Last updated: October 26, 2023

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Summarytoggle arrow icon

Sunburn is an acute self-limited inflammatory skin reaction that occurs after excessive ultraviolet radiation (UVR) exposure and typically manifests as a first-degree burn. It more commonly affects individuals with light skin than those with darker skin. Most sunburns are superficial, manifesting with redness, pain, pruritus, and swelling that begins a few hours after exposure and typically resolves within 1 week. Diagnosis is based on skin examination, recent UVR exposure, and the exclusion of differential diagnoses using clinical history. Management primarily involves symptomatic treatment of pain and pruritus with topical ointments, oatmeal baths, and moisturizers (e.g., petroleum jelly). Analgesics and antihistamines may be used as needed for persistent pain and pruritus. The use of photoprotective measures should be recommended to all individuals to prevent sunburn and chronic complications of UVR exposure.

Epidemiologytoggle arrow icon

  • ∼ 1 in 3 of adolescents and adults report sunburn every year. [2][3]
  • ∼ 50% of children < 11 years of age have reportedly experienced sunburn. [4]
  • Sunburn most commonly occurs in non-Hispanic White individuals. [2][3]

Epidemiological data refers to the US, unless otherwise specified.

Etiologytoggle arrow icon

Sunburn is most commonly caused by ultraviolet B (UVB) radiation. [5][6]

Risk factors for sunburn [3]

  • Individuals who are sensitive to UV radiation, e.g. those with: [7]
    • Light skin tones [5][6]
    • History of sunburn within 1 hour of exposure to UVR
    • History of photodermatoses
  • Nonadherence to photoprotective measures
  • Use of indoor tanning beds or tanning products [3]
  • Extensive time spent outdoors for work or recreation [7]

Pathophysiologytoggle arrow icon

UV radiation → DNA mutations → apoptosis of keratinocytes in the epidermis and release of inflammatory markers (including chemokines, prostaglandins) → inflammation of the dermis hours after exposure [8]

Clinical featurestoggle arrow icon

  • The following typically manifest 4–12 hours after UVR exposure: [5][7]
    • Erythema
    • Pruritus
    • Tenderness
    • Swelling
    • Blanching
    • Warmth
  • Features of severe sunburn may also be present and include: [7][9]
  • Peak severity is usually 24–36 hours after exposure. [5]
  • Resolution typically occurs within 3–8 days; characterized by dry, hyperpigmented skin that easily peels. [4][10]

Individuals may also develop photokeratitis if the eyes are exposed to UVR. [11]

Diagnosticstoggle arrow icon

Differential diagnosestoggle arrow icon

The differential diagnoses listed here are not exhaustive.

Managementtoggle arrow icon

General principles [4][10]

Blisters should be left intact to reduce the risk of infection. [7]

Supportive therapy [4][7][10]

  • Encourage oral hydration to compensate for excessive fluid loss. [10][13]
  • For pain and pruritus [4][7]
    • Oatmeal baths
    • Moisturizers (e.g., coconut oil, petroleum jelly, lotions); can be refrigerated before use to increase relief [7]
    • Cooling ointments (e.g., aloe vera)
    • Wet gauze or a cool cloth
  • If symptoms do not improve, consider adding the following: [4]
  • Topical steroids are widely used to treat sunburn; however, there is a lack of evidence supporting their use. [15]

Do not use very cold wet dressings or ice to cool sunburn; ice causes vasoconstriction of blood vessels in the dermis, which can damage the tissue further. [4]

Avoid using moisturizers and cooling ointments on broken skin (e.g., open blisters). [10]

Complicationstoggle arrow icon

Skin conditions [6]

One sunburn during childhood doubles the risk of melanoma as an adult. [16]

Ocular conditions [11]

We list the most important complications. The selection is not exhaustive.

Preventiontoggle arrow icon

General principles

  • All individuals, regardless of age or skin tone, should combine the following photoprotective measures to reduce the risk of sunburn: [3][7][16]
    • Sun avoidance when possible
    • Protective clothing
    • Sunscreen
  • Children, especially those < 3 years of age, are at increased risk for sunburn compared to adults. [7][16][17]
  • Infants < 6 months of age may experience adverse effects from sunscreen ingredients; sun avoidance is the primary photoprotective strategy in this age group. [3][8][16]

Indoor tanning is associated with an increased risk of melanoma; individuals should be strongly counseled against it. [16][17]

Sun avoidance [4][7]

  • Avoid sun exposure from 10 am to 4 pm. [4][7]
  • Seek shade often (e.g., use umbrellas, stroller canopies).

