What is the management for severe sunburn to the legs?

From the Guidelines

Severe sunburn to the legs should be treated with immediate cooling using running water, followed by pain management with over-the-counter medications, hydration, and skin care with petrolatum or aloe vera. The management of severe sunburn involves several key components to reduce morbidity, mortality, and improve quality of life.

• Cooling measures: According to the 2024 American Heart Association and American Red Cross guidelines for first aid 1, cooling of burns with running water is an established and beneficial intervention with little risk of harm.
• Pain management: Over-the-counter pain medications such as ibuprofen or naproxen can be used to reduce inflammation and pain 1.
• Hydration: Drinking plenty of fluids is essential to prevent dehydration.
• Skin care: After cooling, applying petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera and a clean nonadherent dressing to open burn wounds may be reasonable 1. For blistered areas, it is recommended to loosely cover the burn with a clean cloth or nonadherent dry dressing 1. It is crucial to avoid breaking blisters as this increases infection risk. Staying out of the sun until healing occurs and using loose cotton clothing can help minimize irritation. If the sunburn is accompanied by fever over 102°F, extensive blistering, severe pain, signs of infection, or symptoms of heat exhaustion, seeking medical attention immediately is necessary. These treatments work by reducing inflammation, cooling damaged tissue, maintaining skin barrier function, and supporting the body's natural healing processes.

From the FDA Drug Label

Prompt institution of appropriate regimens for care of the burned patient is of prime importance and includes the control of shock and pain. The burn wounds are then cleansed and debrided; silver sulfadiazine cream, USP 1% is then applied under sterile conditions. The burn areas should be covered with silver sulfadiazine cream, USP 1% at all times The cream should be applied once to twice daily to a thickness of approximately one sixteenth of an inch.

The management for severe sunburn to the legs includes:

• Cleansing and debridement of the burn wounds
• Application of silver sulfadiazine cream, USP 1% under sterile conditions
• Covering the burn areas with the cream at all times
• Applying the cream once to twice daily to a thickness of approximately one sixteenth of an inch
• Reapplying the cream after hydrotherapy or whenever necessary 2

From the Research

Management of Severe Sunburn to the Legs

The management of severe sunburn to the legs involves several approaches, including:

• Symptomatic treatment with adequate pain control until the sunburn naturally resolves 3, 4
• Use of topical corticosteroids, although their effectiveness is debated, with some studies showing little or no significant difference in response between steroid-treated areas and inert-base-treated areas 5, 3
• Application of nonsteroidal anti-inflammatory drugs (NSAIDs), which may result in an early and mild reduction of ultraviolet B-induced erythema, but have limited overall effect 3, 6
• Consideration of combination therapies, such as oral NSAIDs and topical corticosteroids, which may have a synergistic effect in reducing UVB-induced erythema and skin blood flow 6

Treatment Options

Some treatment options that have been studied include:

• Topical corticosteroids, such as fluocinolone cream 5
• Systemic and topical nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and indomethacin 3, 6
• Aloe vera cream, although one study found it to have no efficacy in sunburn treatment or prevention 7
• Emollients, antihistamines, and antioxidants, although their effectiveness is also debated 4

Important Considerations

It is essential to note that:

• The damage to epidermal cells caused by sunburn is the same regardless of the treatment modality 4
• There is no consensus on an algorithm for the treatment of sunburn, and the results of studies on various treatments are often conflicting 4
• The most effective and practical approach to acute sunburn may be symptomatic treatment of UV light-induced symptoms, including erythema, pain, and pruritus 3, 4