FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

SUNBURN THAT MAKES YOU FEEL SICK SHOULD PROMPT A TRIP TO DOCTORS

Question: Because I'm very active outdoors, I seem to get sunburned every summer. It's usually mild and clears up in a few days, but last year I got blisters and my wife made me go to see the doctor. He treated the sunburn and said that I had a second degree burn. Is that right? I thought that was just where you were burned by a flame or hot liquid.

Answer: A sunburn is produced when the ultraviolet rays in sunlight damage the deeper growing layers of the skin. The resulting irritation to the skin, blood vessels, and associated tissue causes the inflammation we call a sunburn. Pain develops when the nerve cells within the skin are stimulated as part of the inflammation process. It may take anywhere from one to 12 hours after the sun exposure for the pain to start. The degree of pain is directly related to the severity of the burn and the size of affected skin area.

Health problems associated with burns are related to the amount of skin involved, the depth of the burn, the individual's age and pre-existing health conditions (e.g, diabetes) that may be present. As your doctor indicated, the specific cause of the burn -- the sun, boiling water, chemical injury or other cause -- is not important. The extent of skin damage is what counts. The label "sunburn" only tells that the damage came from being out in the sun, not the extent of the injury.

A typical sunburn is painful with or without being touched, but the "sunburned" look and associated discomfort improve after two or three days. The dead, damaged skin usually peels off in a week or two. This type of burn is referred to as a superficial, or first-degree, burn. A second-degree burn produces damage deeper into the skin and can be very painful. Even air blowing across the burn can hurt. In addition to the pain, the skin will blister. Healing usually takes two or three weeks and a permanent mild scar or change in skin color may, but usually does not, occur.

A third-degree or "total-thickness burn" damages all the layers of skin. Touching a new third-degree burn with slight pressure may give some discomfort, but it's nothing like the sheer agony that this would produce if the burn was of the less severe, partial-thickness variety. Healing takes many weeks and always produces a scar.

As a general guideline, if you have only a mild sunburn, you can probably take care of it yourself. You should protect the skin, stay out of the sun, and take aspirin, acetaminophen or ibuprofen for the discomfort. Don't put butter or other "gooey" substances on the burn. Non-prescription sunburn products may be soothing, but they will not speed healing.

If you feel sick because of the burn, or if it covers a large percentage of your body, you should see your doctor. More severe burns with immediate blistering or blackening of the skin should have a doctor's attention today -- don't wait until next week. Deep burns over a large amount of the body surface can be immediately life threatening and require prompt hospitalization.

Here are two tips that will help keep you from having to deal with the pain of sunburn this summer:

* Avoid being outdoors during the hours of the day when the sun's rays are the most direct -- between about 10 a.m. and 2 p.m.

* When you go outside during the day, protect your skin with clothing or by putting a number 15, or higher, sunscreen lotion on the exposed areas of your body.

Some studies suggest that 2000-mg of vitamin C a day or use of vitamin E will reduce the risk of sunburn. That seems to me like a safe and inexpensive additional precaution.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.