11.02 Sunburn
=============

agk's Library of Common Simple Emergencies

Presentation: Patients generally seek help only 
if their sunburn is severe. There will be a 
history of extended exposure to sunlight or to 
an artificial source of ultraviolet radiation, 
such as a sunlamp. The burns will be 
accompanied by intense pain and the patient 
will not be able to tolerate anything touching 
the skin. There may be systemic complaints that 
include nausea, chills, and fever. The affected 
areas are erythematous and are accompanied by 
mild edema. The more severe the burn, the 
earlier it will appear and the more likely it 
will progress to edema and blistering.

What to do:
-----------

- Inquire as to whether or not the patient is 
    using a photosensitizing drug (e.g., 
    tetracyclines, thiazides, sulfonamides, 
    phenothiazines) and have the patient 
    discontinue its use.
- Have the patient apply cool compresses of 
    water or Burow's solution (Domeboro Powder 
    Packets---1 pkt in 1 pint of water) as 
    often as desired to relieve pain. This is 
    the most comforting therapy.
- The patient may be helped by applying a 
    topical steroid spray such as dexamethasone 
    (Decaspray) and using an emollient such as 
    Lubriderm.
- With a more severe burn prescribe a short 
    course of systemic steroids (40-60mg of 
    Prednisone qd x 3d). This will reduce 
    inflammation, swelling, pain, and itching.

What not to do:
---------------

- Do not allow the patient to use OTC sunburn 
    medications that contain local anesthetics 
    (benzocaine, dibucaine or lidocaine). They 
    are usually ineffective or only provide 
    very transient relief. In addition there is 
    the potential hazard of sensitizing the 
    patient to these ingredients.
- Do not trouble the patient with unnecessary 
    burn dressings. These wounds have a very 
    low probability of becoming infected. 
    Treatment should be directed at making the 
    patient as comfortable as possible.

Discussion
----------

With sunburn, the onset of symptoms is usually 
delayed for 2-4 hours. Maximum discomfort 
usually occurs after 14-20 hours, and symptoms 
last between 24 and 72 hours. Patients should 
be instructed on the future use of sunscreens 
containing para-aminobenzoic acid (PABA) (e.g., 
Pabanol and PreSun). Prophylactic use of 
aspirin prior to sun exposure has also been 
recommended.

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 from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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 1.202.237.0971 fax 1.202.244.8393 electra@clark.net
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