Sunburn is a radiation burn to the skin caused by too much exposure to the sun’s ultraviolet (UV) rays or artificial sources such as tanning beds. The biggest risk factors for sunburn is the amount of time the skin is exposed to UV rays, plus the intensity. Many factors such as time of day, medications, ozone depletion, high altitude, clear skies, and skin phototypes influence sunburns. An increase in the number of sunburns someone obtains is directly related to an increase in the risk of skin cancer. Therefore, by fully understanding the cause, treatment, and prevention of sunburns, patients can drastically decrease their risk of skin cancers. This will improve their quality of life. Additionally, by preventing sunburn, patients can reduce the solar effects of aging, which can lead to better cosmetic results.

Sunburn is caused by too much exposure to the ultraviolet radiation from the sun or similar artificial sources such as tanning beds. Many factors contribute to facility and severity of sunburn:

Medications

Sunburn risk is increased by tetracyclines (especially doxycycline), thiazide diuretics, sulfonamides, fluoroquinolones, nonsteroidal anti-inflammatory drugs, retinoids, and St. John's wort amongst other photosensitizing medication.

Increased UV index

• The time between 10 am and 4 pm is when the sun's rays are at their strongest.
• Decreased cloud coverage corresponds with increased exposure to stronger UV rays.
• Higher altitudes are correlated with an increased risk of sunburn due to a smaller layer of the earth's atmospheric protection.
• Proximity to the equator is correlated with more direct UV ray exposure.

Ozone depletion

Certain areas of the world have decreased ozone or holes in the ozone layer. This equates to increased penetrance of the sun's UV rays.

Fitzpatrick skin phototype

The lighter the skin color, the easier it is to sunburn.

According to a cross-sectional study using a nationally representative sample of 31,162 US adults from the 2015 National Health Interview Survey, 34% of respondents reported having at least 1 sunburn in 2015. Prevalence was highest among Fitzpatrick skin types I to III, those in younger age groups (adults 18 to 29 years old), and non-Hispanic white individuals. Additionally, individuals who used tanning lotions, engaged in physical activity, binge drink, and are overweight were also more likely to get sunburned.

Fitzpatrick's Skin Phototypes

• Type I: Pale white skin, burns easily, does not tan
• Type II: White skin, burns easily, tans with difficulty
• Type III: White skin, may burn but tans easily
• Type IV: Light brown/olive skin, hardly burns, tans easily
• Type V: Brown skin, usually does not burn, tans easily
• Type VI: Black skin, very unlikely to burn, becomes darker with UV radiation exposure

As mentioned above, individuals with Type I to III Fitzpatrick skin phototypes were at increased risk for sunburn. This is due to decreased melanin pigment in the skin that blocks UV radiation. People with a lower Fitzpatrick skin phototype have a lower MED, or minimal erythema dose, the amount of UV radiation measured in energy per unit area that leads to erythema of non-diseased skin.

Tanning

Tanning or spending increased amounts of time in the sun to acquire darker skin, has been a popular American pastime for decades. Tanning increases the risk of skin cancers and accelerated skin aging. Rapid tanning may cause sunburn.

The majority of sunburns will heal on their own without any further intervention. However, patients can take the following steps to treat their sunburns:

• Avoid the sun to avoid further skin damage
• Use nonsteroidal anti-inflammatory drugs to decrease pain
• Drink plenty of water to avoid dehydration
• Apply topical creams such as aloe vera or hydrocortisone cream while avoiding local anesthetic creams
• Cool colloidal oatmeal baths may help soothe the skin

If a patient presents with a severe sunburn that leads to large areas of blistering and massive fluid loss with electrolyte imbalances, the use of the Parkland formula for rehydration is indicated. Additionally, the patient should be transferred to a burn unit where specialty care can be provided.

• 4 mL x (body surface area %) x weight (kg) = volume of Ringer's lactate
• Administer one-half of the solution for the first 8 hours. Give the remaining half for the next 16 hours.

Sunburns can range from mild to severe based on the degree of exposure to the sun’s ultraviolet rays. Prevention is easy and straightforward. A broad-spectrum sunscreen with SPF of at least 30 should be applied 30 minutes before sun exposure and every 90 minutes, after that. Water resistant sunscreen should be considered and frequently reapplied when spending time in the water. Sun protective clothing should be worn as an added barrier. Direct exposure to the sun should be avoided between the hours of 10 AM and 4 PM.

The UV Index scale used in the United States conforms with international guidelines for UVI reporting established by the World Health Organization. Learn how to read the UV index Scale to help you avoid harmful exposure to UV radiation.