Do not recommend sun exposure to prevent vitamin D deficiency; a healthy diet and/or oral supplements should be recommended instead. [18]

Protective clothing [3][7]

  • Wide-brimmed hat with ≥ 3-inch diameter
  • Long-sleeve shirt
  • Full-length pants
  • Sunglasses with UVR protection

UVR can penetrate wet clothing and thin fabric. [7]

Sunscreen [5][7][16]

  • A topical solution applied to the skin to protect against UVR and, in some cases, visible light
  • Protection is determined by the sun protection factor (SPF). [6]
    • SPF is a measure of the amount of UVR that causes sunburn on skin protected by sunscreen compared to unprotected skin.
    • SPF ranges from 2–100; products offering SPF 15–50 are recommended to reduce adverse risks of sun exposure. [19]

Types of sunscreen [5][20]

  • Chemical sunscreen: a type of sunscreen that contains organic UV filters that absorb UV radiation [7]
  • Mineral-based sunscreen (physical sunscreen)
    • A type of sunscreen that contains inorganic UV filters (e.g., zinc oxide, titanium dioxide) that scatter or reflect UVR
    • Can protect against both UVR and visible light [21][22]
      • Products containing zinc oxide or titanium oxide protect against UVR and visible light but have a chalky white appearance.
      • Microionized formulas have reduced visibility on the skin but do not protect against visible light. [21]
      • Tinted sunscreens use pigments such as iron oxides to match skin tones; these protect against visible light and UVR.
  • Broad-spectrum sunscreen: protects against both UVB and UVA radiation
  • Water-resistant sunscreen: provides protection for 40–80 minutes while sweating or in water [7]

Broad-spectrum sunscreens are preferred, as while UVB radiation is responsible for the majority of sunburns, UVA radiation is associated with photosensitivity reactions and premature skin aging. [7]

Mineral-based sunscreen may be preferred for individuals with sensitive skin (e.g., those with photodermatoses or contact dermatitis). [7][16]

Application of sunscreen [7]

  • Apply a thin layer of sunscreen 15–30 minutes prior to sun exposure. [16]
    • Adults and children ≥ 6 months of age [7]
      • Typically, a broad-spectrum, water-resistant sunscreen is preferred, with a minimum SPF of 15–30. [7][16]
      • Approximately 2 tablespoons of sunscreen (one shot glass) is required to effectively cover the body.
      • If lip balm and/or cosmetics are used, encourage the selection of products with SPF ≥ 30.
    • Children < 6 months of age: If sun exposure is unavoidable, use a mineral-based sunscreen with SPF ≥ 30. [7][8]
      • Limit use to sun-exposed areas (e.g., cheeks, hands).
      • Immediately wash off after sun exposure. [3][16]
  • Spray-on sunscreen should be sprayed onto the palm and then spread onto the skin to avoid inhalation. [8]
  • After the sunscreen dries, apply insect repellent, if needed. [7]
  • Reapply sunscreen every 2–3 hours or more frequently if in water (e.g., swimming, showering) or sweating.

