How to treat a sunburn?

Cynthia Bailey, MD|July 4, 2011

sunburn: Sun Protection with Beach UmbrellasThe 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:

  1. SunburnThe 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.)
  2. 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!
  3. 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.
  4. 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!

Zinc oxide sunscreens are the best!... Other people were using SPF 50s and burning.  Because mine had zinc it worked and my skin didn’t burn like theirs. Brenda W, Sebastopol CA

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

"Replenix makes an enormous difference in my skin tone- taking out the red.  The new one with the caffeine is especially good. Carolyn K, Santa Rosa

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

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