What is the medical therapy for sunburn skin reactions?

Medical Therapy for Sunburn Skin Reactions

For sunburn skin reactions, the most effective treatment approach involves cooling measures, oral NSAIDs for pain relief, and moisturizers, as topical corticosteroids have limited efficacy in treating sunburn symptoms.

Initial Assessment and Treatment

Severity Assessment

• Evaluate the extent of sunburn (percentage of body surface area affected)
• Assess for signs of severe reaction:
  • Extensive blistering
  • Systemic symptoms (fever, chills, nausea)
  • Dehydration

Immediate Interventions

1. Cooling measures:

   • Cool compresses or cool baths (not ice cold)
   • Apply for 10-15 minutes several times daily
   • Helps reduce inflammation and provides symptomatic relief

2. Pain management:

   • Oral NSAIDs (ibuprofen, naproxen) for both pain relief and anti-inflammatory effects
   • Acetaminophen as an alternative if NSAIDs are contraindicated

3. Hydration:

   • Increase oral fluid intake
   • Monitor for signs of dehydration in severe cases

Topical Treatments

Moisturizers

• Apply alcohol-free moisturizers frequently, preferably with urea 5-10% 1
• Use after cooling measures when skin is still slightly damp
• Reapply several times daily to maintain skin hydration

Topical Corticosteroids

• Evidence regarding efficacy is mixed and limited:
  • Some studies show no significant difference between corticosteroid-treated areas and control areas 2, 3
  • Other research suggests mild benefit with topical glucocorticosteroids like 0.1% methylprednisolone aceponate milk or 0.1% hydrocortisone 17-butyrate 4
• If used, mild potency corticosteroids (hydrocortisone 1%) are preferred for most common skin reactions 1
• Best applied to dry/scaly areas rather than wet/weeping areas

Antihistamines

• Consider oral antihistamines for itch relief 1
• Options include:
  • Non-sedating: fexofenadine 180mg or loratadine 10mg daily
  • Sedating: cetirizine 10mg if sleep is affected

Management Based on Severity

Mild Sunburn (<10% BSA)

• Cooling measures
• Moisturizers
• Oral NSAIDs
• Alternative antihistamines if itching is present 1

Moderate Sunburn (10-30% BSA)

• All treatments for mild sunburn
• Consider adding neuromodulators (gabapentin/pregabalin) for more severe discomfort 1
• More frequent application of moisturizers

Severe Sunburn (>30% BSA or with systemic symptoms)

• All treatments for moderate sunburn
• Consider short course of oral corticosteroids (prednisolone 0.5-1 mg/kg once daily for 3 days, then tapered over 1-2 weeks) 1
• Consider mirtazapine or immunosuppressants 1
• Immediate dermatology referral
• Assess for dehydration and need for IV fluids

Ongoing Care and Prevention

Follow-up

• Reassess after 2 weeks of treatment
• If the reaction worsens or doesn't improve, consider increasing potency of topical treatments or adjusting systemic medication 1

Prevention Strategies

• Avoid skin irritants (hot water, OTC anti-acne medications, chemical irritants) 1
• Use sun protection measures:
  • Sunscreen (SPF 15 or higher)
  • Protective clothing
  • Avoid peak sun hours (10 AM - 4 PM)
  • Seek shade when outdoors 1

Special Considerations

• Elderly patients require special attention due to age-related physiological changes and higher risk of adverse drug reactions 1
• Patients with atopic dermatitis may require more aggressive moisturization and lower-potency steroids 1

Common Pitfalls to Avoid

1. Overreliance on topical corticosteroids - Evidence for their efficacy in sunburn is limited and mixed 2, 4, 3

2. Using ice directly on sunburned skin - Can cause vasoconstriction and potentially worsen tissue damage

3. Applying petroleum-based products immediately after sunburn - May trap heat and worsen symptoms

4. Neglecting adequate hydration - Sunburn draws fluid to the skin surface and away from the rest of the body

5. Failing to recognize signs of infection - Consider bacterial culture if infection is suspected 1

Remember that prevention remains the most effective approach to sunburn management, as the best treatment for sunburn damage is prevention 5.