Treatment of Severe Sunburn
For a severe sunburn, immediately cool the affected area with clean running water for 5-20 minutes, then apply petrolatum-based ointment or aloe vera, cover with a non-adherent dressing, and take oral NSAIDs or acetaminophen for pain control—topical corticosteroids are not effective and should not be used. 1, 2, 3, 4
Immediate Cooling and Initial Management
- Cool the burn with clean running water for 5-20 minutes to limit tissue damage and reduce pain 2
- Remove all jewelry from affected areas immediately before swelling occurs to prevent vascular compromise 1, 2
- Gently clean the wound with tap water, isotonic saline, or antiseptic solution before applying any dressing 2
Topical Treatment
Apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera to the burned areas 1, 2. These create a protective barrier and promote healing without the complications associated with other topical agents.
- For second-degree burns with blistering, apply paraffin gauze as a primary dressing to create a non-adherent barrier that protects the wound while allowing drainage 2
- Cover with a clean, non-adherent dressing 1, 2
- Change dressings every 1-2 days based on wound condition, reassessing for signs of infection at each change 2
Pain Management
Administer oral NSAIDs (ibuprofen) or acetaminophen for pain control 1, 2. These are the most effective treatments for sunburn discomfort, as topical therapies provide minimal benefit.
What NOT to Do: Common Pitfalls
Do not apply topical corticosteroids—multiple high-quality studies demonstrate they provide no clinically meaningful benefit when applied after sun exposure 5, 3, 4, 6
Do not apply ice directly to burns as this causes additional tissue damage 2
Avoid prolonged use of silver sulfadiazine on superficial burns as it may delay healing 2
When to Seek Emergency Care
Seek immediate medical attention if any of the following are present:
- Burns involving the face, hands, feet, or genitalia 1, 2
- Full-thickness burns of any size 1
- Partial-thickness burns covering >10% total body surface area in adults or >5% in children 1, 2
- Signs of inhalation injury: facial burns, difficulty breathing, singed nasal hairs, or soot around nose/mouth 1, 2
Monitoring for Complications
- Watch for signs of infection: increased pain, redness extending beyond burn margins, swelling, or purulent discharge 2
- Do not use prophylactic antibiotics—reserve systemic antibiotics only for clinically evident infections 2
- Monitor urine output (0.5-1 mL/kg/hr) in severe burns 1
- Reassess pain control regularly 1
Natural Course and Expectations
Mild to moderate sunburn typically resolves in 3-5 days without intervention 5. The acute reaction peaks within 12-24 hours after exposure, gradually subsides, and is followed by hyperpigmentation and peeling 7. The damage to epidermal cells is already done at the time of presentation, so treatment is purely symptomatic 6.