Beware of sunburn

Q) I’ve got a really nasty sun burn; What is the best way to treat it?

A) During this extended period of simply awesome weather (at least for those of us who are able to enjoy the heat and I realize many are unable to), working in one of Ontario’s premier beach destinations provides plenty of opportunities to deal with this particular subject. When deciding upon how to treat sunburn in a youth or adult, the first step is to gauge the severity of the burn.

All burns, whether they be from the sun, water, chemical or other means can be classified anywhere from 1st degree to 4th degree based on how much damage has been done to the skin. The majority of the burns we see from the sun are of the 1st degree variety and they typically present with redness on the skin, tenderness to the touch, mild swelling and peeling within 24 to 48 hours afterwards. The damage is limited to the most superficial layer which is the epidermis of the skin.

Occasionally, we are unfortunately presented with burns that fall under the 2nd degree category. This is often seen in people who have drifted off to sleep while lying out on the beach. A 2nd degree burn means that the injury to the skin has gone deeper than the outermost layer (the epidermis and most of the underlying layer known as the dermis). They usually present with fluid filled blisters, a deeper redness, skin that is significantly more painful to the touch and the burned area may also appear wet and shiny and/or be white or discoloured in an irregular pattern.

A third degree burn is also called a full thickness burn since all 3 layers of the skin are damaged. This harm may also extend to the underlying muscles and bone. This type of burn is often painless because the nerves have been damaged so badly and the skin may be white, brown, black or leathery instead of red.

Third and forth degree burns should always be seen immediately by a doctor but first and second degree burns can often be treated on your own.

*Huge caveat here however since there are a number of factors that may cause a 1st or 2nd degree burn to be referred to a medical doctor. These range from the age of the patient, the size of the burn, the location of the burn, the causative agent (eg. chemical should always seek prompt medical care) and other factors that may affect the patient’s health (e.g. pregnancy, immune deficient…).

For a run-of-the-mill first degree burn which comprises most of the sunburns we come across, the treatment should begin with cooling the area by running it under cool running water or applying a cold wet compress (like a sodden towel) on it for 10 to 30 minutes. While this may seem excessive, there is some proof of benefit if this extended for up to 3 hours.

**Note: ice should not be used since it may constrict blood vessels which slows blood flow to the damaged area and further exacerbate the situation. As well, this puts the patient at risk for hypothermia.

Following this, the burn should be very gently cleaned with soap and water to help reduce the risk of infection. This should help with pain somewhat as will pain killers such as acetaminophen/ Tylenol or an NSAID like ibuprofen/Advil or naproxen/Aleve. Applying a good moisturizer such as Eucerin will help minimize skin dryness and irritation down the road but should only be used if the skin has not been “broken”.

Lots of people find aloe vera soothing although there is no hard evidence that it is of benefit. Cortisone creams don’t seem to help and Polysporin is probably a waste of money since the risk of infection with these types of burns is very low anyway.

The various anaesthetics (like Solarcaine) which numb the skin work for only a few hours at most and seem to cause allergic skin reactions more frequently than they really should given their limited benefit.

Home remedies either lack evidence that they work (apple cider vinegar or buttermilk) or are a potential hazard such as is the case with butter which traps heat making burns worse and serves as an excellent vehicle in which to promote bad bacterial growth in (sorry Mom, I know you meant well…).

The itching that often occurs as the burn heals often responds nicely to oral antihistamine pills (like diphenhydramine) or a baking soda bath along with the aforementioned Eucerin moisturizer. Covering the area with a non-stick sterile dressing and protecting it from further sun exposure are both low risk and helpful strategies.

The jury is out on whether Vitamin E applied to the area later on aids in skin recovery but it does appear to be low risk.