Sunburn | |
---|---|
A sunburnt neck | |
Specialty | Dermatology |
Complications | Skin cancer |
Risk factors | Working outdoors, skin unprotected by clothes or sunscreen, skin type, age |
Prevention | Use of sunscreen, sun protective clothing |
Treatment | Avoiding further exposure to the sun. Cool, frequent baths or showers for pain relief. Anti-inflammatory medications such as ibuprofen or aspirin can also help with pain. Drinking water to stay hydrated. |
Sunburn is a form of radiation burn that affects living tissue, such as skin, that results from an overexposure to ultraviolet (UV) radiation, usually from the Sun. Common symptoms in humans and other animals include red or reddish skin that is hot to the touch or painful, general fatigue, and mild dizziness. Other symptoms include blistering, peeling skin, swelling, itching, and nausea. Excessive UV radiation is the leading cause of (primarily) non-malignant skin tumors, [1] [2] which in extreme cases can be life-threatening. Sunburn is an inflammatory response in the tissue triggered by direct DNA damage by UV radiation. When the cells' DNA is overly damaged by UV radiation, type I cell-death is triggered and the tissue is replaced. [3]
Sun protective measures like sunscreen and sun protective clothing are widely accepted to prevent sunburn and some types of skin cancer. [4] Special populations, including children, are especially susceptible to sunburn and protective measures should be used to prevent damage. [5]
Typically, there is initial redness, followed by varying degrees of pain, the severity of which correlates with the duration and intensity of sun exposure.[ citation needed ]
Other symptoms can include blistering, swelling (edema), itching (pruritus), peeling skin, rash, nausea, fever, chills, and fainting (syncope). Also, heat is produced from capillaries close to the skin surface, therefore the affected area feels warm to touch. Sunburns may be classified as superficial or partial-thickness burns. Blistering is a sign of second-degree sunburn. [6]
Minor sunburns typically cause nothing more than slight redness and tenderness to the affected areas. In more serious cases, blistering can occur. Extreme sunburns can be painful to the point of debilitation and may require hospital care. [7]
Sunburn can occur in less than 15 minutes in response to sun exposure and in seconds when exposed to non-shielded welding arcs or other sources of intense ultraviolet light. Nevertheless, the inflicted harm is often not immediately obvious.[ citation needed ]
After sun exposure, the skin may turn red in as little as 30 minutes, but sunburn usually takes 2 to 6 hours. Pain is usually strongest 6 to 48 hours after exposure. The burn continues to develop for 1 to 3 days, occasionally followed by peeling skin after 3 to 8 days. Some peeling and itching may continue for several weeks.[ citation needed ]
Ultraviolet radiation causes sunburns and increases the risk of three types of skin cancer: melanoma, basal-cell carcinoma and squamous-cell carcinoma. [1] [2] [8] Of greatest concern is that the melanoma risk increases dose-dependently proportional to the number of a person's lifetime cumulative episodes of sunburn. [9] An estimated 1/3 of melanomas in the United States and Australia could be prevented with regular sunscreen use. [10]
Sunburn is caused by UV radiation from the Sun but may also result from artificial sources, such as tanning lamps, welding arcs, or ultraviolet germicidal irradiation. It is the body's reaction to direct DNA damage from UVB light. This damage is mainly the formation of a thymine dimer. The damage is recognized by the body, which then triggers several defense mechanisms, including DNA repair to revert the damage, apoptosis and peeling to remove irreparably damaged skin cells, and increased melanin production to prevent future damage. [3]
Melanin readily absorbs UV wavelength light, acting as a photoprotectant. By preventing UV photons from disrupting chemical bonds, melanin inhibits both the direct alteration of DNA, as well as the generation of free radicals, to prevent them from indirectly damaging DNA. However, human melanocytes contain over 2,000 genomic sites that are highly sensitive to UV, and such sites can be up to 170-fold more sensitive to UV induction of cyclobutane pyrimidine dimers than the average site [11] These sensitive sites often occur at biologically significant locations near genes.