0 to 2: Low

No protection needed. You can safely stay outside using minimal sun protection.

3 to 7: Moderate to High

Protection needed. Seek shade during late morning through mid-afternoon. When outside, generously apply broad-spectrum SPF-15 or higher sunscreen on exposed skin, and wear protective clothing, a wide-brimmed hat, and sunglasses.

8+: Very High to Extreme

Extra protection needed. Be careful outside, especially during late morning through mid-afternoon. If your shadow is shorter than you, seek shade and wear protective clothing, a wide-brimmed hat, and sunglasses, and generously apply a minimum of SPF-15, broad-spectrum sunscreen on exposed skin.

The Shadow Rule

An easy way to tell how much UV exposure you are getting is to look for your shadow:

• If your shadow is taller than you are (in the early morning and late afternoon), your UV exposure is likely to be lower.
• If your shadow is shorter than you are (around midday), you are being exposed to higher levels of UV radiation. Seek shade and protect your skin and eyes.

Ozone layer depletion decreases our atmosphere’s natural protection from the sun’s harmful ultraviolet (UV) radiation. This page provides an overview of the major health problems linked to overexposure to UV radiation. Understanding these risks and taking sensible precautions will help you enjoy the sun while reducing your chances of sun-related health problems.

Skin Cancer

Each year, more new cases of skin cancer are diagnosed in the U.S. than new cases of breast, prostate, lung, and colon cancer combined. One in five Americans will develop skin cancer in their lifetime. One American dies from skin cancer every hour. Unprotected exposure to UV radiation is the most preventable risk factor for skin cancer.

Melanoma

Melanoma, the most serious form of skin cancer, is now one of the most common cancers among adolescents and young adults ages 15-29. While melanoma accounts for about three percent of skin cancer cases, it causes more than 75 percent of skin cancer deaths. UV exposure and sunburns, particularly during childhood, are risk factors for the disease. Not all melanomas are exclusively sun-related—other possible influences include genetic factors and immune system deficiencies.

Nonmelanoma Skin Cancers

Non-melanoma skin cancers are less deadly than melanomas. Nevertheless, they can spread if left untreated, causing disfigurement and more serious health problems. There are two primary types of non-melanoma skin cancers: basal cell and squamous cell carcinomas. If caught and treated early, these two cancers are rarely fatal.

• Basal cell carcinomas are the most common type of skin cancer tumors. They usually appear as small, fleshy bumps or nodules on the head and neck, but can occur on other skin areas. Basal cell carcinoma grows slowly, and it rarely spreads to other parts of the body. It can, however, penetrate to the bone and cause considerable damage.
• Squamous cell carcinomas are tumors that may appear as nodules or as red, scaly patches. This cancer can develop into large masses, and unlike basal cell carcinoma, it can spread to other parts of the body.

Premature Aging and Other Skin Damage

Other UV-related skin disorders include actinic keratoses and premature aging of the skin. Actinic keratoses are skin growths that occur on body areas exposed to the sun. The face, hands, forearms, and the “V” of the neck are especially susceptible to this type of lesion. Although premalignant, actinic keratoses are a risk factor for squamous cell carcinoma. Look for raised, reddish, rough-textured growths and seek prompt medical attention if you discover them.

Chronic exposure to the sun also causes premature aging, which over time can make the skin become thick, wrinkled, and leathery. Since it occurs gradually, often manifesting itself many years after the majority of a person’s sun exposure, premature aging is often regarded as an unavoidable, normal part of growing older. However, up to 90 percent of the visible skin changes commonly attributed to aging are caused by the sun. With proper protection from UV radiation, most premature aging of the skin can be avoided.

Cataracts and Other Eye Damage

Cataracts are a form of eye damage in which a loss of transparency in the lens of the eye clouds vision. If left untreated, cataracts can lead to blindness. Research has shown that UV radiation increases the likelihood of certain cataracts. Although curable with modern eye surgery, cataracts diminish the eyesight of millions of Americans and cost billions of dollars in medical care each year.

Other kinds of eye damage include pterygium (tissue growth that can block vision), skin cancer around the eyes, and degeneration of the macula (the part of the retina where visual perception is most acute). All of these problems can be lessened with proper eye protection. Look for sunglasses, glasses or contact lenses if you wear them, that offer 99 to 100 percent UV protection.

Immune Suppression

Scientists have found that overexposure to UV radiation may suppress proper functioning of the body’s immune system and the skin’s natural defenses. For example, the skin normally mounts a defense against foreign invaders such as cancers and infections. But overexposure to UV radiation can weaken the immune system, reducing the skin’s ability to protect against these invaders.

