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Condition
Sunburn

Class
Skin

Description
Overexposure to the sun without adequate sun protection will result in sunburn, where the skin becomes red and tender and may even blister and peel.

While sunburn used to be regarded as a temporary inconvenience of getting a suntan, it is now widely accepted that sunburn is a serious medical complaint. Many deaths occur as a result of excessive exposure to the sun, causing the body's temperature to rise uncontrollably, through a condition known as acute heat stroke or acute sunstroke.

In addition, regular exposure to the sun damages the underlying layers of the skin, causing premature ageing of the skin, age spots (also known as lentigo or liver spots) and increasing the risk of skin cancer.

There are over 100,000 new cases of skin cancer diagnosed each year in the UK, many more cases are probably missed. Over 2,500 people die from skin cancer each year in the UK. Most of these cases of skin cancer are believed to be due to damage caused by sunlight and the use of sun beds.

The number of cases of skin cancer has trebled since the early 1980s, an increase largely attributed to the increase in outdoor leisure pursuits, sun bed use, holidays to sunny destinations, to people living longer and to people ignoring advice to protect themselves from the sun.

Causes
When skin is exposed to the sun, a brown pigment called melanin is secreted by special cells within the skin called melanocytes. The pigment is produced to stop the skin from burning, and it is the pigment's brown colour that creates a suntan. Sunburn occurs when the amount of exposure to the sun exceeds the protective ability of melanin.

Fair skinned people, those with fair hair, red hair or blue eyes have less melanin than black or brown skinned people and therefore tend to burn more quickly when exposed to the sun, and are more likely to develop skin cancer.

The rays of the sun carry two main types of ultraviolet (UV) light, called UVA and UVB. UVB rays burn the topmost layer of skin, causing sunburn and cell damage that can lead to cancerous changes. UVA rays do not burn, but penetrate deep into the layers of the skin. They cause cell damage that contributes to premature ageing of the skin and skin cancer.

UVA and UVB radiation levels vary from country to country but the nearer a country is to the equator, the stronger the UV radiation, because the sun's rays are more intense. UV radiation levels also vary during the day and from day to day. The rays are strongest between 11am and 3pm than at any other time during the day, and are stronger in the summer months when the sun is higher in the sky than they are in the winter months when the sun is lower in the sky.

Symptoms
The symptoms of sunburn are not felt immediately and do not appear immediately as they do for a burn caused by a hot object, but tend to develop a number of hours after exposure to the sun. The problem is that by the time the skin starts to appear red and become sensitive, the damage has already been done. Pain is worst between 6 hours and 48 hours after exposure to the sun. The skin becomes red, swells and the area affected looks 'puffy'. If the sunburn is severe, the skin will blister and, after about 3 to 8 days, will peel and fall off.

Skin cancer develops as the long term consequences of overexposure to the sun. There are three main types of skin cancer - malignant melanoma, basal cell cancer and squamous cell cancer.

Malignant melanoma is a cancer which usually starts in the skin, either in a mole or in normal-looking skin. It is very rare in childhood, but children and young adults who are overexposed to the sun and have severe burning or blistering are at risk of developing melanoma in later life. One blistering sunburn event in childhood doubles the risk of developing malignant melanoma later in life.

Basal cell carcinoma is a cancer of the cells at the bottom of the skin's outermost layer, the epidermis. Squamous cell carcinoma is a cancer of the epidermis. The risk of developing these types of skin cancer is directly related to the amount of sun exposure, skin pigmentation and hours in the sun.

Other long term consequences of the sun are the damaging effects of UVA radiation on the collagen in the skin. As a result, the skin loses its elasticity and becomes prematurely aged.

Sun exposure and ultraviolet damage have also been implicated in the development of cataracts in the eyes leading to blindness.

Treatment
The best option is to prevent sunburn occurring in the first place as very little can be done once the skin has been burnt. See 'Protecting yourself and family from sunburn' section below.

If someone does get sunburnt, a cold flannel, a cool bath or shower should help reduce swelling and ease the symptoms, especially if the person has been bathing in the sea as salt can irritate the skin.

Painkillers such as paracetamol and ibuprofen can also help ease the pain.

After-Sun products will help keep skin hydrated and soothe any redness. A lotion containing aloe vera or calamine is ideal, but they should not be used on broken skin.

When to see your pharmacist
Creams and lotions providing protection against the sun are available from your local pharmacy. Your pharmacist or healthcare assistant will be able to explain the SPF and star rating of the products if you are not sure.