Sunburn causes an inflammation process that includes the production of prostanoids and bradykinin. These chemical compounds increase sensitivity to heat by reducing the threshold of heat receptor (TRPV1) activation from 109 °F (43 °C) to 85 °F (29 °C). [12] The pain may be caused by the overproduction of a protein called CXCL5, which activates nerve fibers. [13]
Skin type determines the ease of sunburn. People with lighter skin tones and limited capacity to develop a tan after UV radiation exposure have a greater risk of sunburn. Fitzpatrick's Skin phototypes classification describes the normal variations of skin responses to UV radiation. Persons with type I skin have the greatest capacity to sunburn, and type VI have the least capacity to burn. However, all skin types can develop sunburn. [14]
Fitzpatrick's skin phototypes:
Age also affects how skin reacts to the sun. Children younger than six and adults older than sixty are more sensitive to sunlight. [16]
Certain genetic conditions, for example, xeroderma pigmentosum, increase a person's susceptibility to sunburn and subsequent skin cancers. These conditions involve defects in DNA repair mechanisms which decrease the ability to repair DNA damaged by UV radiation. [17]
The risk of sunburn can be increased by pharmaceutical products that sensitize users to UV radiation. Certain antibiotics, oral contraceptives, antidepressants, acne medications, and tranquillizers have this effect. [18]
The UV Index indicates the risk of sunburn at a given time and location. Contributing factors include: [16]
Because of variations in the intensity of UV radiation passing through the atmosphere, the risk of sunburn increases with proximity to the tropic latitudes, located between 23.5° north and south latitude. All else being equal (e.g., cloud cover, ozone layer, terrain, etc.), each location within the tropic or polar regions receives approximately the same amount of UV radiation over a year. In the temperate zones between 23.5° and 66.5°, UV radiation varies substantially by latitude and season. The higher the latitude, the lower the intensity of the UV rays. Sun intensity in the northern hemisphere is greatest during May, June and July—and in the southern hemisphere, November, December and January. On a minute-by-minute basis, the amount of UV radiation depends on the Sun's angle. Ultraviolet radiation is easily determined by the height ratio of any object to the size of its shadow. Height is measured parallel to the Earth's gravitational field and the projected shadow is measured on a flat, level surface. For objects wider than skulls or poles, the height and length are best measured relative to the same occluding edge. The most significant risk is at solar noon when shadows are at their minimum, and the Sun's radiation passes most directly through the atmosphere. Regardless of one's latitude (assuming no other variables), equal shadow lengths mean equal amounts of UV radiation.[ citation needed ]
The skin and eyes are most sensitive to damage by UV at 265–275 nm wavelength, which is in the lower UVC band that is rarely encountered except from artificial sources like welding arcs. Longer wavelengths of UV radiation cause most sunburn because those wavelengths are more prevalent in ground-level sunlight.[ citation needed ]
In recent decades, the incidence and severity of sunburn have increased worldwide, partly because of chemical damage to the atmosphere's ozone layer. Between the 1970s and the 2000s, average stratospheric ozone decreased by approximately 4%, contributing an approximate 4% increase to the average UV intensity at the Earth's surface. Ozone depletion and the seasonal "ozone hole" have led to much larger changes in some locations, especially in the southern hemisphere. [22]
Suntans, which naturally develop in some individuals as a protective mechanism against the sun, are viewed by most in the Western world as desirable. [23] Tanning has led to an increased exposure to UV radiation from both the natural sun and tanning lamps. Suntans can provide a modest sun protection factor (SPF) of 3, meaning that tanned skin would tolerate up to three times the UV exposure as pale skin. [24]
Sunburns associated with indoor tanning can be severe. [25]
The World Health Organization, American Academy of Dermatology, and the Skin Cancer Foundation have recommended avoiding artificial UV sources such as tanning beds. Suntans are not recommended as a form of sun protection. [26] [27] [28]
The differential diagnosis of sunburn includes other skin pathology induced by UV radiation, including photoallergic reactions, phototoxic reactions to topical or systemic medications, and other dermatologic disorders that are aggravated by exposure to sunlight. Considerations for diagnosis include duration and intensity of UV exposure, topical or systemic medication use, history of dermatologic disease, and nutritional status.