Is it true that only people with light skin get skin cancer?

No. Anyone can get skin cancer. It's more common among people with a light (fair) skin tone, but skin cancer can affect anyone. Skin cancer can affect both men and women. Even teenagers and, rarely, younger children can develop skin cancer.

How can people with dark skin get skin cancer?

Although dark skin does not burn in the sun as easily as fair skin, everyone is at risk for skin cancer. Even people who don't burn are at risk for skin cancer. It doesn't matter whether you consider your skin light, dark, or somewhere in between. You are at risk for skin cancer. Being in the sun can damage your skin. Sunlight causes damage through ultraviolet, or UV rays, (they make up just one part of sunlight). Two parts of UV, UVA and UVB, can both cause damage to skin. Also, the sun isn't the only cause of skin cancer. There are other causes. That's why skin cancer may be found in places on the body never exposed to the sun.

How can I find skin cancer early?

• Talk with your doctor if you see any changes on your skin that do not go away within one month.
• Check the skin on all surfaces of your body, even in your mouth.
• Watch for a new mole or other new growth on your skin.
• Check for changes in the appearance of an old growth on the skin or scar (especially a burn scar).
• Watch for a patch of skin that is a different color and becomes darker or changes color.
• Watch for a sore that does not heal – it may bleed or form a crust.
• Check your nails for a dark band. Check with your doctor if you see changes, such as if the dark band begins to spread.

When skin cancer is found early, it can be treated more easily.

What does skin cancer look like?

There are many different types of skin cancer (such as melanoma and basal cell skin cancer). Each type looks different. Also, skin cancer in people with dark skin often looks different from skin cancer in people with fair skin. A change on the skin is the most common sign of skin cancer. This may be any new growth on the skin, a sore that doesn't heal, or a change in an old growth.

If you notice a change on your skin, see your doctor. Don't wait until the change looks like the more advanced skin cancers in these photos.

How can I protect myself from skin cancer?

Have your doctor check your skin if you are concerned about a change.
Your doctor may take a sample of your skin to check for cancer cells.

Ask your doctor about your risk of skin cancer:

• Some skin conditions and certain medicines (such as some antibiotics or hormones) may make your skin more sensitive to damage from the sun.
• Medicines or medical conditions (such as HIV) that suppress the immune system may make you more likely to develop skin cancer.
• Having scars or skin ulcers increases your risk.
• Exposure to a high level of arsenic (a poison that is sometimes found in well water or pesticides) increases your risk.

Stay out of the sun as much as you can. Whenever possible, avoid exposure to the sun from
10 a.m. to 4 p.m. If you work or play outside, then…

• Try to wear long sleeves, long pants, and a hat that shades your face, ears, and neck with a brim all around.
• Use sunscreen with a label that says it is broad spectrum or is at least SPF 15 and can filter both UVA and UVB rays.
• Wear sunglasses that filter UV to protect your eyes and the skin around your eyes.
• If you are concerned about having a low level of vitamin D from not being in the sun, talk with your doctor about supplements.

Don't use tanning beds, tanning booths, or sunlamps.

Fun in the sun will be on everyone’s list of things to do during the spring and summer months, but these are not the only times you should practice protective measures. Keeping yourself and others protected from UV radiation is an important, year-round responsibility.

Ultraviolet (UV) radiation is a form of non-ionizing radiation that is emitted by the sun and artificial sources, such as tanning beds. While it has some benefits for people, including the creation of Vitamin D, it also can cause health risks.

• Our natural source of UV radiation:
  • The sun
• Some artificial sources of UV radiation include:
  • Tanning beds
  • Mercury vapor lighting (often found in stadiums and school gyms)
  • Some halogen, fluorescent, and incandescent lights
  • Some types of lasers

What are the different types of UV radiation rays?

UV radiation is classified into three primary types: ultraviolet A (UVA), ultraviolet B (UVB), and ultraviolet C (UVC). These groups are based on the measure of their wavelength, which is measured in nanometers (nm= 0.000000001 meters or 1×10-9 meters).

All of the UVC and most of the UVB radiation is absorbed by the earth’s ozone layer, so nearly all of the ultraviolet radiation received on Earth is UVA. UVA and UVB radiation can both affect health. Even though UVA radiation is weaker than UVB, it penetrates deeper into the skin and is more constant throughout the year. Since UVC radiation is absorbed by the earth’s ozone layer, it does not pose as much of a risk.

