Now that Spring Break is over, we’re all left with the fond memories of relaxing, pictures of those crazy nights with friends and a bright red reminder of how easily we really were taking it: a sunburn. I know many of you traveled to the ski slopes instead of the beach this past week, but you might have come back with a sunburned face — as a result of sunlight reflecting off all that pure white snow — so this applies to you as well.
First, some physiology. A sunburn is just what you’d think it is: burn damage to the skin caused by the sun’s UVA and UVB radiation. The mechanism of skin injury from a sunburn is direct DNA damage that activates bodily defense systems. These defenses include DNA repair, increased melanin — the primary determinant of skin color — production to prevent further damage and destruction of the affected cells through apoptosis (programmed cell death). The dead cells cause the symptoms of sunburn, namely redness, pain, swelling and sometimes low-grade fever, because the dead cells trigger the release of cytokines — the body’s inflammatory mediators — which signal the release of inflammatory cells including white blood cells. This process allows for the body to clear away the dead cells; this process often is experienced as peeling. New cells that have not been damaged by the sun eventually replace the dead cells.
The body rids itself of cells with DNA damage because, as we’ve all heard over the years, cancer is caused by unregulated cell growth as a result of damaged DNA. Skin damage caused by the sun specifically increases the risk of developing basal cell carcinoma and squamous cell carcinoma of the skin through direct DNA damage, also known as thymine dimer formation. Sun damage also increases the risk of developing malignant melanoma, the deadliest form of skin cancer, caused by indirect DNA damage.
Second, tips to ease the pain (adapted from several articles and admittedly personal experience):
1. Get out of the sun! It seems logical and simple enough, but avoiding further exposure is crucial to prevent further damage and to allow one’s skin time to heal. It is important to cover up your skin with clothing rather than sunscreen after a burn because sunscreen actually can worsen inflammation. Staying out of the sun also is important — although it is a difficult task now that it’s warming up outside. If you absolutely cannot avoid going outside until your burn is completely healed, try to wear long sleeves and pants and find the shadiest spot you can or invest in an umbrella to protect your skin.
2. Because sunburn is caused by inflammatory cells, taking anti-inflammatories, such as ibuprofen (Advil), acetaminophen (Tylenol) or naproxen (Aleve) can go a long way toward reducing the swelling, redness and pain of a sunburn. The earlier these medications are taken, the more effective they will be because they actually can block the release of certain inflammatory modulators known as interleukins and can prevent inflammation from developing.
3. Drink water. We have all heard that staying hydrated can help skin look fresh and help minimize acne, so it only makes sense that when your skin is damaged, you want to give it all the nourishment you can. Also, as with all burns, the skin damage leads to dilation of blood vessels — called “leaky capillaries” — near the surface of the skin, causing fluids to leave the vascular space and take up residence in cells and tissues (where it does not belong, this is called “third spacing” in medicine and leads to swelling). The dilation ultimately makes it easier for fluids to evaporate from the body and could lead to dehydration, which hinders the healing process because your body is mostly water. Also, dehydration can cause the low-grade fever associated with sunburn.
4. Apply cold compresses and moisturizers. Like any painful swelling, cooling injured tissues down with ice or cold packs can be very soothing because it helps reduce inflammation and the “heat” produced by an injury. Cool moisturizers, including aloe vera gel and Eucerin calming cream, also can help the skin heal and relieve the pain. Be careful to avoid thick lotions and creams that can prevent the skin from breathing and delay the healing process. Try to avoid the popular sunburn creams and aloes with numbing medications, such as benzocaine and lidocaine. While these products will relieve the pain, they also can create an allergic reaction known as contact dermatitis, which is associated with itchiness and redness of the sin, and will really make you regret using it on top of your already painful sunburn. If you have used these medications in the past without a problem, then it’s probably OK to continue using them if your burn is really painful, but I wouldn’t use them for the first time on top of a sunburn — at least try a patch of unaffected skin first to check for reaction.
5. Take cool or lukewarm showers and baths. Avoid hot water showers because they can further irritate the skin and lead to more inflammation and redness. And I’m sure you know how painful the hot water can feel on your sunburn anyway, so pure aversion should help with this.
6. Don’t pop those blisters. It’s tempting, I’m aware, but the blisters serve as a protectant seal over your skin and help prevent further damage. Additionally, if you pop them, the sensitive layers of skin underneath them that are new and still healing will be exposed, and it is quite painful. If any of you have ever popped a blister before, like on your foot, and then walked, then you know how excruciating it can be to have that sensitive skin exposed. Also, blisters can be an indication of the amount of skin damage you have received, so it’s important to let the body heal itself naturally.
7. Don’t peel the dead skin off. The post-sunburn peel is the closest humans will ever come to a snake-like shedding of the skin, and it’s often one of the grossest thing many of us have ever seen on ourselves. The appearance of peeling skin is not appealing, but resist the temptation to pull it off. As tempting as it might be to enter a contest with your friends to find out who can peel off the biggest single piece of skin (gross as it sounds, I know people who have done it), avoid the urge and let the dead skin slough off in the shower.
8. In extreme cases, seek medical attention. Most sunburns will heal themselves in a few days without incident, and the above tips serve only as stop-gaps for the pain and inflammation. But in cases of extensive burns or blistering (think: that lobster-esque look you obtained after falling asleep on your back in the sun), or for a really painful burn on an important part of your body (hands, feet, face, genitalia if you’re inclined to go nude), you may want to seek help from a physician who can prescribe topical steroid creams to reduce inflammation and potent pain killers to ease the discomfort.
Katie McBeth is a University Medical student. She can be reached at k.mcbeth@cavalierdaily.com.
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