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    Sunburn

    Sunburn

    Topic Overview

    Sunlight can help our mental outlook and help us feel healthier. For people who have arthritis, the sun's warmth can help relieve some of their physical pain. Many people also think that a suntan makes a person look young and healthy. But sunlight can be harmful to the skin, causing immediate problems as well as problems that may develop years later.

    A sunburn is skin damage from the sun's ultraviolet (UV) rays. Most sunburns cause mild pain and redness but affect only the outer layer of skin ( first-degree burn ). The red skin might hurt when you touch it. These sunburns are mild and can usually be treated at home.

    Skin that is red and painful and that swells up and blisters may mean that deep skin layers and nerve endings have been damaged ( second-degree burn ). This type of sunburn is usually more painful and takes longer to heal.

    Other problems that can be present along with sunburn include:

    • Heatstroke or other heat-related illnesses from too much sun exposure.
    • Allergic reactions to sun exposure, sunscreen products, or medicines.
    • Vision problems, such as burning pain, decreased vision, or partial or complete vision loss.

    Long-term problems include:

    • An increased chance of having skin cancer.
    • An increase in the number of cold sores .
    • An increase in problems related to a health condition, such as lupus .
    • Cataracts , from not protecting your eyes from direct or indirect sunlight over many years. Cataracts are one of the leading causes of blindness.
    • Skin changes, such as premature wrinkling or brown spots.

    Your skin type affects how easily you become sunburned. People with fair or freckled skin, blond or red hair, and blue eyes usually sunburn easily.

    Although people with darker skin don't sunburn as easily, they can still get skin cancer. So it's important to use sun protection, no matter what your skin color is.

    Your age also affects how your skin reacts to the sun. The skin of children younger than 6 and adults older than 60 is more sensitive to sunlight.

    You may get a more severe sunburn depending on:

    • The time of day. You are more likely to get a sunburn between 10 in the morning and 4 in the afternoon, when the sun's rays are the strongest. You might think the chance of getting a sunburn on cloudy days is less, but the sun's damaging UV light can pass through clouds.
    • Whether you are near reflective surfaces, such as water, white sand, concrete, snow, and ice. All of these reflect the sun's rays and can cause sunburns.
    • The season of the year. The position of the sun on summer days can cause a more severe sunburn.
    • Altitude. It is easy to get sunburned at higher altitudes, because there is less of the earth's atmosphere to block the sunlight. UV exposure increases about 4% for every 1000 ft (305 m) gain in elevation.
    • How close you are to the equator (latitude). The closer you are to the equator, the more direct sunlight passes through the atmosphere. For example, the southern United States gets 1.5 times more sunlight than the northern United States.
    • The UV index of the day, which shows the risk of getting a sunburn that day.

    Preventive measures and home treatment are usually all that is needed to prevent or treat a sunburn.

    • Protect your skin from the sun.
    • Do not stay in the sun too long.
    • Use sunscreens, and wear clothing that covers your skin.

    If you have any health risks that may increase the seriousness of sun exposure, you should avoid being in the sun from 10 in the morning to 4 in the afternoon.

    Check your symptoms to decide if and when you should see a doctor.

