What is the treatment for actinic dermatitis in a healthy adolescent?

From the Guidelines

To manage this 13-year-old girl's sunburn, I recommend a combination of cooling measures, pain relief, and hydration. Apply cool compresses to the affected areas for 10-15 minutes several times daily. For pain relief, use over-the-counter ibuprofen (Advil, Motrin) at a dose of 400mg every 6-8 hours with food, or acetaminophen (Tylenol) 650mg every 4-6 hours as needed. Apply aloe vera gel or moisturizing lotion containing aloe to the sunburned areas 3-4 times daily. Ensure she drinks plenty of fluids to stay hydrated. Avoid further sun exposure until the burn heals, and when outdoors, cover affected areas with lightweight, tightly-woven clothing. For future prevention, sunscreen should be reapplied every 2 hours and after swimming or sweating, even with "water-resistant" formulations. The sunburn occurred because water resistance typically lasts only 40-80 minutes, and a single morning application was insufficient. Despite her family's tendency to tan, everyone needs proper sun protection to prevent both immediate damage (sunburn) and long-term risks like premature aging and skin cancer, as noted in guidelines for managing sun damage 1. Some key points to consider in her care include:

• The importance of regular reapplication of sunscreen
• The use of protective clothing to prevent further sun exposure
• Staying hydrated to help the skin heal
• Using pain relief medications as needed to manage discomfort
• Applying aloe vera or moisturizing lotion to soothe the skin It's also important to note that while her family may have a tendency to tan, this does not eliminate the risk of skin cancer or other damage from sun exposure, and proper prevention measures should still be taken, as actinic keratoses are a multifocal manifestation of sun damage 1.

From the FDA Drug Label

Directions for itching of skin irritation, inflammation, and rashes: adults and children 2 years of age and older: apply to affected area not more than 3 to 4 times daily children under 2 years of age: ask a doctor for external anal and genital itching, adults: when practical, clean the affected area with mild soap and warm water and rinse thoroughly gently dry by patting or blotting with toilet tissue or a soft cloth before applying apply to affected area not more than 3 to 4 times daily children under 12 years of age: ask a doctor

The patient is 13 years old, so according to the label, hydrocortisone (TOP) can be applied to the affected area not more than 3 to 4 times daily for itching of skin irritation, inflammation, and rashes 2.

• The patient's symptoms of painful redness and peeling are consistent with sunburn, which can be considered a minor skin irritation.
• Hydrocortisone (TOP) is indicated for temporarily relieving itching associated with minor skin irritations, inflammation, and rashes 2. However, it is essential to note that the labels do not explicitly address the treatment of sunburn. Given the patient's age and symptoms, it is recommended to ask a doctor before applying hydrocortisone (TOP), as the labels do not provide clear guidance for this specific condition 2.

From the Research

Treatment of Sunburn

The patient's symptoms of painful redness on the face and shoulders that has started to peel are consistent with sunburn. The following treatment options have been studied:

• Topical corticosteroids: Studies have shown that topical corticosteroids can be effective in reducing the symptoms of sunburn 3, 4. However, the effectiveness of topical corticosteroids may depend on the timing of application, with one study showing that treatment with topical moderate-potency or high-potency corticosteroids does not provide a clinically useful decrease in the acute sunburn reaction when applied 6 or 23 hours after UV exposure 3.
• Oral nonsteroidal anti-inflammatory drugs (NSAIDs): Some studies have suggested that oral NSAIDs, such as ibuprofen, may be effective in reducing the symptoms of sunburn 5, 6. However, the evidence is not consistent, and one study failed to show the expected superiority of ibuprofen over placebo in reducing erythema and heat pain threshold 6.
• Combination therapy: One study found a synergistic effect of reduction of UVB-induced erythema and skin blood flow with combinations of oral NSAIDs and topical corticosteroids 5.
• Symptomatic treatment: Given the lack of convincing data and consensus of opinion regarding sunburn management, the most effective and practical approach to acute sunburn is symptomatic treatment of UV light-induced symptoms, including erythema, pain, and pruritus 7.

Key Findings

• Topical corticosteroids can be effective in reducing the symptoms of sunburn, but the timing of application may be important 3, 4.
• Oral NSAIDs may be effective in reducing the symptoms of sunburn, but the evidence is not consistent 5, 6.
• Combination therapy with oral NSAIDs and topical corticosteroids may be effective in reducing the symptoms of sunburn 5.
• Symptomatic treatment is a practical approach to managing sunburn, given the lack of convincing data and consensus of opinion regarding sunburn management 7.