Additionally, since sunburn is a type of radiation burn, [30] [31] it can initially hide a severe exposure to radioactivity. Excess radiation exposure may result in acute radiation syndrome or other radiation-induced illnesses, especially in sunny conditions. For instance, the difference between the erythema caused by sunburn and other radiation burns is not immediately obvious. Symptoms common to heat illness and the prodromic stage of acute radiation syndrome like nausea, vomiting, fever, weakness/fatigue, dizziness or seizure can add to further diagnostic confusion. [32]
The most effective way to prevent sunburn is to reduce the amount of UV radiation reaching the skin. The World Health Organization, American Academy of Dermatology, and Skin Cancer Foundation recommend the following measures to prevent excessive UV exposure and skin cancer: [33] [34] [35]
The strength of sunlight is published in many locations as a UV Index. Sunlight is generally strongest when the Sun is close to the highest point in the sky. Due to time zones and daylight saving time, this is not necessarily at 12 pm, but often one to two hours later. Seeking shade using umbrellas and canopies can reduce UV exposure, but does not block all UV rays. The WHO recommends following the shadow rule: "Watch your shadow – Short shadow, seek shade!" [33]
Commercial preparations that block UV light are known as sunscreens or sunblocks. They have a sun protection factor (SPF) rating based on the sunblock's ability to suppress sunburn: The higher the SPF rating, the lower the amount of direct DNA damage. The stated protection factors are correct only if 2 mg of sunscreen is applied per square cm of exposed skin translates into about 28 mL (1 oz) to cover the whole body of an adult male. The recommended dose is much more than many people use in practice. [36] Sunscreens function as chemicals such as oxybenzone and dioxybenzone (organic sunscreens) or opaque materials such as zinc oxide or titanium oxide (inorganic sunscreens) that mainly absorb UV radiation. Chemical and mineral sunscreens vary in the wavelengths of UV radiation blocked. Broad-spectrum sunscreens contain filters that protect against UVA radiation as well as UVB. Although UVA radiation does not primarily cause sunburn, it contributes to skin aging and increases skin cancer risk.[ citation needed ]
Sunscreen is effective and thus recommended for preventing melanoma [37] and squamous cell carcinoma. [38] There is little evidence that it is effective in preventing basal cell carcinoma. [39] Typical use of sunscreen does not usually result in vitamin D deficiency, but extensive usage may. [40]
Research has shown that the best sunscreen protection is achieved by application 15 to 30 minutes before exposure, followed by one reapplication 15 to 30 minutes after exposure begins. Further reapplication is necessary after activities such as swimming, sweating, and rubbing. [41] Recommendations are product dependent varying from 80 minutes in water to hours based on the indications and protection shown on the label. The American Academy of Dermatology recommends the following criteria in selecting a sunscreen: [42]
The eyes are also sensitive to sun exposure at about the same UV wavelengths as skin; snow blindness is sunburn of the cornea. Wrap-around sunglasses or the use by spectacle-wearers of glasses that block UV light reduce harmful radiation. UV light has been implicated in the development of age-related macular degeneration, [43] pterygium [44] and cataracts. [45] Concentrated clusters of melanin, commonly known as freckles, are often found within the iris.
The tender skin of the eyelids can also become sunburned and can be especially irritating.[ citation needed ]
The lips can become chapped (cheilitis) by sun exposure. Sunscreen on the lips does not have a pleasant taste and might be removed by saliva. Some lip balms (ChapSticks) have SPF ratings and contain sunscreens.[ citation needed ]
The skin of the feet is often tender and protected, so sudden prolonged exposure to UV radiation can be particularly painful and damaging to the top of the foot. Protective measures include sunscreen, socks, or swimwear that covers the foot.
Dietary factors influence susceptibility to sunburn, recovery from sunburn, and risk of secondary complications. Several dietary antioxidants, including essential vitamins, are effective in protecting against sunburn and skin damage associated with ultraviolet radiation, in both human and animal studies. Supplementation with Vitamin C and Vitamin E was shown in one study to reduce the amount of sunburn after a controlled amount of UV exposure. [46] A review of scientific literature through 2007 found that beta carotene (Vitamin A) supplementation had a protective effect against sunburn. The effects of beta carotene were only evident in the long-term, with studies of supplementation for periods less than ten weeks in duration failing to show any effects. [47] There is also evidence that common foods may have some protective ability against sunburn if taken for a period before exposure. [48] [49]
Babies and children are particularly susceptible to UV damage which increases their risk of both melanoma and non-melanoma skin cancers later in life. Children should not sunburn at any age, and protective measures can reduce their future risk of skin cancer. [50]
The WHO recommends that artificial UV exposure, including tanning beds, should be avoided as no safe dose has been established. [51] Special protective clothing (for example, welding helmets/shields) should be worn when exposed to any artificial source of occupational UV. Such sources can produce UVC, an extremely carcinogenic wavelength of UV, which ordinarily is not present in normal sunlight, having been filtered out by the atmosphere.[ citation needed ]
The primary measure of treatment is avoiding further exposure to the sun. The best treatment for most sunburns is time; most sunburns heal completely within a few weeks.
