Management of Sunburns by Severity
Immediate First Aid (All Severities)
Cool thermal burns immediately with clean running water for 5-20 minutes, as this is the single most effective intervention to reduce subsequent need for medical care. 1
- Monitor preadolescent children during active cooling for signs of hypothermia 1
- If clean running water unavailable, ice wrapped in cloth may be used for superficial burns with intact skin 1
- Remove jewelry before swelling develops to prevent vascular compromise 1
Severity Classification and Management
Mild Sunburn (First-Degree)
Characteristics: Erythema and pain without blistering, intact skin 1, 2
Investigations:
- None required for isolated mild sunburn 1
Medical Management:
- Over-the-counter NSAIDs (ibuprofen) or acetaminophen for pain control 1
- High-strength topical corticosteroids have minimal clinical benefit when applied after UV exposure and are not recommended 3
Non-Medical Management:
- Apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera to improve healing time 1
- Cover with clean nonadherent dressing 1
- Cool compresses for symptomatic relief 4
- Emollients to maintain skin hydration 5
Moderate Sunburn (Second-Degree, <10% BSA)
Characteristics: Blistering, partial-thickness burns involving <10% body surface area, no mucosal involvement 1
Investigations:
- Clinical assessment of body surface area involvement 1
- Assess for signs of infection if blisters are open 1
Medical Management:
- Over-the-counter analgesics (ibuprofen 800mg or acetaminophen) 1
- Topical petrolatum-based products or honey for open blisters 1
- Oral antihistamines for pruritus 4
Non-Medical Management:
- Loosely cover intact blisters with clean cloth or nonadherent dry dressing 1
- Do not unroof intact blisters 1
- Serial clinical photography for monitoring 1
Severe Sunburn (Second/Third-Degree, ≥10% BSA or Special Sites)
Characteristics: Skin sloughing ≥10% BSA, mucosal involvement, blistering of face/hands/feet/genitals 1
Investigations:
- CBC with differential 1
- Liver and kidney function tests 1
- Urinalysis if systemic symptoms present 1
- Blood cultures if febrile 1
- Skin biopsy if full-thickness necrosis suspected 1
Medical Management:
- Immediate hospital admission to burn center or ICU 1
- IV methylprednisolone 0.5-1mg/kg, convert to oral when responding, taper over ≥4 weeks 1
- IVIG or cyclosporine for steroid-unresponsive cases 1
- Pain management consultation 1
Non-Medical Management:
- Fluid and electrolyte balance management 1
- Minimize insensible water losses 1
- Wound care with topical emollients and petrolatum products 1
- Dimethicone as alternative to petrolatum 1
Critical Indications for Emergency Department Referral
Activate EMS immediately for: 1
- Facial burns, singed nasal hairs, or soot around nose/mouth (inhalation injury risk)
- Difficulty breathing
- Burns involving face, hands, feet, or genitalia
- Partial-thickness burns >10% BSA (>5% in children)
- Any mucosal membrane involvement
- Full-thickness burns of any size
Common Pitfalls to Avoid
- Do not apply topical corticosteroids after UV exposure - they provide no clinically useful benefit when applied 6-23 hours post-exposure 3
- Avoid prolonged cooling in children due to hypothermia risk 1
- Do not delay jewelry removal - must occur before edema develops 1
- Recognize that epidermal cell damage is identical regardless of treatment modality; symptomatic management is the primary approach 6