IJRPC 2014, 4(2), 342-345 Roshini et al.

ISSN: 22312781

INTERNATIONAL JOURNAL OF RESEARCH IN PHARMACY AND CHEMISTRY

Available online at www.ijrpc.com Review Article

EVALUATION AND MANAGEMENT OF SUNBURN

Roshni PR*,Remya Reghu, Meenu Vijayan and Parvati Krishnan

Department of Pharmacy Practice, Amrita School of Pharmacy, Amrita Vishwavidyapeetham

University, Kochi, Kerala, India.

INTRODUCTION reaction of the body to the direct DNA damage,

A sunburn is a form of radiation burn that affects which can result from the excitation of DNA by
living tissue, such as skin, that results from an UV-B light. This damage is mainly the formation
overexposure to ultraviolet (UV) radiation, of a thymine dimer. The damage is recognized
commonly from the sun. Usually, normal by the body, which then triggers several defense
symptoms in humans and other animals consist mechanisms, including DNA repair to revert the
of red or reddish skin that is hot to the touch, damage and increased melanin production to
general fatigue, and mild dizziness. An excess prevent future damage. Melanin readily absorbs
of UV radiation can be life-threatening in UV wavelength light, acting as
extreme cases. Exposure of the skin to lesser a photoprotectant. By preventing the disruption
amounts of UV radiation will often produce of bonds that higher energy photons can
a suntan. Sunburn inflammation has been used produce, it inhibits both direct alteration of DNA,
as end point for many photobiologic studies of and generation of free radicals, thus indirect
skin. The patient’s minimal erythema dose DNA damage.
(MED), defined as the minimal dose in
producing just-perceptible erythema determined CLASSIFICATION OF BURNS
24 hoursafter irradiation, is an example. Burn depth and size are important factors in
Sunburn is a major problem which can cause determining whether a burn can be classified as
lost workdays and lead to disciplinary action. minor, and are crucial in dictating the initial steps
The assessment of acute effect of epidermis of burn assessment and management2
after UVB exposure is rarely analyzed by .Superficial burns can often be managed on an
noninvasive quantitative means. The traditional outpatient basis, whereas full-thickness burns
visual MED reading lacks accuracy, must be evaluated by a specialist for possible
reproducibility, and quantification.2 excision and grafting. Determination of burn
depth can be complicated by the conversion of
SYMPTOMS burns to a higher burn category within the first
Major symptom is shown by initial redness several days. Conversion occurs when the
(erythema), followed by varying degrees of pain, damaged skin continues to spread and burn
proportional in severity to both the duration and depth increases because of thermal injury that
intensity of exposure.Other symptoms did not fully present on initial assessment;
includes edema, itching, peeling therefore, frequent evaluation and reassessment
1
skin, rash, nausea, fever, chills, and syncope. are necessary for all categories of burns.
Also, a small amount of heat is given off from
the burn, caused by the concentration of blood SUPERFICIAL (FIRST-DEGREE) BURNS
in the healing process, giving a warm feeling to First-degree burns involve only the epidermis;
the affected area. like a sunburn, they are erythematous, painful,
and dry. They are most often the result of severe
CAUSE ultraviolet exposure or minor thermal injury.
Sunburn is caused by UV radiation, either from First-degree burns usually heal in five to 10
the sun or from artificial sources, such as days.1
welding arcs, the lamps used in sunbeds,
and ultraviolet germicidal irradiation. It is a

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SUPERFICIAL PARTIAL-THICKNESS in the US), Nonsteroidal anti-inflammatory