Benefits

Beneficial effects of UV radiation include the production of vitamin D, a vitamin essential to human health. Vitamin D helps the body absorb calcium and phosphorus from food and assists bone development. The World Health Organization (WHO) recommends 5 to 15 minutes of sun exposure 2 to 3 times a week.

Risks

• Sunburn is a sign of short-term overexposure, while premature aging and skin cancer are side effects of prolonged UV exposure.
• Some oral and topical medicines, such as antibiotics, birth control pills, and benzoyl peroxide products, as well as some cosmetics, may increase skin and eye sensitivity to UV in all skin types.
• UV exposure increases the risk of potentially blinding eye diseases, if eye protection is not used.
• Overexposure to UV radiation can lead to serious health issues, including cancer. Skin cancer is the most common cancer in the United States. The two most common types of skin cancer are basal cell cancer and squamous cell cancer. Typically, they form on the head, face, neck, hands, and arms because these body parts are the most exposed to UV radiation. Most cases of melanoma, the deadliest kind of skin cancer, are caused by exposure to UV radiation.

Anyone can get skin cancer, but is more common in people who:

• Spend a lot of time in the sun or have been sunburned.
• Have light-color skin, hair, and eyes.
• Have a family member with skin cancer.
• Are over age 50.

To protect yourself from UV radiation:

• Stay in the shade, especially during midday hours.
• Wear clothes that cover your arms and legs.
• Consider options to protect your children.
• Wear a wide brim hat to shade your face, head, ears, and neck.
• Wear wraparound sunglasses that block both UVA and UVB rays.
• Use sunscreen with sun protection factor (SPF) 15 or higher, for both UVA and UVB protection.
• Avoid indoor tanning. Indoor tanning is particularly dangerous for younger users; people who begin indoor tanning during adolescence or early adulthood have a higher risk of developing melanoma.

Sun safety is always in season. It’s important to protect your skin from sun damage throughout the year, no matter the weather. Why? Sun exposure can cause sunburn, skin aging (such as skin spots, wrinkles, or “leathery skin”), eye damage, and skin cancer, the most common form of cancer in the U.S.

Skin cancer is on the rise in the U.S. The National Cancer Institute estimates there will be 99,780 new cases of skin melanomas and 7,650 related deaths in 2022. In 2019, there were an estimated 1.3 million people living with melanoma of the skin in the U.S. About 4.3 million people are treated for basal cell carcinoma and squamous cell carcinoma, two of the most common types of skin cancer, in the U.S. every year, according to published data from the Centers for Disease Control and Prevention.

The U.S. Food and Drug Administration continues to evaluate sunscreen products to ensure that they are safe and effective. Sunscreens help protect people from sunburn and, for broad spectrum products with sun protection factor (SPF) values of at least 15, from skin cancer and early skin aging caused by the sun when used as directed with other sun protection measures.

As you may have recently heard, certain spray sunscreens have been recalled because of benzene contamination. The FDA recommends that consumers not use recalled sunscreens. Find out here if your sunscreen has been recalled. The FDA continues to monitor the quality of drugs and, when appropriate, encourages retailers to remove products from store shelves and online marketplaces when issues arise. Consumers should continue to use sunscreen, along with other sun protection measures, to reduce risks from sun exposure.

Lower Your Risk for Sunburn, Skin Cancer, and Early Skin Aging

Sun damage to the body is caused by invisible ultraviolet (UV) radiation. Sunburn is a type of skin damage caused by the sun. Tanning is also a sign of the skin reacting to potentially damaging UV radiation by producing additional pigmentation that provides it with some, but often not enough, protection against sunburn.

Spending time in the sun increases your risk of skin cancer and early skin aging. People of all skin colors are at risk for this damage. You can reduce your risk by:

• Limiting your time in the sun, especially between 10 a.m. and 2 p.m., when the sun’s rays are most intense.
• Wearing clothing to cover skin exposed to the sun, such as long-sleeve shirts, pants, sunglasses, and broad-brim hats. Sun-protective clothing is now available. (The FDA regulates these products only if they are intended to be used for medical purposes.)
• Using broad spectrum sunscreens with an SPF value of 15 or higher regularly and as directed. (Broad spectrum sunscreens offer protection against both UVA and UVB rays, two types of the sun’s ultraviolet radiation.)
• Reading the label to ensure you use your sunscreen correctly.
• Consulting a health care professional before applying sunscreen to infants younger than 6 months.

