sunburn

Synonyms in the broader sense

medical: dermatitis solaris, UV erythema, see also: skin cancer
English: sunburn

definition

A sunburn is an inflammation of the skin caused by artificial or solar ( sun-derived ) UV radiation. The sunburn is manifested by redness and swelling of the affected skin. In extreme cases, sunburn can also cause blistering. Particularly vulnerable are the face, especially the nose, ears and shoulders and décolleté, as these so-called sun terraces get by their location particularly much UV radiation.

Damage to the skin due to UV radiation, in addition to the damage to the skin cells and the connective and supporting tissue, also includes damage to the genome of the affected skin areas, which can only be partially repaired by the body.

Frequent sunburn therefore increases the risk of developing skin cancer many times over. Skin aging is also accelerated, resulting in earlier and increased wrinkling and age spots.

Epidemiology / frequency distribution

According to US studies, more than a third of the local population suffer from a sunburn at least once a year. The steady increase in skin cancers due to sunburn can be traced back to frequent and unprotected sunbathing in nature and in the solarium, and will continue to increase in the following years.

Currently, around 200, 000 people in Germany are diagnosed with skin cancer every year, including around 150, 000 known as basal cell carcinoma as a result of sunburn (a form of " white skin cancer "), most of which is caused by photodamage of the skin. Malignant melanoma, which causes around 15, 000 cases a year, colloquially called " black skin cancer ", is also caused by sunburns and too frequent sunbathing and the resulting damage to the genome of the skin. While melanoma accounts for "only" 10% of annual skin cancers, it accounts for more than 90% of skin cancer deaths.

symptoms

The sun-exposed skin areas show in a sunburn four to eight hours after sunbathing a widespread redness and swelling (see: red spots on the face after exposure to sunlight), with very severe damage and blistering to skin detachment. Some people notice even during the sun a load on the skin, the skin tenses and the sun feels uncomfortable.

The peak of the sunburn is reached after 12 to 24 hours, it can last up to 48 hours.

In large burns, the development of fever is possible by the inflammation. Circulatory failure or even shock can occur in severe sunburn. This is due to the strong water retention of the inflamed tissue, which leads to a relative lack of fluid in the systemic circulation. Blood pressure drops and weakness, dizziness and even powerlessness are the result.

If you experience headache, dizziness and nausea or vomiting in addition to sunburn, it is most likely a sun-stroke. A sunstroke is an overheating of the head and thus of the brain, it can lead to serious complications. In this case and in case of extensive burns, especially in children, medical advice should be sought immediately.

After a sunburn and the decay of redness often the top layer of the skin peels off flaky.

treatment

Often, the sunburn is noticed too late, because the first symptoms often occur only three to six hours after sunbathing. Therefore, you should already take preventive measures in advance and ensure sufficient and continuous sun protection. If you have a particularly light skin type (skin type 1 or 2), you need to protect yourself from the sun and should stick to the recommended maximum length of stay at the specific time of day.

Anyone who suffers from a sunburn should immediately go out of the sun and avoid the sun for a few more days. It should be remembered that even in the shade the UV radiation reaches the skin and can further increase the sunburn. The most effective protection against further solar radiation is therefore given inside buildings. Those who go outside should cover the red spots well, preferably with light clothes and sun hats and ensure sufficient UV protection on the entire body.

In addition to the cooling is also very important for the treatment of sunburn, that you take enough liquid, because the inflammatory reaction, the skin barrier is disturbed and much fluid is lost. In addition, a balanced water balance (hydration) supports the regeneration processes of the body and gets the circulation going.

Even more important is increased drinking after a sunstroke. Dizziness, headache, nausea and fever may occur after sunbathing and you should consult a doctor urgently. The sunstroke can be associated with severe general symptoms and even be fatal.

If it comes in the context of sunburn in addition to blistering, so you should go to a doctor and leave the opening of the bladder, so this happens under sterile conditions and thus prevents the formation of an infection.
Also, consider a doctor's visit if the sunburn is severe or painful, if it occurs in children, and if it is accompanied by other symptoms such as: headache, neck stiffness, nausea, or vomiting.

Against the occurring pain you can take appropriate medication, such as ibuprofen or diclofenac, as they also have an anti-inflammatory effect. Some doctors recommend, as soon as you notice the first signs of sunburn, to take 1000mg acetylsalicylic acid (eg: 2 tablets of ASA 500mg) to immediately inhibit the inflammatory cells. As a result, the sunburn is less pronounced and in addition, acetylsalicylic acid also relieves pain. It should absolutely be noted that acetylsalicylic acid in children (especially with fever) should not be given in the rule! Likewise, it should not be taken during pregnancy.

Those who suffer more frequently from sunburn should regularly undergo a skin cancer screening, since a higher incidence significantly increases the risk of skin cancer. This is done by dermatologists, as well as family doctors with appropriate qualifications. During the screening process, the whole skin is inspected and suspicious birthmarks can be examined more closely in a magnifying glass (dermatoscope) and, if necessary, subsequently removed by minimal surgical means.

Cool the sunburn

Cooling is the most important therapy for sunburn. By cooling the overheating and inflammation is counteracted and the pain is alleviated. It is best to start cooling as soon as possible, that is, as soon as you notice the first symptoms. This can be a tightening of the skin, itching or pain in the burned area or the known redness of the skin.
Towels or sheets should be dipped in cold water and placed directly on the skin. Similarly, you can put light cotton garments in cold water and then put on, this is also possible with children. Especially lotions (après sun, after-sun lotion) are also used, as they have a strong cooling effect. There is also the possibility to use lotions containing hydrocortisone, as it also has anti-inflammatory and calms the skin. The itching is also reduced by hydrocortisone-containing lotions. Also popular are aloe vera-containing lotions, as aloe vera also has a moisturizing and anti-inflammatory effect. You can also store the lotions in the refrigerator and thus strengthen the cooling effect.
One should cool the skin continuously and change the sheets or clothes at least every hour and immerse again in the cold water. The sunburn should be cooled for one to three hours. Cooling can also lead to hypothermia, so you should cool and watch carefully, especially in children. It is also important to take plenty of fluids, preferably water, as the skin loses a lot of fluid due to burning and inflammation, as its barrier is disturbed.

