How to treat first-degree sunburn?

Treatment of First-Degree Sunburn

For first-degree sunburn, immediately cool the affected area with clean running water for 5-20 minutes, then apply aqueous oil-in-water (O/W) emulsions or petrolatum-based products, and manage pain with oral NSAIDs or acetaminophen—topical corticosteroids are not recommended as they provide no clinically meaningful benefit. 1, 2, 3

Immediate Cooling

• Cool the burn with clean running water (15-25°C) for 5-20 minutes to limit tissue damage and reduce pain 1, 4
• Do not apply ice directly to the burn, as this causes further tissue ischemia and damage 1, 4
• Remove any jewelry from affected areas before swelling occurs to prevent constriction 1, 5

Topical Treatment

Apply aqueous emulsions with small amounts of lipids (oil-in-water emulsions) as the preferred topical treatment: 2

• Water evaporates to produce cooling and reduce inflammation 2
• The lipid component accelerates repair of the damaged skin barrier and reduces drying 2
• Foam sprays and lotions are ideal because they are easy and painless to apply 2

Alternative topical agents include: 1, 4

• Petrolatum or petrolatum-based antibiotic ointment (without sulfonamides) 1, 4
• Medical-grade honey 1, 4
• Aloe vera gel 1, 4

Pain Management

• Administer oral NSAIDs or acetaminophen for pain relief 1, 4
• Consider combining both acetaminophen and NSAIDs for multimodal analgesia if pain is significant 4

What NOT to Use

Topical corticosteroids are not recommended for sunburn treatment: 2, 6, 3

• Multiple randomized controlled trials show no significant clinical benefit when applied after UV exposure 6, 3
• A 2008 double-blind RCT found that both moderate-potency and high-potency corticosteroids applied 6 or 23 hours after UV exposure provided no clinically useful decrease in sunburn reaction 3
• Even when applied 30 minutes before UV exposure, only high-potency steroids showed marginal benefit (SIF 1.7), which is not practical for sunburn treatment 3
• Superiority to vehicle alone has not been demonstrated 2

Clinical Course

• First-degree sunburn typically peaks within 12-24 hours after exposure 7
• Natural resolution occurs in approximately 3-5 days 6
• Expect subsequent hyperpigmentation and peeling as part of normal healing 7

Common Pitfalls to Avoid

• Do not use topical corticosteroids—they are ineffective and waste resources 2, 6, 3
• Avoid prolonged cold exposure to large areas, which can cause hypothermia 4
• Do not apply ice directly to burns 1, 4

When to Seek Specialized Care

• Burns involving the face, hands, feet, or genitalia require specialized evaluation regardless of size 1, 5
• If blistering is extensive or signs of second-degree burn develop, reassess management 1, 5