History and exam

Key diagnostic factors

common

sun exposure

Factors such as previous exposure, daytime exposure, and knowledge of risks should be determined.

lack of sun protection

Factors such as sun protection methods, clothing worn, and knowledge of risks should be determined.

skin discomfort

Skin tightness and a burning sensation are characteristic features.

pruritus

Pruritus and tenderness are common, as is the sensation of increased warmth radiating from the skin.

skin tenderness

Pruritus and tenderness are common, as is the sensation of increased warmth radiating from the skin.

sensation of warmth

Pruritus and tenderness are common, as is the sensation of increased warmth radiating from the skin.

erythema

Erythema localized to sun-exposed areas is the hallmark of sunburn. Signs and symptoms of sunburn may begin 2 to 4 hours after severe ultraviolet overexposure. Erythema peaks by 12 to 24 hours, but pain, discomfort, and other symptoms may have a longer time course.

Other diagnostic factors

common

chronic actinic damage

Photodistributed freckling and lentigos, with or without diffuse scaly erythematous actinic keratoses, indicate chronic actinic damage due to repeated overexposure to ultraviolet radiation. Individuals are at higher risk of photoaging and skin cancer.

uncommon

malaise, fever, chills, nausea, headache

These systemic manifestations can be associated with severe sunburn.

edema

Edema and vesicles/bullae may also be present. Most sunburns resolve with desquamation.

vesicles/bullae

Edema and vesicles/bullae may also be present. Most sunburns resolve with desquamation.

Risk factors

strong

Fitzpatrick skin type I-III

Skin phototypes may be utilized to classify an individual's risk from both acute and chronic ultraviolet (UV) exposure. These categories are determined by an individual's inherent pigmentation, tendency to burn, and ability to tan.[1] Individuals with skin types I to III and those who are particularly fair-skinned or have red or blond hair consistently exhibit the highest rates of sunburn prevalence, as well as the greatest risk for developing long-term effects of sun exposure, such as skin cancer and photoaging.[2][12]

photosensitizing medications

Both topical and systemic retinoids may decrease tolerance to ultraviolet radiation. Phototoxic reactions are associated with amiodarone, doxycycline, griseofulvin, nonsteroidal anti-inflammatory drugs (NSAIDs), and fluoroquinolones, among others.[9]

intentional tanning

10% of respondents in one large population-based survey reported ≥4 sunburns within 1 year.[2] 70% of respondents in a beach survey stated they were there to get or maintain a suntan.[13]

lack of or improper use of sunscreen

An estimated 50% of the US white population fails to practice appropriate sun protection/avoidance.[14] Moreover, several studies have demonstrated that people use significantly less sunscreen than is necessary to achieve the indicated sun protection factor.[15]

injudicious sun exposure

Other means of exposure include patterns of outside activity during peak hours 10 a.m. to 4 p.m., failure to use sun-protective clothing, and purchase of poor-quality sunscreen.

age under 6 months

Children under 6 months of age are prone to sunburn and should be kept out of direct strong sunlight.[16]

immunosuppression

Immunosuppression related to disease or drugs may reduce resistance to sun-related skin problems.[16]

history of skin cancer

People with a family history of skin cancer may be at higher risk, even if they have darker skin than the family member who had cancer.[16]

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