alternative. It is a chemical sunscreen and as I’ve mentioned before this means it enters the skin and neutralizes UV with a chemical reaction that generates heat. I much prefer mineral particles laying on the surface of the skin bouncing rays off. Also, the zinc does actually provide protection through to 400nm but as the graph demonstrates that protection starts to drop off towards the end. It does give the most complete and reliable protection available though and remember, no sunscreen gives perfect protection. That’s why we recommend sun protective clothing, hats and shade as your primary protection. Also, the article you included is over 11 years old and formulation has gotten even better since then. The actual formulation of a given product is key though and that’s why I recommend only buying products that are well formulated and have proven themselves to work. I have such extensive experience with Solbar Zinc, Citrix and Glycolix Elite Sunscreen that I trust them 100%. It’s why I don’t add other products to my site based on ingredient listing. Lastly, remember that application of a sunscreen product also determines functionality. Phew, it’s complex! I’m glad you found a system that works for your skin. Thanks for a thoughtful comment.