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Sunburn is the most common sun-induced disease of childhood. Usually erythema and skin tenderness begin in 30 minutes to 4 hours after sun exposure, depending on the intensity of the exposure and the degree of the child's natural protection from the sun based on the child's skin type (Table 1). Immediate erythema occurs within minutes and then fades. Then redness reappears (4-12 hours) and persists for days (delayed erythema). Vascular permeability of varying degrees results in edema and blisters. Desquamation (peeling) which is the shedding of 5-10 cell layers of the epidermis occurs within a week after intense sun exposure. Sunburn ranges in severity from simply erythema to erythema with tenderness or to erythema with tenderness and blisters. Extensive sunburn can cause a reduction in the sweating rate and may contribute to collapse from heatstroke when severe.

Differential diagnosis

The differential diagnosis includes idiopathic photodermatoses, erythropoietic protoporphyria, lupus erythematosus, dermatomyositis, photosensitizing drugs, viral exanthems, and xeroderma pigmentosum.

Pathophysiology

Sunburn is an immediate response to skin injury from ultraviolet (UV) rays. A tan is a later protective response of the skin to too much UV light. Tanning protects the skin's vulnerable lower layers. It is living proof that the skin has suffered UV attacks. The exact mechanism of UV radiation damage to the skin is unknown, but it is hypothesized to be secondary to the production of toxic oxygen species and inflammatory mediators. UV radiation effects are cumulative with long-term effects such as wrinkles, actinic keratoses (scaly, red macules or patches), and skin cancer.

Treatment

Treatment options are very limited. The symptoms of sunburn can be treated with cool water compresses and soothing baths with baking soda. Non-steroidal anti-inflammatory agents such as ibuprofen can modify sunburn if given within 48 hours. Sunburn is preventable and prevention is far superior to treatment. Protection from sunburn can be accomplished by staying out of the sun between 10 AM and 4 PM, using a broad-spectrum sunscreen with an SPF (sun protection factor) of 30 or greater with protection from UVA and UVB, and protective clothing and hats.