Sunburn

What is sunburn?

Sunburn is red, painful, damaged skin from being out in the sun for too long. When you get a sunburn, ultraviolet (UV) rays from the sun (or a tanning bed!) burn your skin. You don’t have to spend the day at the beach or pool to get a sunburn. Some people get sunburns doing everyday things without using sunscreen, like taking a lunch break outside, gardening or walking the dog.

Multiple sunburns can lead to premature skin aging and skin cancer. You can minimize your risk of sunburn by taking steps to protect your skin every day. It’s important to pay attention to your sun exposure when you spend any amount of time outdoors.

What are the types of sunburn?

Healthcare providers group sunburns by the severity of skin damage. The two most common types of sunburn are:

• First-degree sunburn: Damage to your skin’s outer layer. This usually heals on its own in a few days to a week.
• Second-degree sunburn: Damage to the middle section of your skin (dermis). You’ll develop blisters on the sunburned skin. Your skin may take weeks to heal and you may need medical treatment.

A third-degree sunburn is very rare and requires emergency treatment. It severely damages all layers of your skin, including the fat layer beneath your skin. It can also destroy nerve endings. Most third-degree burns result from a chemical burn or a fire and not from sun exposure.

How common is sunburn?

Sunburns are very common, especially in young people. Between 50% and 75% of children younger than 18 have sunburns each year. More than half of adults ages 18 to 29 reported having one or more sunburns in 2015.

What are the symptoms of sunburn?

If you get a sunburn, your skin might feel like it’s on fire — a hot and burning sensation that gets worse when you touch it, even with clothing.

Symptoms of sunburn depend on how severe your burn is. Symptoms may include:

First-degree sunburn symptoms

• Redness on lighter skin. People with dark skin can get sunburns, but they can be harder to see unless they peel or blister.
• Skin feels hot or tight.
• Pain or tenderness.
• Swelling.
• Peeling skin (after several days).

You may also experience:

• Fatigue.
• Fever.
• Headache.
• Nausea.

Second-degree sunburn symptoms

• Extremely red skin.
• Blisters
• Swelling over a larger area.
• Wet-looking skin.
• Pain.
• White discoloration within the burn.

You may also experience symptoms of heat illness, including:

• Confusion.
• Dizziness.
• Exhaustion.
• Fast breathing.
• Fever.
• Headache.
• Muscle cramps.
• Nausea.
• Shivers.

Third-degree sunburn symptoms

• Leathery-looking burn.
• Numb skin.
• White or dull skin color.
• All the above heat illness symptoms including shock and/or heat stroke.

What does a bad sunburn look like?

No sunburn is good. But a bad sunburn looks very red and inflamed. You may develop blisters and your skin will likely peel.

What are the three stages of sunburn?

While others may notice your skin turning pink in the sun, unless you’re looking in a mirror, you probably won’t notice sunburn until the pain starts. Your sunburn will go through three stages:

1. Pain from sunburn usually starts within a few hours of your burn.
2. Your skin will get redder and more irritated, with pain peaking at about 24 hours after your burn. If you have a second-degree sunburn, you’ll start to blister.
3. Over the next week or so, your skin may peel and should gradually return to its normal shade. If you have a severe sunburn, this may take a few weeks.

What causes sunburn?

Sunburn is caused by ultraviolet rays. There are two types of UV rays: UVA and UVB. Both types of rays can burn your skin.

Anyone can get a sunburn. But your chance of getting a sunburn increases depending on:

• The amount of time you spend in the sun.
• Certain medications, including antibiotics like doxycycline and Bactrim™, nonsteroidal anti-inflammatory drugs (NSAIDs), retinoids and heart medications (like diuretics).
• Intensity of UV rays. This is affected by the time of day, cloud coverage, altitude and closeness to the equator.
• Ozone depletion, depending on where you are in the world.
• Skin type and color.
• Use of tanning beds without sunscreen.

How is a sunburn diagnosed?