The American Academy of Dermatology recommends the following for the treatment of sunburn: [52]
Non-steroidal anti-inflammatory drugs (NSAIDs; such as ibuprofen or naproxen), and aspirin may decrease redness and pain. [53] [54] Local anesthetics such as benzocaine, however, are contraindicated. [55] Schwellnus et al. state that topical steroids (such as hydrocortisone cream) do not help with sunburns, [54] although the American Academy of Dermatology says they can be used on especially sore areas. [55] While lidocaine cream (a local anesthetic) is often used as a sunburn treatment, there is little evidence for the effectiveness of such use. [56]
A home treatment that may help the discomfort is using cool and wet cloths on the sunburned areas. [54] Applying soothing lotions that contain aloe vera to sunburned areas was supported by multiple studies. [57] [58] However, others have found aloe vera to have no effect. [54] Note that aloe vera cannot protect people from new or further sunburn. [59] Another home treatment is using a moisturizer that contains soy. [55] Furthermore, sunburn draws fluid to the skin's surface and away from the rest of the body. Drinking extra water is recommended to help prevent dehydration. [55]
Ultraviolet (UV) light is electromagnetic radiation of wavelengths of 10–400 nanometers, shorter than that of visible light, but longer than X-rays. UV radiation is present in sunlight, and constitutes about 10% of the total electromagnetic radiation output from the Sun. It is also produced by electric arcs, Cherenkov radiation, and specialized lights, such as mercury-vapor lamps, tanning lamps, and black lights.
Skin cancers are cancers that arise from the skin. They are due to the development of abnormal cells that have the ability to invade or spread to other parts of the body. It occurs when skin cells grow uncontrollably, forming malignant tumors. The primary cause of skin cancer is prolonged exposure to ultraviolet (UV) radiation from the sun or tanning devices. Skin cancer is the most commonly diagnosed form of cancer in humans. There are three main types of skin cancers: basal-cell skin cancer (BCC), squamous-cell skin cancer (SCC) and melanoma. The first two, along with a number of less common skin cancers, are known as nonmelanoma skin cancer (NMSC). Basal-cell cancer grows slowly and can damage the tissue around it but is unlikely to spread to distant areas or result in death. It often appears as a painless raised area of skin that may be shiny with small blood vessels running over it or may present as a raised area with an ulcer. Squamous-cell skin cancer is more likely to spread. It usually presents as a hard lump with a scaly top but may also form an ulcer. Melanomas are the most aggressive. Signs include a mole that has changed in size, shape, color, has irregular edges, has more than one color, is itchy or bleeds.
Sunscreen, also known as sunblock, sun lotion or sun cream, is a photoprotective topical product for the skin that helps protect against sunburn and prevent skin cancer. Sunscreens come as lotions, sprays, gels, foams, sticks, powders and other topical products. Sunscreens are common supplements to clothing, particularly sunglasses, sunhats and special sun protective clothing, and other forms of photoprotection.
Sun tanning or tanning is the process whereby skin color is darkened or tanned. It is most often a result of exposure to ultraviolet (UV) radiation from sunlight or from artificial sources, such as a tanning lamp found in indoor tanning beds. People who deliberately tan their skin by exposure to the sun engage in a passive recreational activity of sun bathing. Some people use chemical products that can produce a tanning effect without exposure to ultraviolet radiation, known as sunless tanning.
Indoor tanning involves using a device that emits ultraviolet radiation to produce a cosmetic tan. Typically found in tanning salons, gyms, spas, hotels, and sporting facilities, and less often in private residences, the most common device is a horizontal tanning bed, also known as a sunbed or solarium. Vertical devices are known as tanning booths or stand-up sunbeds.
Basal-cell carcinoma (BCC), also known as basal-cell cancer, basalioma or rodent ulcer, is the most common type of skin cancer. It often appears as a painless raised area of skin, which may be shiny with small blood vessels running over it. It may also present as a raised area with ulceration. Basal-cell cancer grows slowly and can damage the tissue around it, but it is unlikely to spread to distant areas or result in death.
Melanoma is the most dangerous type of skin cancer; it develops from the melanin-producing cells known as melanocytes. It typically occurs in the skin, but may rarely occur in the mouth, intestines, or eye.
Actinic keratosis (AK), sometimes called solar keratosis or senile keratosis, is a pre-cancerous area of thick, scaly, or crusty skin. Actinic keratosis is a disorder of epidermal keratinocytes that is induced by ultraviolet (UV) light exposure.
Sunless tanning, also known as UV filled tanning, self tanning, spray tanning, or fake tanning, refers to the effect of a suntan without exposure to the Sun. Sunless tanning involves the use of oral agents (carotenids), or creams, lotions or sprays applied to the skin. Skin-applied products may be skin-reactive agents or temporary bronzers (colorants).