In general, the FDA recommends that you use broad spectrum sunscreen with an SPF of 15 or higher, even on cloudy days. In addition:

• Apply sunscreen liberally to all uncovered skin, especially your nose, ears, neck, hands, feet, and lips (but avoid putting it inside your mouth and eyes).
• Reapply at least every two hours. Apply more often if you’re swimming or sweating. (Read the label for your specific sunscreen. An average-size adult or child needs at least one ounce of sunscreen, about the amount it takes to fill a shot glass, to evenly cover the body.)
• If you don’t have much hair, apply sunscreen to the top of your head or wear a hat.
• No sunscreen completely blocks UV radiation. So other protections are needed, such as protective clothing, sunglasses, and staying in the shade.
• No sunscreen is waterproof.

Currently, only sunscreens in lotion, cream, stick, gel, oil, butter, paste, spray, and powder dosage forms can be legally marketed. Sunscreen in all other dosage forms, including wipes, towelettes, body washes, and shampoos, cannot be legally marketed without further FDA action.

Read Sunscreen Labels

Although UVB rays are the primary cause of sunburn, both UVA and UVB rays contribute to skin cancer. All sunscreens help protect against sunburn. But only those that are broad spectrum and have an SPF of at least 15 have been shown to also reduce the risk of skin cancer and early skin aging caused by the sun when used as directed with other sun protection measures.

Current requirements applicable to sunscreens marketed without approved applications state:

• Only products that pass the FDA’s broad spectrum requirements can be labeled “broad spectrum.”
• Sunscreens that are not broad spectrum or that lack an SPF of at least 15 must carry a warning: “Skin Cancer/Skin Aging Alert: Spending time in the sun increases your risk of skin cancer and early skin aging. This product has been shown only to help prevent sunburn, not skin cancer or early skin aging.”
• Water resistance claims, for 40 or 80 minutes, tell you how much time you can expect to get the labeled SPF-level of protection while swimming or sweating.
• Manufacturers may not make claims that their sunscreens are “waterproof” or “sweat proof.”
• Products may not be identified as “sunblocks” or claim instant protection or protection for more than two hours without reapplying.

Risk Factors for Harmful Effects of UV Radiation

People of all skin colors are potentially at risk for sunburn and other harmful effects of UV radiation, so always protect yourself. Be especially careful if you have:

• pale skin
• blond, red, or light brown hair
• been treated for skin cancer
• a family member who has had skin cancer

If you take medications, ask your health care professional about sun-care precautions. Some medications may increase sun sensitivity. Even on an overcast day, up to 80 percent of the sun’s UV rays can get through the clouds. Stay in the shade as much as possible.

The FDA is committed to ensuring that safe and effective sunscreen products are available for consumer use. Because the body of scientific evidence linking UVA exposure to skin cancers and other harms has grown significantly in recent years, the FDA has proposed a new requirement that all sunscreen products with SPF values of 15 and above must be broad spectrum, and that as the SPF of these products increases, broad spectrum protection increases as well. The FDA also proposed changes to the labeling of SPF values to make it easier for consumers to compare and choose sunscreen, and to raising the maximum proposed SPF value from SPF 50+ to SPF 60+. These and FDA’s other sunscreen-related proposals are described in detail in the 2021 Proposed Order, Amending Over-the-Counter (OTC) Monograph M020: Sunscreen Drug Products for OTC Human Use.

Protect Your Eyes With Sunglasses

Sunlight reflecting off sand, water, or even snow further increases exposure to UV radiation and increases your risk of developing eye problems. Certain sunglasses can help protect your eyes.

When using sunglasses:

• Choose sunglasses with a UV400 rating or “100% UV protection” on the label. These sunglasses block more than 99% of UVA and UVB radiation and provide the most protection against UV rays.
• Do not mistake dark-tinted sunglasses as having UV protection. The darkness of the lens does not indicate its ability to shield your eyes from UV rays. Many sunglasses with light-colored tints – such as green, amber, red, and gray – can offer the same UV protection as very dark lenses.
• Check to see if your tinted glasses have UV protection. If you are unsure, your eye care professional may be able to check for you. When you wear tinted glasses, your pupils dilate and can increase exposure of your retinas to UV light. Without UV protection, you are putting yourself at risk to harmful effects associated with solar radiation.
• Be aware that children should wear sunglasses that indicate the UV protection level. Toy sunglasses may not have UV protection; so be sure to look for the UV protection label.
• Consider large, wraparound-style frames, which may provide more UV protection because they cover the entire eye socket.
• Know that pricier sunglasses don’t ensure greater UV protection.
• Even if you wear UV absorbing contact lenses, wear quality sunglasses that offer UV protection.
• Even when you wear sunglasses, wearing a wide-brim hat and sunscreen can help further protect you from sun exposure.