What are the management options for a patient with sunburn?

Sunburn Management

Immediately cool the sunburn with clean running water for 5-20 minutes, as this is the single most effective intervention to reduce tissue damage and subsequent need for medical care. 1, 2, 3

Immediate First Aid (All Sunburns)

• Apply clean running water for 5-20 minutes as soon as possible after sun exposure to limit tissue damage and reduce pain 1, 2, 3
• Monitor preadolescent children during active cooling for signs of hypothermia, as they are at higher risk 1, 2
• If clean running water is unavailable, ice wrapped in cloth may be used for superficial burns with intact skin only—never apply ice directly to the burn 1, 2
• Remove all jewelry and tight clothing from affected areas before swelling develops to prevent vascular compromise 1, 2, 3

Pain Management

• Administer over-the-counter NSAIDs (ibuprofen 800mg) or acetaminophen for pain control, as these are well-tolerated and generally recommended 1, 2, 3, 4
• NSAIDs provide mild anti-inflammatory effects when used at optimal dosing, though they only modestly reduce erythema 5, 6

Topical Treatment After Cooling

For Small Partial-Thickness Burns (Open Blisters or Deroofed Skin):

• Apply petrolatum or petrolatum-based antibiotic ointment as first-line treatment to promote faster reepithelialization and reduce scar formation 1, 2, 3, 4
• Honey is an effective alternative, showing decreased mean healing time of 7.8 days compared to silver sulfadiazine, with benefits for infection resolution and reduced hypertrophic scarring 1, 4
• Aloe vera may be reasonable for small burns managed at home in non-allergic patients 1, 2, 4
• Cover with a clean, nonadherent dressing (such as Xeroform or Mepitel) and change daily 1, 3, 4

For Intact Skin or Intact Blisters:

• Loosely cover with a clean cloth or nonadherent dry dressing while awaiting evaluation 1, 2
• Apply emollients to maintain skin hydration 2

Critical Pitfalls to Avoid

• Never use silver sulfadiazine as first-line therapy—it delays healing and worsens scarring compared to petrolatum-based treatments 4
• Do not apply ice directly to burns, as this causes additional tissue damage 3, 4
• Do not apply butter, oil, or other home remedies, which can exacerbate injury 3, 4
• Do not break intact blisters, as this significantly increases infection risk 3, 4
• Avoid topical or systemic corticosteroids for routine sunburn management, as they have little to no clinically important effect on the sunburn reaction 5, 6

When to Activate EMS or Seek Specialized Burn Center Care

Immediate Emergency Department Referral Required For:

• Burns involving the face, hands, feet, or genitals (regardless of size)—these require specialized burn center evaluation due to high risk of functional disability and cosmetic deformity 1, 2, 3, 4
• Partial-thickness burns covering >10% body surface area in adults (>5% in children) 1, 2, 3, 4
• Any full-thickness (third-degree) burns 2, 3
• Signs of inhalation injury: facial burns, singed nasal hairs, soot around nose/mouth, or difficulty breathing—these indicate potential airway compromise and carbon monoxide poisoning 1, 2, 3, 4
• Any mucosal membrane involvement 2
• Circumferential burns or signs of vascular compromise (blue, purple, or pale extremities) 4

Common Pitfall:

The American Burn Association emphasizes that burns to special anatomic sites (face, hands, feet, genitals) warrant burn center referral even if small, as these frequently require surgical intervention to prevent permanent disability 1. Many clinicians underestimate the need for specialized care based solely on burn size.

Monitoring and Follow-Up

• Reassess burns every 3 days for progression or improvement 1
• Serial clinical photography may be used for monitoring moderate burns 2
• Watch for signs of infection in open wounds: increased pain, purulent drainage, expanding erythema, or fever 2