    Check Your Symptoms

    Do you have a sunburn?
    Yes
    Sunburn
    No
    Sunburn
    How old are you?
    Less than 3 months
    Less than 3 months
    3 months to 11 years
    3 months to 11 years
    12 years or older
    12 years or older
    Are you male or female?
    Male
    Male
    Female
    Female
    Do you think you may have a heat-related illness, like heat exhaustion or heat cramps?
    Yes
    Possible heat-related illness
    No
    Possible heat-related illness
    Yes
    Symptoms of allergic reaction
    No
    Symptoms of allergic reaction
    Yes
    Heatstroke symptoms
    No
    Heatstroke symptoms
    Do you think you may be dehydrated?
    Yes
    May be dehydrated
    No
    May be dehydrated
    Are the symptoms severe, moderate, or mild?
    Severe
    Severe dehydration
    Moderate
    Moderate dehydration
    Mild
    Mild dehydration
    Are you having trouble drinking enough to replace the fluids you've lost?
    Little sips of fluid usually are not enough. You need to be able to take in and keep down plenty of fluids.
    Yes
    Unable to maintain fluid intake
    No
    Able to maintain fluid intake
    Is there any pain?
    Yes
    Pain
    No
    Pain
    How bad is the pain on a scale of 0 to 10, if 0 is no pain and 10 is the worst pain you can imagine?
    8 to 10: Severe pain
    Severe pain
    5 to 7: Moderate pain
    Moderate pain
    1 to 4: Mild pain
    Mild pain
    Are you having eye or vision problems?
    Yes
    Eye or vision problems
    No
    Eye or vision problems
    Has blurred vision or vision loss lasted for more than 30 minutes?
    Yes
    Vision loss or blurred vision for more than 30 minutes
    No
    Vision loss or blurred vision for more than 30 minutes
    Do you have any eye pain?
    Yes
    Eye pain
    No
    Eye pain
    How bad is the pain on a scale of 0 to 10, if 0 is no pain and 10 is the worst pain you can imagine?
    8 to 10: Severe pain
    Severe eye pain
    5 to 7: Moderate pain
    Moderate eye pain
    1 to 4: Mild pain
    Mild eye pain
    Has the pain lasted for more than 1 full day (24 hours)?
    Yes
    Mild eye pain for more than 24 hours
    No
    Mild eye pain for more than 24 hours
    Does light make your eyes hurt?
    Yes
    Sensitivity to light
    No
    Sensitivity to light
    Do you have more than a mild fever?
    A mild fever is common with sunburn. Home treatment usually is all that's needed for a mild fever.
    Yes
    Possible fever
    No
    Possible fever
    Do you have a severe headache or extreme fatigue?
    Yes
    Severe headache or fatigue
    No
    Severe headache or fatigue
    Does your baby have a sunburn with blisters?
    Yes
    Baby has sunburn with blisters
    No
    Baby has sunburn with blisters
    Are there any blisters, bleeding under the skin, or bruising in the sunburned area?
    Yes
    Blisters, bleeding under the skin, or bruising in sunburned area
    No
    Blisters, bleeding under the skin, or bruising in sunburned area
    Are you worried about scarring from large blisters?
    Yes
    Concerns about scarring
    No
    Concerns about scarring
    Are there any symptoms of infection?
    Yes
    Symptoms of infection
    No
    Symptoms of infection
    Do you think you may have a fever?
    Yes
    Possible fever
    No
    Possible fever
    Are there red streaks leading away from the area or pus draining from it?
    Yes
    Red streaks or pus
    No
    Red streaks or pus
    Do you have diabetes, a weakened immune system, peripheral arterial disease, or any surgical hardware in the area?
    "Hardware" includes things like artificial joints, plates or screws, catheters, and medicine pumps.
    Yes
    Diabetes, immune problems, peripheral arterial disease, or surgical hardware in affected area
    No
    Diabetes, immune problems, peripheral arterial disease, or surgical hardware in affected area
    Are you taking a medicine that may cause you to sunburn easily?
    Yes
    Taking medicine that may increase risk of sunburn
    No
    Taking medicine that may increase risk of sunburn
    Allergic Reaction

    Seek Care Today

    Based on your answers, you may need care soon. The problem probably will not get better without medical care.

    • Call your doctor today to discuss the symptoms and arrange for care.
    • If you cannot reach your doctor or you don't have one, seek care today.
    • If it is evening, watch the symptoms and seek care in the morning.
    • If the symptoms get worse, seek care sooner.

    Pain in children under 3 years

    It can be hard to tell how much pain a baby or toddler is in.

    • Severe pain (8 to 10): The pain is so bad that the baby cannot sleep, cannot get comfortable, and cries constantly no matter what you do. The baby may kick, make fists, or grimace.
    • Moderate pain (5 to 7): The baby is very fussy, clings to you a lot, and may have trouble sleeping but responds when you try to comfort him or her.
    • Mild pain (1 to 4): The baby is a little fussy and clings to you a little but responds when you try to comfort him or her.

    If you're not sure if a fever is high, moderate, or mild, think about these issues:

    With a high fever:

    • You feel very hot.
    • It is likely one of the highest fevers you've ever had. High fevers are not that common, especially in adults.

    With a moderate fever:

    • You feel warm or hot.
    • You know you have a fever.

    With a mild fever:

    • You may feel a little warm.
    • You think you might have a fever, but you're not sure.

    Many things can affect how your body responds to a symptom and what kind of care you may need. These include:

    • Your age. Babies and older adults tend to get sicker quicker.
    • Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
    • Medicines you take. Certain medicines, herbal remedies, and supplements can cause symptoms or make them worse.
    • Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
    • Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.