Referencestoggle arrow icon

  1. Young AR, Claveau J, Rossi AB. Ultraviolet radiation and the skin: Photobiology and sunscreen photoprotection. J Am Acad Dermatol. 2017; 76 (3): p.S100-S109.doi: 10.1016/j.jaad.2016.09.038 . | Open in Read by QxMD
  2. Cestari T, Buster K. Photoprotection in specific populations: Children and people of color. J Am Acad Dermatol. 2017; 76 (3): p.S110-S121.doi: 10.1016/j.jaad.2016.09.039 . | Open in Read by QxMD
  3. Brunette GW, Nemhauser JB. Environmental Hazards & Other Noninfectious Health Risks. CDC Yellow Book 2020. 2019: p.125-168.doi: 10.1093/med/9780190928933.003.0003 . | Open in Read by QxMD
  4. Sun Exposure - Sunburn. Updated: May 21, 2018. Accessed: February 23, 2023.
  5. Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J. Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2). McGraw-Hill Education / Medical ; 2018
  6. Neale RE, Lucas RM, Byrne SN, et al. The effects of exposure to solar radiation on human health. Photochem Photobiol Sci. 2023.doi: 10.1007/s43630-023-00375-8 . | Open in Read by QxMD
  7. $Contributor Disclosures - Sunburn. All of the relevant financial relationships listed for the following individuals have been mitigated: Alexandra Willis (copyeditor, was previously employed by OPEN Health Communications). None of the other individuals in control of the content for this article reported relevant financial relationships with ineligible companies. For details, please review our full conflict of interest (COI) policy:.
  8. Centers for Disease Control and Prevention (CDC). Sunburn and sun protective behaviors among adults aged 18-29 years--United States, 2000-2010.. MMWR Morb Mortal Wkly Rep. 2012; 61 (18): p.317-22.
  9. Holman DM, Ding H, Guy GP, Watson M, Hartman AM, Perna FM. Prevalence of Sun Protection Use and Sunburn and Association of Demographic and Behaviorial Characteristics With Sunburn Among US Adults. JAMA Dermatol. 2018; 154 (5): p.561.doi: 10.1001/jamadermatol.2018.0028 . | Open in Read by QxMD
  10. Lanham JS, Nelson NK, Hendren B, Jordan TS. Outpatient Burn Care: Prevention and Treatment.. Am Fam Physician. 2020; 101 (8): p.463-470.
  11. Dowd MD. Treatment and Prevention of Pediatric Sunburn. Pediatr Ann. 2019; 48 (6).doi: 10.3928/19382359-20190520-02 . | Open in Read by QxMD
  12. Han A, Maibach HI. Management of Acute Sunburn. Am J Clin Dermatol. 2004; 5 (1): p.39-47.doi: 10.2165/00128071-200405010-00006 . | Open in Read by QxMD
  13. Grossman DC, Curry SJ, et al. Behavioral Counseling to Prevent Skin Cancer. JAMA. 2018; 319 (11): p.1134.doi: 10.1001/jama.2018.1623 . | Open in Read by QxMD
  14. Matsui MS. Vitamin D Update. Curr Dermatol Rep. 2020; 9 (4): p.323-330.doi: 10.1007/s13671-020-00315-0 . | Open in Read by QxMD
  15. Latha MS, Martis J, Shobha V, et al. Sunscreening agents: a review. J Clin Aesthet Dermatol. 2013; 6 (1): p.16-26.
  16. Heurung AR, Raju SI, Warshaw EM. Adverse Reactions to Sunscreen Agents. Dermatitis. 2014; 25 (6): p.289-326.doi: 10.1097/der.0000000000000079 . | Open in Read by QxMD
  17. Geisler AN, Austin E, Nguyen J, Hamzavi I, Jagdeo J, Lim HW. Visible light. Part II: Photoprotection against visible and ultraviolet light. J Am Acad Dermatol. 2021; 84 (5): p.1233-1244.doi: 10.1016/j.jaad.2020.11.074 . | Open in Read by QxMD
  18. Lyons AB, Trullas C, Kohli I, Hamzavi IH, Lim HW. Photoprotection beyond ultraviolet radiation: A review of tinted sunscreens. J Am Acad Dermatol. 2021; 84 (5): p.1393-1397.doi: 10.1016/j.jaad.2020.04.079 . | Open in Read by QxMD
  19. Guan LL, Lim HW, Mohammad TF. Recognizing photoallergy, phototoxicity, and immune-mediated photodermatoses. J Allergy Clin Immunol. 2022; 149 (4): p.1206-1209.doi: 10.1016/j.jaci.2022.02.013 . | Open in Read by QxMD
  20. Palmieri TL, Greenhalgh DG. Topical Treatment of Pediatric Patients with Burns. Am J Clin Dermatol. 2002; 3 (8): p.529-534.doi: 10.2165/00128071-200203080-00003 . | Open in Read by QxMD
  21. Gulin SJ, Chiriac A. Diclofenac-Induced Allergic Contact Dermatitis: A Series of Four Patients. Drug Saf Case Rep. 2016; 3 (1).doi: 10.1007/s40800-016-0039-3 . | Open in Read by QxMD
  22. Faurschou A, Wulf HC. Topical corticosteroids in the treatment of acute sunburn: a randomized, double-blind clinical trial. Arch Dermatol. 2008; 144 (5): p.620-624.doi: 10.1001/archderm.144.5.620 . | Open in Read by QxMD

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