Sunburn

Last reviewed: 28 Dec 2022

Last updated: 25 May 2021

Sunburn is an acute inflammatory skin condition characterised by erythema, oedema, vesiculation, and desquamation, with associated symptoms of pain and/or pruritus.

Sunburn is a major preventable risk factor for accelerated photo-ageing and most common forms of skin cancer.

The disease typically runs a self-limited course and is treated symptomatically.

Education about future sunburn prevention via sun avoidance during peak daylight hours and the use of protective clothing/sunscreen are key interventions.

Definition

Sunburn is an acute inflammatory reaction of the skin induced by over-exposure to ultraviolet (UV) radiation. Skin findings include erythema and oedema, with or without vesiculation, followed by desquamation. Symptoms include pain and/or pruritus. Acute sunburn is a self-limited condition and typically requires only supportive care. However, primary prevention is critical, as cellular damage caused by UV radiation is irreversible and may with time increase the risk of skin cancer.

History and exam

Key diagnostic factors

presence of risk factors
sun exposure
lack of sun protection
skin discomfort
pruritus
skin tenderness
sensation of warmth
erythema

More key diagnostic factors

Other diagnostic factors

chronic actinic damage
malaise, fever, chills, nausea, headache
oedema
vesicles/bullae

Other diagnostic factors

Risk factors

Fitzpatrick skin type I-III
photo-sensitising medications
intentional tanning
lack of or improper use of sunscreen
injudicious sun exposure
age under 6 months
immunosuppression
history of skin cancer

More risk factors

Diagnostic investigations

Investigations to consider

skin biopsy
photo-testing

More investigations to consider

Treatment algorithm

ACUTE

all patients

Contributors

Authors

Elena B. Hawryluk, MD, PhD

Assistant Professor

Department of Dermatology

Harvard Medical School

Boston

Disclosures

EBH is an author and reviewer for UpToDate and a consultant for Purity Brands LLC. EBH declares that her spouse receives salary and stock from Gritstone Oncology LLC.

Acknowledgements

Dr Elena B. Hawryluk would like to gratefully acknowledge Dr Aimee S. Payne and Dr Ronald M. Bernardin, previous co-contributors to this topic. ASP and RMB declare that they have no competing interests.

Peer reviewers

Chad M. Hivnor, Major, USAF, MC, FS

Chief

Outpatient & Pediatric Dermatology

59th Medical Wing/ SGOMD

Lackland Air Force Base

San Antonio

Disclosures

CMH declares that he has no competing interests.

Stephen Richardson, MD, FAAD

Clinical Assistant Professor

Florida State University College of Medicine

Tallahassee

Disclosures

SR declares that he has no competing interests.

Ravi Ubriani, MD, FAAD

Assistant Professor of Clinical Dermatology

Columbia University

New York

Disclosures

RU declares that he has no competing interests.

Peter M. Farr, MD, FRCP

Consultant Dermatologist and Professor of Clinical Photobiology

Royal Victoria Infirmary

Newcastle upon Tyne

Disclosures

PMF declares that he has no competing interests.

Differentials
- Polymorphous light eruption (PMLE)
- Photo-toxic dermatitis
- Photo-allergic dermatitis
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Sunburn

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

Investigations to consider

Treatment algorithm

all patients

Contributors

Authors

Elena B. Hawryluk, MD, PhD

Disclosures

Acknowledgements

Peer reviewers

Chad M. Hivnor, Major, USAF, MC, FS

Disclosures

Stephen Richardson, MD, FAAD

Disclosures

Ravi Ubriani, MD, FAAD

Disclosures

Peter M. Farr, MD, FRCP

Disclosures

Differentials

Patient leaflets

Log in or subscribe to access all of BMJ Best Practice

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