    Severe dehydration means:

    • The baby may be very sleepy and hard to wake up.
    • The baby may have a very dry mouth and very dry eyes (no tears).
    • The baby may have no wet diapers in 12 or more hours.

    Moderate dehydration means:

    • The baby may have no wet diapers in 6 hours.
    • The baby may have a dry mouth and dry eyes (fewer tears than usual).

    Mild dehydration means:

    • The baby may pass a little less urine than usual.

    Severe dehydration means:

    • Your mouth and eyes may be extremely dry.
    • You may pass little or no urine for 12 or more hours.
    • You may not feel alert or be able to think clearly.
    • You may be too weak or dizzy to stand.
    • You may pass out.

    Moderate dehydration means:

    • You may be a lot more thirsty than usual.
    • Your mouth and eyes may be drier than usual.
    • You may pass little or no urine for 8 or more hours.
    • You may feel dizzy when you stand or sit up.

    Mild dehydration means:

    • You may be more thirsty than usual.
    • You may pass less urine than usual.

    Symptoms of infection may include:

    • Increased pain, swelling, warmth, or redness in or around the area.
    • Red streaks leading from the area.
    • Pus draining from the area.
    • A fever.

    Try Home Treatment

    You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

    • Try home treatment to relieve the symptoms.
    • Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.

    Many prescription and nonprescription medicines can cause the skin to sunburn more easily. A few common examples are:

    • Some antibiotics.
    • Aspirin, ibuprofen (such as Advil or Motrin), and naproxen (such as Aleve).
    • Skin products that contain vitamin A or alpha hydroxy acids (AHA).
    • Some acne medicines.
    • Some diabetes medicines that you take by mouth.
    Heat-Related Illnesses

    Seek Care Now

    Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

    • Call your doctor now to discuss the symptoms and arrange for care.
    • If you cannot reach your doctor or you don't have one, seek care in the next hour.
    • You do not need to call an ambulance unless:
      • You cannot travel safely either by driving yourself or by having someone else drive you.
      • You are in an area where heavy traffic or other problems may slow you down.

    Symptoms of an allergic reaction may include:

    • A rash, or raised, red areas called hives.
    • Itching.
    • Swelling.
    • Trouble breathing.

    You can get dehydrated when you lose a lot of fluids because of problems like vomiting or fever.

    Symptoms of dehydration can range from mild to severe. For example:

    • You may feel tired and edgy (mild dehydration), or you may feel weak, not alert, and not able to think clearly (severe dehydration).
    • You may pass less urine than usual (mild dehydration), or you may not be passing urine at all (severe dehydration).

    Certain health conditions and medicines weaken the immune system's ability to fight off infection and illness. Some examples in adults are:

    • Diseases such as diabetes, cancer, heart disease, and HIV/AIDS.
    • Long-term alcohol and drug problems.
    • Steroid medicines, which may be used to treat a variety of conditions.
    • Chemotherapy and radiation therapy for cancer.
    • Other medicines used to treat autoimmune disease.
    • Medicines taken after organ transplant.
    • Not having a spleen.

    Pain in adults and older children

    • Severe pain (8 to 10): The pain is so bad that you can't stand it for more than a few hours, can't sleep, and can't do anything else except focus on the pain.
    • Moderate pain (5 to 7): The pain is bad enough to disrupt your normal activities and your sleep, but you can tolerate it for hours or days. Moderate can also mean pain that comes and goes even if it's severe when it's there.
    • Mild pain (1 to 4): You notice the pain, but it is not bad enough to disrupt your sleep or activities.

    Call 911 Now

    Based on your answers, you need emergency care.

    Call 911 or other emergency services now.

    Symptoms of heatstroke may include:

    • Feeling or acting very confused, restless, or anxious.
    • Trouble breathing.
    • Sweating heavily, or not sweating at all (sweating may have stopped).
    • Skin that is red, hot, and dry, even in the armpits.
    • Passing out.
    • Seizure.

    Heatstroke occurs when the body can't control its own temperature and body temperature continues to rise.

    Home Treatment

    Home treatment measures may provide some relief from a mild sunburn.

    • Use cool cloths on sunburned areas.
    • Take frequent cool showers or baths.
    • Apply soothing lotions that contain aloe vera to sunburned areas. Topical steroids (such as 1% hydrocortisone cream) may also help with sunburn pain and swelling. Note: Do not use the cream on children younger than age 2 unless your doctor tells you to. Do not use in the rectal or vaginal area in children younger than age 12 unless your doctor tells you to.

