Photosensitivity Disorder

What are the symptoms of sunburn?

Some of the immediate symptoms of sunburn after exposure are the following:

• First, the skin becomes red, tender and hot.
• Touching or rubbing the skin causes pain.
• Because heat triggers fluid loss, a sunburn victim can also become dehydrated.
• For several days after exposure, the skin may swell, blister, and peel. Some sufferers develop welts or rashes.
• Skin peeling can occur several days later after a sun rash develops and is a sign of healing and rebuilding of skin.

More subtle exposures to the sun may not have any obvious immediate symptoms such as the ones listed above. Most sunburns are mild causing only skin redness, pain, and irritation due to involvement of the outer layer of skin (first degree burn). This type of burn may be painful to touch.

The skin is swollen, very red, and painful blisters may occur. This may indicate a more moderate sunburn (second degree burn). This type of sun rash may take longer to heal.

People who have chronic (long standing) exposure to sun can increase their changes of developing chronic skin damage from sun exposure (wrinkles, aging, age spots, freckles, skin cancer, scarring, etc.).

What are the symptoms of severe sunburn (sun poisoning)?

In severe cases of sunburn, the individual may experience:

• fever,
• nausea,
• chills,
• dizziness,
• rapid pulse,
• rapid breathing,
• dehydration,
• heat stroke (a severe form of hyperthermia that constitutes a medical emergency),
• shock with loss of consciousness, and/or
• severe blisters or soreness.

Severe cases of sunburn require emergency medical treatment.

What first-aid measures should be taken with sunburn?

If symptoms of severe sunburn are present, the individual should contact their primary health care practitioner, urgent care facility, or Emergency Department. While awaiting treatment, the affected person should not drink cold water, which can trigger chills. If compresses are applied, they should be dipped in cool or tepid water, not cold water.

If the symptoms of sunburn are mild or moderate, the patient may drink plenty of water to replenish the fluid lost from the sunburn and to avoid dehydration. Other simple home remedies for sunburn are listed in the following sections.

Are there any home remedies to treat sunburn?

There are some simple measures that can be applied at home to help with sunburns. The easiest and most important remedy to sunburn is using effective preventative measures to avoid sunburn. These steps include:

• Do not spend too much time in the sun, especially in direct sunlight in the middle of the day.
• Wear protective clothing such as long-sleeved shirts, hats with a large brim, and use sunscreen.
• Drink water to keep hydrated while spending time in the sun.

Once sunburn occurs, there are sunburn remedies that can help with treating sunburn symptoms. These include:

• Apply dampened cloths or compresses to reduce the heat and lessen the pain
• Soak in a bathtub of plain, soap-free water (soap can irritate the burn).
• Gently pat the skin dry afterward – do not rub it
• Apply a soothing cream, lotion, or another preparation approved by a physician or pharmacist
  • Note that some preparations, in particular those containing benzocaine (Endocaine, Hurricaine), can trigger an allergic reaction in some individuals, and certain ointments can retard healing by sealing off the skin from the air.

• If the discomfort is significant, take an OTC painkiller such as acetaminophen (Tylenol and others) or ibuprofen (Advil, Children’s Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever, and others)
• These medications also can be used to treat headache associated with sunburn. Additionally, headache may be caused by dehydration. Drinking plenty of fluids (no caffeine or alcohol) is one way to prevent dehydration while out in the sun for prolonged periods of time.
• Moisturizing measures with creams or Aloe Vera gel may also help with symptoms of sunburn.

If blisters form after sunburn, do not attempt to burst or “pop” them unless they are located in a very painful area, or are otherwise causing a lot of discomfort due to size. Most blisters will break by themselves if they are left alone. Blisters are better left uncovered as rubbing or placing a tight cover over them may cause infections and more discomfort. If blisters need to be covered, for example, because they cause discomfort by rubbing on clothes, they should be covered by a loosely applied dressing.

Once a sunburn blister breaks, home remedies to treat them are simple and practical. The area of the broken blister should be kept clean by washing it frequently with soap and water. The left over skin should be left alone, but cleaned, until it falls off. Broken blisters generally heal on their own, but they are susceptible to infections. Topical antibiotic ointments can be applied to the area of broken blisters to prevent infections.

If a sun blister is uncomfortable or too large or located in a cosmetically unappealing area, consider breaking it carefully. This could be done by gently cleaning the area well with soap and water or rubbing alcohol and using a clean needle to punch a hole at the edge of the blister gently. The fluid inside can be pushed towards the hole and drained. The area should be cleaned again and covered with a loose dressing afterwards. Topical antibiotics can be applied to the broken blister also in order to reduce the risk of infection. 

Who is most susceptible to sunburn?

Persons with certain pigment disorders (such as albinism) and persons with fair skin are at highest risk of suffering a burn. The American Academy of Dermatology classifies skin types into six categories (in terms of susceptibility to sunburn) for skin colors ranging from fair to black. This is called the Fitzpatrick classification. These skin types are as follows:

Types 1 and 2: High Susceptibility to Sunburn

• Individuals with Skin Type 1 have very fair skin (pale or milky white), blond or red hair, and possibly freckles. Such persons can suffer a burn in less than one-half hour when exposed to summer sunlight at midday. People with Skin Type 1 never tan.
• Individuals with Skin Type 2 have very light brown skin and possibly freckles. They burn in a short time in the sun, although they can achieve a very light tan.