Your healthcare provider can evaluate the seriousness of your sunburn. They look at the amount of skin that’s burned, the severity of your sunburn and your symptoms. Then they can recommend the appropriate treatment.

How is sunburn treated?

You can treat most first- and second-degree sunburns by yourself at home. Steps you can take include:

• Covering your sunburned skin while it heals, especially when outside. Cool, damp cloths may help you feel better.
• Using topical cooling and hydrating gels and creams like hydrocortisone cream or aloe vera gel.
• Once you’ve cooled the skin and stopped ongoing damage, ointments — including antibiotic ointment — or petroleum jelly will keep the skin moisturized and help it heal without scarring.
• Drinking water to avoid dehydration.
• Taking a cool bath or shower. Try a bath with oatmeal or baking soda to soothe sore skin.
• Taking NSAIDs for pain relief.
• Leaving blisters alone until they heal — don’t pop them. If they become extremely large, see your provider for help. And don’t peel skin — let it come off on its own.

If you have severe blistering or dehydration, your provider may give you rehydrating fluids.

If you have a third-degree sunburn, you may need a skin graft. A surgeon removes dead skin and transfers healthy skin from elsewhere on your body. These burns take weeks or longer to heal and can have severe complications.

Are there other factors that put me at higher risk?

You’re at a higher risk of sunburn if you:

• Have light skin, freckles, blue eyes, or red or blonde hair.
• Live or spend time at high altitudes or closer to the equator.
• Play sports or swim outdoors frequently.
• Spend a lot of time on the water doing activities like boating, fishing or paddleboarding.
• Tan regularly.
• Work outdoors.
• Use tanning beds.

How can I reduce my risk of sunburn?

You can prevent sunburn and lessen your risk of sun damage. Steps you can take include:

• Applying broad spectrum sunscreen every day to protect against both UVA and UVB rays. Reapply every 90 minutes when outdoors and more often after swimming and sweating.
• Avoiding suntanning and tanning beds.
• Being aware of your sun exposure when taking medications that increase your skin’s sensitivity.
• Limiting your sun exposure between 10 a.m. and 4 p.m., when UV rays are strongest.
• Seeing a dermatologist for annual skin cancer checks.
• Using sunglasses that filter UV rays.
• Wearing a hat when outside if you’re bald.
• Wearing protective clothing such as long-sleeved shirts, long pants and wide-brimmed hats.

How long does sunburn last?

The good news is that the pain of sunburn doesn’t last long. Sunburns often go away on their own within a few days to a week. More severe sunburns take longer to heal. The bad news? The damage to the DNA in your skin cells is permanent. Each sunburn adds to your risk of developing skin cancer.

Are there long-term effects from sunburn?

Frequent sunburns increase your risk of sun damage. Repeated exposure to harmful UV rays can cause:

• Premature skin aging, including discolored age spots, freckles, red veins, wrinkles and sagging.
• Scaly, rough patches that may become skin cancer (precancerous skin lesions).
• Eye damage, which can lead to cataracts.
• Skin cancer, especially on areas most exposed to the sun, such as your arms, back, ears, face and legs. Skin cancers can range from pink scaly spots, to local sores that don’t heal, to multi-colored lesions that can spread to internal organs.

When should I see my healthcare provider?

See your provider if you have any concerns about your sunburn or how it’s healing. Seek medical treatment immediately if you have:

• Blisters over more than 20% of your body (such as a whole leg, your entire back or both arms) or severe swelling.
• Chills.
• Extreme pain.
• A fever of more than 102 degrees Fahrenheit (39 degree Celsius).
• Signs of dehydration, including dizziness, dry mouth, fatigue, thirst and reduced urination.
• Signs of infection, including pus seeping from blisters.
• Sunburn in a baby younger than 1 year old.

How does a sunburn lead to skin cancer?

When your skin becomes sunburned, your skin’s blood vessels dilate, which leads to redness, inflammation and swelling. Your body sends immune cells to repair the damage. Some skin cells can be repaired and some die off. Others may have DNA mutations that can’t be fixed. These effects age your skin and can lead to skin cancer.