The ultraviolet index, or UV index, is an international standard measurement of the strength of the sunburn-producing ultraviolet (UV) radiation at a particular place and time. It is primarily used in daily and hourly forecasts aimed at the general public. The UV index is designed as an open-ended linear scale, directly proportional to the intensity of UV radiation, and adjusting for wavelength based on what causes human skin to sunburn. The purpose of the UV index is to help people effectively protect themselves from UV radiation, which has health benefits in moderation but in excess causes sunburn, skin aging, DNA damage, skin cancer, immunosuppression, and eye damage, such as cataracts.
Skin care or skincare is a range of practices that support skin integrity, enhance its appearance, and relieve skin conditions. They can include nutrition, avoidance of excessive sun exposure, and appropriate use of emollients. Practices that enhance appearance include the use of cosmetics, botulinum, exfoliation, fillers, laser resurfacing, microdermabrasion, peels, retinol therapy, and ultrasonic skin treatment. Skin care is a routine daily procedure in many settings, such as skin that is either too dry or too moist, and prevention of dermatitis and prevention of skin injuries.
Sun protective clothing is clothing specifically designed for sun protection and is produced from a fabric rated for its level of ultraviolet (UV) protection. A novel weave structure and denier may produce sun protective properties. In addition, some textiles and fabrics employed in the use of sun protective clothing may be pre-treated with UV-inhibiting ingredients during manufacture to enhance their effectiveness.
Pyrimidine dimers represent molecular lesions originating from thymine or cytosine bases within DNA, resulting from photochemical reactions. These lesions, commonly linked to direct DNA damage, are induced by ultraviolet light (UV), particularly UVC, result in the formation of covalent bonds between adjacent nitrogenous bases along the nucleotide chain near their carbon–carbon double bonds, the photo-coupled dimers are fluorescent. Such dimerization, which can also occur in double-stranded RNA (dsRNA) involving uracil or cytosine, leads to the creation of cyclobutane pyrimidine dimers (CPDs) and 6–4 photoproducts. These pre-mutagenic lesions modify the DNA helix structure, resulting in abnormal non-canonical base pairing and, consequently, adjacent thymines or cytosines in DNA will form a cyclobutane ring when joined together and cause a distortion in the DNA. This distortion prevents DNA replication and transcription mechanisms beyond the dimerization site.
UV-B lamps are lamps that emit a spectrum of ultraviolet light with wavelengths ranging from 290–320 nanometers. This spectrum is also commonly called the biological spectrum due to the human body's sensitivity to light of such a wavelength. UV-B light does not tan the skin very much, compared to the UV-A lamps that are used in tanning beds.
Tanning activators are chemicals that increase the effect of UV-radiation on the human skin.
Photoaging or photoageing is a term used for the characteristic changes to skin induced by chronic UVA and UVB exposure. Tretinoin is the best studied retinoid in the treatment of photoaging.
Exposure of skin to ultraviolet radiation from sunlight presents both positive and negative health effects. On the positive side, UV exposure enables the synthesis of vitamin D3, which is essential for bone health and potentially plays a role in inhibiting certain cancers. While vitamin D can also be obtained through dietary supplements, UV exposure offers benefits such as enhanced subdermal nitric oxide production and improved endorphin levels, which are not achievable through supplementation alone. Additionally, exposure to visible light supports melatonin synthesis, maintains circadian rhythms, and reduces the risk of seasonal affective disorder.
Solumbra is a line of sun protection clothing and patented fabric that was introduced in 1992.
The Sunscreen Innovation Act is a 2014 law that amended the Federal Food, Drug, and Cosmetic Act to establish an expedited process for the review and approval of over-the-counter (OTC) sunscreens. The US Food and Drug Administration (FDA) had not approved a new active ingredient in sunscreen since 1999, despite some sunscreens having been approved and used overseas for a decade. The new law gave the FDA one year to respond to the existing backlog of sunscreen ingredient approval requests, and then 18 months to reply to any future applications.
Skin cancer in Australia kills over 2,000 each year, with more than 750,000 diagnosed and treated. Tanning became embedded in Australian culture and proved to be a controversial issue because of its popularity among teens and solarium users, despite correlations between tanning and an increased risk of developing melanoma. Australia experienced relative success through skin cancer prevention campaigns started in the 1980s and continued to invest and promote awareness through government-funded mass media strategies. Although Australia has one of the highest national rates of skin cancer, mortality trends in melanoma stabilized.
Up to 80% of solar UV radiation can penetrate light cloud cover.
Clear skies allow virtually 100% of UV to pass through, scattered clouds transmit 89%, broken clouds transmit 73%, and overcast skies transmit 31%.
A UVB-induced tan provides minimal sun protection, equivalent to an SPF of about 3.
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