    A sunburn can cause a mild fever and a headache. Lie down in a cool, quiet room to relieve the headache. A headache may be caused by dehydration , so drinking fluids may help. For more information, see the topic Dehydration.

    There is little you can do to stop skin from peeling after a sunburn-it is part of the healing process. Lotion may help relieve the itching.

    Other home treatment measures, such as chamomile, may help relieve your sunburn symptoms.

    Medicine you can buy without a prescription
    Try a nonprescription medicine to help treat your fever or pain:

    Talk to your child's doctor before switching back and forth between doses of acetaminophen and ibuprofen. When you switch between two medicines, there is a chance your child will get too much medicine.

    Safety tips
    Be sure to follow these safety tips when you use a nonprescription medicine:
    • Carefully read and follow all directions on the medicine bottle and box.
    • Do not take more than the recommended dose.
    • Do not take a medicine if you have had an allergic reaction to it in the past.
    • If you have been told to avoid a medicine, call your doctor before you take it.
    • If you are or could be pregnant, do not take any medicine other than acetaminophen unless your doctor has told you to.
    • Do not give aspirin to anyone younger than age 20 unless your doctor tells you to.

    Care of blisters

    Home treatment may help decrease pain, prevent infection, and help the skin heal.

    • A small, unbroken blister about the size of a pea, even a blood blister, will usually heal on its own. Use a loose bandage to protect it. Avoid the activity that caused the blister.
    • If a small blister is on a weight-bearing area like the bottom of the foot, protect it with a doughnut-shaped moleskin pad . Leave the area over the blister open.
    • If a blister is large and painful, it may be best to drain it. Here is a safe method:
      • Wipe a needle or straight pin with rubbing alcohol.
      • Gently puncture the edge of the blister.
      • Press the fluid in the blister toward the hole so it can drain out.
      • If you have a condition such as diabetes, HIV, cancer, or heart disease, you do not want to drain a blister because of the risk of infection.
    • After you have opened a blister, or if it has torn open:
      • Wash the area with soap and water. Do not use alcohol, iodine, or any other cleanser.
      • Don't remove the flap of skin over a blister unless it's very dirty or torn or there is pus under it. Gently smooth the flap over the tender skin.
      • Apply an antibiotic ointment and a clean bandage. If the skin under the bandage begins to itch or a rash develops, stop using the ointment. The ointment may be causing a skin reaction.
      • Change the bandage once a day or anytime it gets wet or dirty. Remove it at night to let the area dry.

    Watch for a skin infection while your blister is healing. Signs of infection include:

    • Increased pain, swelling, redness, or warmth around the blister.
    • Red streaks extending away from the blister.
    • Drainage of pus from the blister.
    • Fever.

    Symptoms to watch for during home treatment

    Call your doctor if any of the following occur during home treatment:

    • Vision problems continue after you get out of the sun.
    • Fever develops.
    • Dehydration develops and you are unable to drink enough to replace lost fluids.
    • Signs of skin infection in blisters develop.
    • Symptoms become more severe or more frequent.

    Prevention

    Protecting your skin

    Most skin cancer can be prevented. Use the following tips to protect your skin from the sun. You may decrease your chances of developing skin cancer and help prevent wrinkles.

    Avoid sun exposure

    The best way to prevent a sunburn is to avoid sun exposure.

    Stay out of the midday sun (from 10 in the morning to 4 in the afternoon), which is the strongest sunlight. Find shade if you need to be outdoors. You can also calculate how much ultraviolet (UV) exposure you are getting by using the shadow rule: A shadow that is longer than you are means UV exposure is low; a shadow that is shorter than you are means the UV exposure is high.

    Other ways to protect yourself from the sun include wearing protective clothing, such as:

    • Hats with wide 4 in. (10 cm) brims that cover your neck, ears, eyes, and scalp.
    • Sunglasses with UV ray protection, to prevent eye damage.
    • Loose-fitting, tightly woven clothing that covers your arms and legs.
    • Clothing made with sun protective fabric. These clothes have a special label that tells you how effective they are in protecting your skin from ultraviolet rays.

    Preventing sun exposure in children

    You should start protecting your child from the sun when he or she is a baby. Because children spend a lot of time outdoors playing, they get most of their lifetime sun exposure in their first 18 years.