(SUPERFICIAL SECOND-DEGREE) BURNS drugs(such as Ibuprofen or Naproxen),
Second-degree burns involve all of the and Aspirin have all shown to reduce the pain of
epidermis and part of the underlying dermis. sunburns.1,8-11
Superficial partial-thickness burns damage the Home treatment-Use of cool clothes on
upper layers of the papillary dermis; they are sunburned areas.Taking frequent cool showers
identified by clear blisters and weeping, wet, ery- or baths.Applying soothing lotions especially
thematous skin, and they blanch painfully when those containing aloe vera to the body shows
touched. These burns heal within two weeks and effect.A sunburn can cause a mild fever and
generally do not cause scarring; however, a headache. Lie down in a cool, quiet room to
scarring and pigment changes are possible.1 relieve the headache. A headache may be
caused by dehydration, so drinking fluids may
DEEP PARTIAL-THICKNESS (DEEP help. For more information, see the
SECOND-DEGREE) BURNS topic Dehydration. Home treatment may help
Deep second-degree burns involve the deeper decrease pain, prevent infection, and help the
layers of the dermis (i.e., reticular dermis). They skin heal.Small,unbroken blisters,[less than 1 in.
appear white and do not blanch .These burns do (2.5 cm) across] usually heal on their own.1,4-7
not heal in less than three weeks and often Sunscreen lotion - Sunscreen is a lotion, spray,
result in scarring and contractures.1 gel or other topical product that absorbs or
reflects some of the sun's ultraviolet (UV)
FULL-THICKNESS (THIRD-DEGREE) BURNS radiation on the skin exposed to sunlightand
Third-degree burns destroy all skin layers, thus helps protect against sunburn. Skin-
including underlying subcutaneous fat. They are lightening products have sunscreen to protect
dark brown or tan and have a leathery feel with lightened skin because light skin is more
no sensitivity to touch. These wounds often susceptible to sun damage than darker skin.
require skin grafts, and can result in Different sunscreens were tested to determine
contractures.1 their protection of epidermis from ultraviolet light
effects. Ultraviolet light-induced changes in
MANAGEMENT hairless mouse epidermal DNA synthesis were
More than 95 percent of burn wounds can be used for measurement of sunscreen protection.
successfully managed in the outpatient Visual assessment of erythema and edema was
setting.16 excellent results can be achieved by also performed. This initial study has evaluated
primary care physicians with knowledge of basic sunscreens containing para-aminobenzoic acid
concepts of burn care. Close monitoring and (PABA) as the principal sunscreen chemical.
follow-up are important aspects of outpatient These experiments were conducted using
management because of the dynamic and fluorescent sunlamp tubes and hydroxylapatite
fragile progression of burn injuries.16 Goals of extraction of epidermal DNA. The ultraviolet light
burn management include rapid healing, pain exposure was measured using a recording
control, return of full function to the injured area, radiometer. The results showed that the
1,5-8
and good aesthetic results. sunscreens tested were able to partially prevent
The most important aspects of sunburn care are ultraviolet light induced changes in epidermal
to avoid exposure to the sun while healing and DNA synthesis. It may be possible to use this
to take precautions to prevent future burns. The assay as one of the initial evaluations of
best treatment for most sunburns is time. Most potential ultraviolet light protectants.3,4
sunburns heal completely within a few weeks.
Home treatments that help manage the 8 major treatment methods for sunburn or
discomfort or facilitate the healing process prevention of sunburn
include using cool and wet clothes on the Take an over-the-counter pain reliever.
sunburned areas, taking frequent cold showers Ibuprofen and aspirin are popular options. These
or baths, and applying soothing lotions that can help reduce the inflammation around your
contain aloe vera to the sunburn areas. Topical sunburn, as well as lessen the pain.
steroids (such as 1%hydrocortisone cream) may Use an anti-inflammatory paste. Suitable topical
also help with sunburn pain and swelling. The applications include aloe vera, cortisone cream,
peeling that comes after some sunburn is or other soothing agent specified as suitable for
inevitable. However, there are lotions that may irritated and sunburned skin (see section below).
relieve the itching. Paracetamol (acetaminophen If you don't have any of these, you can make

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ananti-inflammatory paste out of aspirin. Simply your sunburn. You can find low-dose, over-the-
crush up a few pills into a powder that's as fine counter tubes at your local drug store or
as you can manage, then add water, a few supermarket. Look for hydrocortisone or
drops at a time, until it turns into a goopy paste. something similar. Do not use cortisone cream
Apply to the affected areas. on young children. Ask your pharmacist for
advice if you have any doubts or concerns about
COOLING RELIEF using this cream.
 Have a cool bath or a very gentle
shower. Bath: Set the water to a cool KEEPING HYDRATED
temperature that's just below lukewarm Drink plenty of water. Sunburn can be
(that is, not teeth-chattering cold), and dehydrating, so it's important to counterbalance
relax for 10 to 20 minutes. The this by drinking a lot of water while you recover.
temperature will ease the pain, and the Aim for 8 glasses containing 8 ounces/236ml of
water will stop your skin from becoming water each day (or even a little bit more).
as irritated. Repeat as often as you
need to. PROTECTING SUNBURNED SKIN
 Shower: Again, keep the temperature Protect sunburned skin if you're going outside.
just below lukewarm and also use a very Ideally, you should hang out in the shade or
gentle flow or just a sprinkling of water. wear clothing over affected areas if you're going
If it thunders out, your skin will hurt. back out into the sunshine. If you can't avoid
 Avoid using soap, bath oils, or other exposing your skin, though, apply a thin layer of
detergents as you bathe or shower. Any aloe vera on the burn, then put SPF 45
such products will irritate your skin and sunscreen on top to prevent further damage.
possibly make the effects of the sunburn Apply unscented moisturizer to your skin as it
feel even worse. starts to heal over. When you no longer have
 If you have blisters forming on your skin, open blisters, or the redness of the sunburn has
take a bath instead of showering. The subsided a bit, treat your damaged skin to some
pressure from the shower might pop TLC. Liberally apply a creamy, unscented
your blisters. moisturizer to sunburned areas over the next
 When you get out, don't rub your skin few days or weeks to prevent peeling and
dry with a towel. Instead, let yourself air irritation.
dry, or pat the towel over your skin in
small, gentle movements. BLISTER TREATMENT
Apply cold compressions to your skin. If you're Treat blisters. If your sunburn is serious, you
not in a situation where you can bathe, or you'd might notice blisters beginning to form. Here's
just prefer not to, you can instead apply cold, what to do about it:
wet compressions to your skin. Dampen a  Most blisters don't merit popping.
washcloth or other piece of fabric with cold Popping them prematurely can be
water, and lay it over the affected area for 20 to painful, as well as possibly leading to
30 minutes. Re-wet it as often as you need to. infection and scarring. They shouldn't
hang around for more than a few days,
TOPICAL APPLICATIONS FOR RELIEF so resolve to grit your teeth and deal
Apply aloe vera to burned skin. You can buy with it in the meantime.
gels or lotions that contain aloe vera at most  However, if you do have a large blister
stores, or you can cut a chunk off the plant itself that needs to be drained, pop it
if you have one available.Using the pads of your hygienically. Sterilize a needle with
fingers, gently apply the aloe to your rubbing alcohol and water, and make a
sunburn.Don't "rub it in" all the way, like you small hole at the edge of the blister.
might with a regular lotion. Leave it a bit goopy After you've drained all the fluid, pat the
and moist on top of the burn, as this helps area dry with clean gauze. If you feel
prevent the skin from drying out and becoming queasy or unsure about doing this, see
more irritated.Reapply as often as necessary. your doctor.
Treat inflammation with cortisone cream.  Wash your hands with soap and water
Cortisone creams contain a small dose of before touching blisters. Again, this is to
steroids that can work to reduce inflammation to prevent infection.

