Presentaion:
Patients generally seek help only if their sunburn is
severe. There will be a history of extended exposure to
sunlight or to an artificial source of ultraviolet
radiation, such as a sunlamp. The burns will be accompanied
by intense pain and the patient will not be able to tolerate
anything touching the skin. There may be systemic complaints
that include nausea, chills, and fever. The affected areas
are erythematous and are accompanied by mild edema. The more
severe the burn, the earlier it will appear and the more
likely it will progress to edema and blistering.
What to do:
Inquire as to whether or not the patient is using a
photosensitizing drug
(e.g., tetracyclines, thiazides, sulfonamides,
phenothiazines) and have the patient discontinue its use.
Have the patient apply cool compresses of water or Burow's
solution (Domeboro Powder Packets-1 pkt in 1 pint of water)
as often as desired to relieve pain. This is the most
comforting therapy.
The patient may be helped by applying a topical steroid
spray such as dexamethasone (Decaspray) and using an
emollient such as Lubriderm.
With a more severe burn prescribe a short course of
systemic steroids (40-60mg of Prednisone qd x 3d). This will
reduce inflammation, swelling, pain, and itching.
What not to do:
Do not allow the patient to use OTC sunburn medications
that contain local anesthetics (benzocaine, dibucaine or
lidocaine). They are usually ineffective or only provide
very transient relief. In addition there is the potential
hazard of sensitizing the patient to these ingredients.
Do not trouble the patient with unnecessary burn dressings.
These wounds have a very low probability of becoming
infected. Treatment should be directed at making the patient
as comfortable as possible.
Discussion
With sunburn, the onset of symptoms is usually delayed for
2-4 hours. Maximum discomfort usually occurs after 14-20
hours, and symptoms last between 24 and 72 hours. Patients
should be instructed on the future use of sunscreens
containing para-aminobenzoic acid (PABA) (e.g., Pabanol and
PreSun). Prophylactic use of aspirin prior to sun exposure
has also been recommended.