Use sun protection products whether going on holiday for summer sun, winter skiing or following other outdoor activities. If you are purchasing the products for other members of your family, remember that the level of protection they require may differ. Allow sufficient amounts to treat everyone, remembering that most people do not usually apply enough cream or lotions.

When to see your doctor
If you develop vomiting, fever, headache and shivering after being out in the sun, you might have sunstroke. Drink plenty of fluids, try to stay cool and see your doctor. If a baby or toddler has sunburn you should also seek medical advice.

Protecting yourself and your family from sunburn
Sunburn and the long term consequences of overexposure to the sun can largely be avoided by taking some simple precautions.

Make sure everyone wears a hat, wears light clothing to cover exposed shoulders, arms and legs, and wears sunglasses with UV protection whenever playing or working outside in the summer or on winter holidays. If you are looking after children, remember that a baby's, infant's or child's skin is far more sensitive than an adult's skin and that they will not be able to stay in the sun as long as an adult.

Babies under 12 months should be kept in the shade, dressed with a sun bonnet and loose cotton clothing and covered with a high factor sun lotion or sunblock with an SPF of 50. Keep an eye on infants and children and make sure that they stay out of the sun between 11am and 3pm when the sun is at its strongest. Young children should be encouraged to play in the shade.

Buy a range of sun creams with a sun protection factor suitable for children and with a sun protection factor suitable for adults. Apply sun creams liberally to all exposed skin and reapply after swimming or paddling. Use a sun cream with a sun protection factor of 50 to cover all exposed surfaces of a baby's or child's skin.

Make sure that everyone, especially babies and children, have plenty to drink to avoid the risk of dehydration.

Do not use sun beds and strongly discourage all members of the family, in particular teenage girls and young women who think a tan is attractive, from using sun-beds.

Understanding Sun Protection
Skin needs to be protected from both UVB and UVA rays, and all sun protection products should be clearly labelled with both an SPF and star rating.

SPF stands for sun protection factor. The higher the SPF number, the better the protection from burning UVB rays. A high SPF of 50 is recommended for children at all times. For adults, a high SPF of at least 30 is recommended, particularly when first exposed to the sun, and for fair skinned people who do not tan easily. An SPF of at least 15 is recommended at all other times. Total Sunblock should be used on exposed and sensitive areas such as the nose, ears and lips.

The star rating system indicates the level of a product's protection against UVA rays in relation to its protection against UVB rays. Although sunscreens with a high SPF factor allow a person to stay in the sun for longer, it does mean that the person is exposed to more UVA rays. This means the higher the SPF, the more UVA protection is needed to achieve the same amount of stars. So an SPF 30 sunscreen with three stars will have more UVA protection than an SPF 15 sunscreen with four stars. To protect skin from ageing and wrinkling, a product with at least four stars should be used.

In all cases, the sun protection product should be applied liberally, about 30 to 40g for each application for an adult and about 20g for each application for a child. Apply about 30 minutes before going out in the sun and reapply after swimming, paddling or sweating excessively.

Useful Tips
  • Stay out of the sun between 11am and 3pm. The sun is at its most dangerous around this time of day, whatever the weather
  • Wear a wide-brimmed hat, sunglasses with UV protection and a cotton T-shirt. Beware on guided tours when it is easy to forget how long you have been in the sun, and when on or near water eg: boat trips, as the sun's rays get reflected from the water onto the skin
  • Take extra care with children. Keep babies under one year of age out of the sun completely. Toddlers and older children should wear protective clothing such as t-shirts and a hat even when swimming, and should be encouraged to play in the shade
  • Use a sunscreen with a SPF50 for babies and children all of the time. For adults, start with a high SPF product on the first days of the holiday and, if you want to do so, gradually reduce the SPF rating as the natural tan develops
  • Use a sunscreen with a SPF of at least 15 and at least a 3 star UVA rating on areas which cannot be covered. Reapply sunscreen liberally and frequently, particularly if you are swimming or sweating excessively
  • Never allow your skin to burn
  • Avoid use of sun lamps and sun beds; use fake tans instead
  • If sunburnt, take a cool shower and later cover-up with loose, cotton clothes

Further information
SunSmart, Cancer Research UK's skin cancer information and sun protection advice web pages provide useful facts and advice on preventing sunburn and enjoying the sun safely.
www.sunsmart.org.uk

Reviewed on 27 July 2011


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