Types 3 and 4: Moderate Susceptibility to Sunburn

• Individuals with Skin Type 3 (called “average Caucasians” by The American Academy of Dermatology) have skin that is slightly more brown than the skin of a Type 2. They can develop a moderate sunburn and a light brown tan.
• Individuals with Skin Type 4 have olive-colored skin. Ordinarily, they develop only a minor sunburn while acquiring a moderate tan.

Types 5 and 6: Minimal or No Susceptibility to Sunburn

• Individuals with Skin Type 5 have brown skin and can develop a dark tan while rarely burning.
• Individuals with Skin Type 6 have black skin and never burn.
• It is often difficult to accurately determine an individual’s skin type simply by looking at the color of the skin. It is best to ask the person how quickly they may burn and how easily they tan. Based on the response to these simple questions, the skin type can be determined.

Can diseases cause a heightened sensitivity to UV rays?

Yes. Certain disorders place their sufferers at very high risk of skin damage — including severe sunburn, blisters, and sores — from exposure to UV radiation. The following is a small sample of afflictions that increase the skin’s sensitivity to UV radiation:

• Albinism: Individuals with classic oculocutaneous albinism lack melanin in their skin and eyes — hence, the term “oculocutaneous” (“oculo” for eyes, and “cutaneous” for skin). Without the protection of this pigment, their white skin and pink eyes are both highly sensitive to UV and susceptible to the rays’ damage.
• Systemic lupus erythematosus: Individuals with lupus can have inflamed tissues, including the skin on the face. The “butterfly” rash (or malar rash) of lupus over the cheeks and nose is extremely sensitive to UV rays. In fact, UV-B and UV-A rays can cause lupus to flare. This butterfly rash and its sensitivity to sun is one of common characteristics of lupus.
• Porphyrias: The porphyrias are disorders of specific enzymes that are needed for the metabolism of heme (part of the pigment hemoglobin that permits red blood cells to transport oxygen and carbon dioxide). Patients with these disorders manufacture abnormally large amounts of substances called porphyrins. Stimulation of the excess porphyrins in the skin by the UV rays causes damage and scarring of the skin. This skin damage is a prominent feature of several forms of porphyria including porphyria cutanea tarda, hereditary coproporphyria, variegate porphyria, and, particularly, congenital erythropoietic porphyria.
• Vitiligo: Vitiligo is a relatively common disorder that causes patches of white de-pigmented skin. These patches lack melanin and are extremely sensitive to UV rays.
• Xeroderma pigmentosum: This disorder appears to result from an inherited hypersensitivity to the cancer-causing (carcinogenic) effects of ultraviolet light. Sunlight causes DNA damage that is normally repaired. Individuals with xeroderma pigmentosum have defective inability to repair the DNA after UV damage. Affected individuals are hundreds of times more vulnerable to developing skin cancer than other people. Their extreme skin photosensitivity predisposes them to pronounced skin damage and scarring but also to the early onset of skin cancer (basal cell and squamous cell carcinomas and malignant melanoma).

What kinds of skin cancer can UV rays cause?

Overexposure to UV rays can cause three varieties of skin cancer; malignant melanoma, basal cell carcinoma, and squamous cell carcinoma.

Malignant melanoma

• Malignant melanoma is by far the most dangerous form of skin cancer.
• The current lifetime risk of developing a melanoma is approximately 1/60.
• Melanomas may begin from changes in a pre-existing mole or birthmark, or arise as a brand new mole from otherwise clear skin (de novo).
• Multiple features are more common in melanomas versus regular moles including asymmetry, irregular borders, multiple colors, and size larger than a pencil eraser.
• Melanomas may be black or brown – and sometimes red, white or blue, or a mixture of those colors.
• Melanoma can spread (metastasize) rapidly. If diagnosed early, melanoma is often curable. However, if the diagnosis is delayed, melanoma can spread and may be potentially fatal.

Basal and squamous cell carcinomas

Basal and squamous cell cancers are slow-growing and are far less likely to metastasize (spread to other parts of the body) than melanoma. Both basal and squamous cell cancers can be cured in at least 90 percent of the cases if diagnosed early.

Basal cell carcinoma

• Basal cell carcinomas are flattened, pearly, small bumps with translucent edges and slightly depressed centers.
• They may bleed.
• Usually, they appear on the head, neck, upper trunk, and hands.
• If ignored, these cancers can cause considerable localized damage.

Squamous cell carcinoma

• Squamous cell carcinomas are rough patches or crusty scaly areas on the skin that do not clear up and do not respond to the usual skin creams.
• They may bleed a little.
• They tend to appear particularly on the ear rims, face, lower lip, and hands.
• If ignored, they can spread to other parts of the body.

These conditions are very common and if diagnosed properly and promptly, they are highly curable. Therefore it is very important to have routine skin checks by a trained skin doctor (dermatologist) annually. Annual screening can help in early diagnosis of skin cancer or pre-cancerous conditions that may lead to skin cancer.