    • It's safest to keep babies younger than 6 months out of the sun.
    • Teach children the ABCs of how to protect their skin from getting sunburned.
      • A = Away. Stay away from the sun in the middle of the day (from 10 in the morning to 4 in the afternoon).
      • B = Block. Use a sunscreen with a sun protection factor (SPF) of 30 or higher to protect babies' and children's very sensitive skin.
      • C = Cover up. Wear clothing that covers the skin, hats with wide brims, and sunglasses with UV protection. Even children 1 year old should wear sunglasses with UV protection.
      • S = Speak out. Teach others to protect their skin from sun damage.

    Sunscreen protection

    If you can't avoid being in the sun, use a sunscreen to help protect your skin while you are in the sun.

    Be sure to read the information on the sunscreen label about the SPF factor listed on the label and how much protection it gives your skin. Follow the directions on the label for applying the sunscreen so it is most effective in protecting your skin from the sun's ultraviolet rays.

    Choosing a sunscreen

    • Sunscreens come in lotions, gels, creams, ointments, and sprays. Use a sunscreen that:
    • Use lip balm or cream that has SPF of 30 or higher to protect your lips from getting sunburned or developing cold sores.
    • Use a higher SPF at when you are near water, at higher elevations or in tropical climates. Sunscreen effectiveness is affected by the wind, humidity, and altitude.

    Some sunscreens say they are water-resistant or waterproof and can protect for about 40 minutes in the sun if a person is doing a water activity.

    Applying a sunscreen

    • Apply the sunscreen at least 30 minutes before going in the sun.
    • Apply sunscreen to all the skin that will be exposed to the sun, including the nose, ears, neck, scalp, and lips. Sunscreen needs to be applied evenly over the skin and in the amount recommended on the label. Most sunscreens are not completely effective because they are not applied correctly. It usually takes about 1 fl oz (30 mL) to cover an adult's body.
    • Apply sunscreen every 2 to 3 hours while in the sun and after swimming or sweating a lot. The SPF value decreases if a person sweats heavily or is in water, because water on the skin reduces the amount of protection the sunscreen provides. Wearing a T-shirt while swimming does not protect your skin unless sunscreen has also been applied to your skin under the T-shirt.

    Other sunscreen tips

    Remember that skin that is healing from a sunburn is sensitive to more damage from the sun, so be sure to prevent more sunburn in those areas. The following tips about sunscreen will help you use it more effectively:

    • Older adults should always use a sunscreen with an SPF of at least 30 to protect their very sensitive skin.
    • If you have sensitive skin that burns easily, use a sunscreen with an SPF of at least 30.
    • If you have dry skin, use a cream or lotion sunscreen.
    • If you have oily skin or you work in dusty or sandy conditions, use a gel, which dries on the skin without leaving a film.
    • If your skin is sensitive to skin products or you have had a skin reaction (allergic reaction) to a sunscreen, use a sunscreen that is free of chemicals, para-aminobenzoic acid (PABA), preservatives, perfumes, and alcohol.
    • If you are going to have high exposure to the sun, consider using a physical sunscreen (sunblock), such as zinc oxide, which will stop all sunlight from reaching the skin.
    • If you need to use sunscreen and insect repellent with DEET, do not use a product that combines the two. You can apply sunscreen first and then apply the insect repellent with DEET, but the sunscreen needs to be reapplied every 2 hours.

    Do not use tanning booths to get a tan. Artificial tanning devices can cause skin damage and increase the risk of skin cancer.

    For information on sun exposure and vitamin D, see Getting Enough Vitamin D.

    Preparing For Your Appointment

    To prepare for your appointment, see the topic Making the Most of Your Appointment.

    You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:

    • What are your main symptoms?
    • How long have you had your symptoms?
    • Do you have blisters?
    • What amount of time did you spend in the sun? Were you at a high altitude?
    • Did you use sunscreen or sunblock, and what SPF was used?
    • Have you had this problem before? If so, do you know what caused the problem at that time? How was it treated?
    • What activities make your symptoms better or worse?
    • What prescription or nonprescription medicines do you take?
    • What home treatment measures have you tried? Did they help?
    • What nonprescription medicines have you tried? Did they help?
    • Do you have any health risks?

    Other Places To Get Help

    Online Resource

    Environmental Protection Agency: SunWise (U.S.)
    Environmental Protection Agency: SunWise (U.S.)
    Web Address: www.epa.gov/sunwise

    Related Information

    Credits

    By Healthwise Staff
    Patrice Burgess, MD - Family Medicine
    H. Michael O'Connor, MD - Emergency Medicine
    Last Revised November 15, 2013

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