Quark or yoghurt envelopes are not recommended today as they can also cause bacteria to enter the skin and cause an infection. In particular, this is discouraged when a higher degree of burns with blistering exists, because through the open areas, when the bubbles open, bacteria can penetrate even faster. In addition, quark and yogurt dry quickly on the skin and then often stick to it. This can be very unpleasant to remove or cause pain.

Never place ice directly on the affected area, as this may even cause damage to the skin or frostbite. If you want to use ice or cold-warm compresses / cool packs from the freezer, you must wrap them in a towel and avoid direct skin contact.

Sunburn itches

If the sunburn begins to itch, this may be an indication of the onset of healing. But there are other causes of itchy sunburn. See: causes of sunburn
As a rule, the itching does not occur immediately, but develops over time (after four to six hours). In no case should be scratched, as this again leads to small wounds and increases the risk of infection. Small children who can not resist the itching should get their fingernails cut very short and distracted. Home remedies that provide relief include moisturizing lotions, aloe vera lotions, and hydrocortisone ointments. Again, quark and yogurt envelopes should be avoided due to the increased risk of infection. However, cortisone ointments should be used in children (especially on the face) only in the short term or better only after medical advice.

The most common cause of itchy sunburn is the "polymorphic (multifaceted) photodermatosis, " known as the allergy to the sun, which is most often caused by the UV-A light and occurs in about one in five people. In particular, it affects fair-skinned people at first sunbath a year and is more common in women. The most common areas are the cleavage and the neck, in children often the face. In principle, all body regions can be affected. In the itchy area, red, occasionally raised nodules form, these can melt together with other nodes to a large area. As a rule, polymorphic photodermatosis returns on its own in a few days, but patients often need anti-itching medications. Another option is the use of antihistamines.

Prophylactically, patients who frequently complain of itching after sunbathing should use sunscreen with UV-A light filters. This often leads to complete freedom from complaints. Sunscreens with antioxidants (vitamin E, alpha-glucosylrutin) also have a protective effect. Optionally, a UV light habituation therapy may be considered by the physician.

Other itching-triggering factors may be allergens, such as fragrances (perfume), UV filters in sun creams, and others. Here, the itchy area is limited to the point where the allergen had skin contact. To test this, the doctor can perform a provocation test by exposing only a specific area of ​​the skin to the possible allergen and then exposing the body to UV-A (photo-patch test).
Also, various medications can cause skin irritation in sun contact, so it is advisable to read the package insert carefully and to consult the doctor or pharmacist.
If the itching does not stop, a doctor should be consulted urgently, so that the symptoms are clarified.

diagnosis

The diagnosis is made on the basis of the skin condition typical for the sunburn and the data of the patient ( anamnesis ). If there are atypical skin conditions such as pustules, wheals, papules or blisters on the skin for sunburn, a sun rash may be the cause.

forecast

The right protection prevents the painful sunburn.

Sunburn usually heals without visible damage to the skin. In case of severe burning, however, the photosensitivity of the affected area may remain, and affected skin areas may be more intense or paler than non-sunburned areas.

With late damage such as skin cancer can be faced in the worst case after a single sunburn, so it is important to avoid any sunburn.

history

About 200 years ago, paleness was considered fancy, people with tanned skin had this work outdoors, z. B. in agriculture, in the then society is not particularly highly regarded activity. Pale skin was the sign of a high and respected social class, and every effort was made to keep the skin as bright as possible. It was helped with powders and creams, long clothes, sun hats and umbrellas to the application of bleaching leaded creams. Also, the repeated bloodletting for a particularly elegant pallor was widespread.

Only since the beginning of the 20th century is tanned skin in the western world modern. The tan suggested health, youth and prosperity, who was tanned in winter, this could only reach by an expensive holiday in the south. Meanwhile, anyone can afford tanned skin, there are tanning beds almost everywhere, for little money you can approach the current beauty ideal. But this is not necessarily healthy: Since brown skin is considered beautiful, the annual new cases of skin cancer are rising continuously. This not only has to do with increased exposure to the sun and artificial UV light, but is primarily due to the negligent behavior of most people. Many are of the opinion that browning is possible only after previous sunburn, others are convinced that sunscreens with sun protection factor prevent the tanning of the skin.

These simply wrong views and the fact that the consequential damage can only be expected years to decades later, ensure a steady increase in skin cancer, which could be prevented by a better prevention.

Summary

Sunburn is a burn of the skin due to UV rays. The UV radiation causes damage to the skin's own proteins and the genetic information of the skin cells. The damage to the proteins is expressed as redness, swelling and pain, the damage to the genetic material can manifest years or decades later as skin cancer.

Sunburn should be treated by cooling in the form of cold envelopes (cryotherapy) and after-sun lotions, in case of severe burns with blistering or in case of extensive burns consult a physician.

Every sunburn can be prevented by good sun protection in the form of sunscreen cream, long clothes and headgear as well as avoidance of strong solar radiation. In particular, in infants and toddlers and in people with very light skin is to pay attention to a sufficient sun protection.


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