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Use topical agents on the blisters. Some andMinimal Erythema Doses:Comparison

suggestions include: of Noninvasive In VivoMeasuring
 Apply aloe vera, as you would in the Techniques afterUVB Irradiation.EURASIP
section above. Journal on Advances in Signal
 Consider using antibiotic ointment (such Processing. 2010:483562.
as polymyxin B or bacitracin) on your 3. Nicholas J Loweand James Breeding.
blisters if you suspect infection. Infection Evaluation of Sunscreen Protection by
might manifest as a foul smell, yellow Measurement of Epidermal DNA
pus, or extra redness and irritation Synthesis.J Invest
around the skin. (Note that some people Dermatol. 1980;74(3):181-2.
are allergic to these ointments, so do a 4. Black HS andChan JI. Experimental
"patch test" on an unaffected area first ultraviolet light
and make sure you don't have a bad carcinogenesis.Photochemistry and
reaction.)Do not tear off the flaps of skin Photobiology. 1977;26:183–199.
left over from broken blisters. You'll 5. Rusch HP, Kline BE and Baumann GA.
shed them soon enough; don't risk Carcinogenesis by ultraviolet rays with
irritating your skin even more now.Cover reference to wavelength and energy. Arch
blisters in a loosely-wrapped gauze Pathol. 1941;31:135–146.
bandage. After you've applied aloe vera 6. SchemppCM,M¨uller K, Schulte-M¨onting J,
or ointment to the area, put a bandage Sch¨opf E andSimon JC. Salt water bathing
over it to prevent chafing against your prior to UVB irradiation leads to a decrease
clothes or anything else. Loosely apply of the minimal erythema dose and an
a sterile piece of gauze over the area; increased erythema index without affecting
use medical tape to secure. skin pigmentation.Photochemistry and
 Change the bandage once every day, or Photobiology.1999;69(3):341–344.
after it gets wet or dirty.Wear loose 7. Freeman RG. Data on the action spectrum
cotton clothing over sunburned areas. for ultraviolet carcinogenesis. J Natl Cancer
Baggy t-shirts and loose cotton pajama inst. 1975;55:1119–1121.
pants are ideal clothing items to wear 8. Willis I andKligman AM. Evaluation of
while you're recovering from a sunburn. sunsereens by human assay. J SocCosmet
If you can't wear loose clothing, at least Chem. 1969;20:639–651,
make sure your garments are cotton 9. De Rios, G, Chan, JT, Black, HS, Rudolph,
(this fabric allows your skin to "breathe") A and Knox JM. Systemic protection by
and fit as loosely as possible. antioxidants against UVL induced
erythema. J Invest Dermatol. 1978;70:123–
CONCLUSION 125.
Sunburn is due to excessive exposure to UVB 10. Vilel FM, Vicentini YM andFonseca MJ.
light which is very hazardous.Treatment is Sunscreen protection against ultraviolet-
mainly using sunscreen lotions.Topical steroids induced oxidative stress: Evaluation of
and NSAID’s can also be given for reduced glutathione levels,
treatment.Providing cooling relief is a very metalloproteinase secretion, and
effective method as it gives stress relief to the myeloperoxidase activity, Die Pharmazie -
victim.The blisters should not be popped as it An International Journal of Pharmaceutical
can be painful. Sciences.2013;68(11):872-876.
11. Kaimal S andAbraham A. Sunscreens.
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