Sunburn and Sun Damage
by Cecilia Mullen, R.N.C., N.P.
July 6, 1999
Those hazy, lazy, crazy days of summer are here! In New England, we look forward to a few months of warm sunny weather. We can go to beautiful white sandy beaches or attend barbecues and concerts or just spend time enjoying the beautiful outdoors. This sudden exposure to sunlight puts us at risk for sun related problems. Certain skin types are at increased for damage. Skin phototypes I and II are most sensitive. In response to short sun exposures these include Caucasian people who can burn or obtain a light tan. Skin phototypes III and IV may get a mild sunburn but eventually obtain a dark tan.
Sunburn is an acute, delayed, inflammatory response to ultraviolet radiation (UVR) from sunlight. It is characterized by redness and can be accompanied by blisters, swelling, pain, and itch. In normal sunburns there is never a rash. A rash results from abnormal reactions to UVR.
UVR is divided into UVA and UVB types. UVB sunburns are expected with about a 20 minute exposure in New England in noon day summer sun and develops within 12-24 hours of exposure and lasts 72-120 hours. UVA sunburns are expected with about 120 minute exposure under similar conditions, develops in 4-16 hours and fades within 48-120 hours.
Sunburn is most frequently seen in individuals who have a limited ability to develop tanning in response to UVR. Increased melanin pigment functions as a filter that reduces the skin's inflammatory response. Melanin is present in the skin as a result of heredity and following exposure. Those persons who inherit skin types I and II are most susceptible to damage after prolonged exposure. Certain drugs such as sulfur drugs, Tetracycline, Furosemide, antibiotics, and Aleve can cause an exaggerated response to the sun and extra precautions should be taken.
A history of blistering sunburns in youth is a risk factor for developing melanoma 20-30 years later. Repeated sunburns results in "photoaging" or premature wrinkling of the skin and skin lesions. A total loss of pigment in certain areas can result from sunburn as a result of melanin destruction. This appears as white patches in the skin following tanning.
Prevent sunburns with sunscreens SPF 15 or greater that filters damaging UVB rays and avoid sun two hours before and after noon. If you develop a sunburn, use cool compresses to the areas and topical corticosteroid creams - available over-the-counter. An anti-inflammatory such as Ibuprofen may be taken.
Photoaging occurs as a result of repeated or prolonged exposure of the skin to UVR. The severity depends principally on the duration and intensity of sun exposure. Those persons with skin type I and II are most susceptible and comprise about 25% of the white population in the United States.
Photoaging is seen primarily in those persons over 40 years. A history of intense sun exposure as a child or young adult can result in premature aging of the skin. This occurs even if exposure is limited in later years. It is advisable throughout your lifetime to limit sun exposure. Certain occupations are more at risk for photoaging and skin cancer. These include farmers, telephone linemen, construction workers, sea workers, lifeguards, swimming instructors, sports persons, and "beach bums."
Photoaging appears as wrinkled, "wizened," leathery skin. The skin appears "prematurely aged," as a person looks older than they really are. Young adults should be aware that tanning now will result in wrinkles and "age spots" later. Prevention is key. Sunscreens with UVB protection are essential. For prolonged exposure, covering with tight weave clothing is also recommended. The color of the clothing is not important. Once photoaging has occurred, certain lotions such as retin A have been used to lessen the changes. These are primarily available through your physician.
The warmth and sun of the summer months are not entirely detrimental to our health. We receive vitamin D for strong healthy bones through sunlight. The incidence of depression is decreased and individuals tend to engage in more physical activity in warmer months. But "trust me on the sunscreen."
Cecilia Mullen is a nurse practitioner at Granite Medical Group. The information in this column is not intended to diagnose individual conditions. Readers should see their own doctors about specific problems.