11.02 Sunburn

agk’s Library of Common Simple Emergencies

Presentation: Patients generally seek help only if their sunburn is severe. There will be a history of extended exposure to sunlight or to an artificial source of ultraviolet radiation, such as a sunlamp. The burns will be accompanied by intense pain and the patient will not be able to tolerate anything touching the skin. There may be systemic complaints that include nausea, chills, and fever. The affected areas are erythematous and are accompanied by mild edema. The more severe the burn, the earlier it will appear and the more likely it will progress to edema and blistering.

What to do:

• Inquire as to whether or not the patient is using a photosensitizing drug (e.g., tetracyclines, thiazides, sulfonamides, phenothiazines) and have the patient discontinue its use.
• Have the patient apply cool compresses of water or Burow’s solution (Domeboro Powder Packets-- 1 pkt in 1 pint of water) as often as desired to relieve pain. This is the most comforting therapy.
• The patient may be helped by applying a topical steroid spray such as dexamethasone (Decaspray) and using an emollient such as Lubriderm.
• With a more severe burn prescribe a short course of systemic steroids (40-60mg of Prednisone qd x 3d). This will reduce inflammation, swelling, pain, and itching.

What not to do:

• Do not allow the patient to use OTC sunburn medications that contain local anesthetics (benzocaine, dibucaine or lidocaine). They are usually ineffective or only provide very transient relief. In addition there is the potential hazard of sensitizing the patient to these ingredients.
• Do not trouble the patient with unnecessary burn dressings. These wounds have a very low probability of becoming infected. Treatment should be directed at making the patient as comfortable as possible.

Discussion

With sunburn, the onset of symptoms is usually delayed for 2-4 hours. Maximum discomfort usually occurs after 14-20 hours, and symptoms last between 24 and 72 hours. Patients should be instructed on the future use of sunscreens containing para-aminobenzoic acid (PABA) (e.g., Pabanol and PreSun). Prophylactic use of aspirin prior to sun exposure has also been recommended.

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