Does The Body Use Protein To Repair Sunburn

Continuing Teaching Activity

A sunburn is caused by excessive exposure to the sun's ultraviolet (UV) rays or by exposure to artificial sources of UV rays such as tanning beds. The biggest adventure factors for sunburn include the duration and intensity of exposure. An increase in the number of sunburns experienced straight correlates to an increased take a chance of skin cancer. This activity reviews the causes, risk factors, and pathophysiology of sunburn and the role of the interprofessional squad in identifying and treating patients with sunburns.

Objectives:

Identify the etiology of sunburns.
Describe the evaluation of a sunburn.
Listing the handling and direction options bachelor for sunburns.
Employ interprofessional team strategies to better care coordination and advice to advance the prevention of sunburns and of the cutaneous malignancies that may effect from them.

Access complimentary multiple pick questions on this topic.

Introduction

Sunburn is a radiation burn to the skin acquired by too much exposure to the sun'due south ultraviolet (UV) rays or artificial sources such as tanning beds. The biggest run a risk factors for sunburn is the corporeality of time the skin is exposed to UV rays, plus the intensity. Many factors such as time of day, medications, ozone depletion, high altitude, clear skies, and pare phototypes influence sunburns. An increase in the number of sunburns someone obtains is directly related to an increase in the risk of skin cancer. Therefore, by fully understanding the crusade, handling, and prevention of sunburns, patients can drastically decrease their run a risk of peel cancers. This will improve their quality of life. Additionally, by preventing sunburn, patients tin reduce the solar effects of crumbling, which can lead to amend cosmetic results.

Etiology

Sunburn is caused by too much exposure to the ultraviolet radiation from the sun or like artificial sources such as tanning beds. Many factors contribute to facility and severity of sunburn:

Medications: Sunburn take chances is increased by tetracyclines (especially doxycycline), thiazide diuretics, sulfonamides, fluoroquinolones, nonsteroidal anti-inflammatory drugs, retinoids, and St. John'south wort amongst other photosensitizing medication [i].
Increased UV index:
- The time between ten am and 4 pm is when the dominicus's rays are at their strongest.
- Decreased cloud coverage corresponds with increased exposure to stronger UV rays.
- Higher altitudes are correlated with an increased gamble of sunburn due to a smaller layer of the earth's atmospheric protection.
- Proximity to the equator is correlated with more direct UV ray exposure.
Ozone depletion: Certain areas of the world have decreased ozone or holes in the ozone layer. This equates to increased penetrance of the lord's day'south UV rays.
Fitzpatrick skin phototype: Please meet epidemiology for more than information. The lighter the peel color, the easier it is to sunburn.
Tanning: Tanning or spending increased amounts of time in the sun to larn darker pare, has been a popular American pastime for decades. Tanning increases the chance of pare cancers and accelerated pare crumbling. Rapid tanning may cause sunburn.

Epidemiology

Co-ordinate to a cross-exclusive written report using a nationally representative sample of 31,162 U.s.a. adults from the 2022 National Wellness Interview Survey, 34% of respondents reported having at least 1 sunburn in 2022. Prevalence was highest amid Fitzpatrick peel types I to 3, those in younger historic period groups (adults 18 to 29 years old), and non-Hispanic white individuals. Additionally, individuals who used tanning lotions, engaged in physical action, binge drink, and are overweight were as well more probable to get sunburned.[2]

Fitzpatrick's Skin Phototypes

Type I: Pale white pare, burns easily, does not tan
Type 2: White peel, burns hands, tans with difficulty
Blazon III: White peel, may fire merely tans easily
Type Four: Light dark-brown/olive skin, hardly burns, tans hands
Type V: Brown skin, usually does not fire, tans easily
Type Half-dozen: Blackness skin, very unlikely to burn down, becomes darker with UV radiations exposure[3]

As mentioned above, individuals with Type I to 3 Fitzpatrick skin phototypes were at increased risk for sunburn. This is due to decreased melanin pigment in the peel that blocks UV radiation. People with a lower Fitzpatrick skin phototype have a lower MED, or minimal erythema dose, the amount of UV radiation measured in energy per unit area that leads to erythema of not-diseased pare.[4][5]

Pathophysiology

UVA and UVB rays both play a role in sunburn, though UVB rays are responsible for direct dissentious DNA by inducing the formation of thymine-thymine cyclobutane dimers.[6] When these dimers are formed, the torso generates a Deoxyribonucleic acid repair response, which includes the induction of apoptosis of cells and the release of inflammatory markers such equally prostaglandins, reactive oxygen species, and bradykinin.[7] This leads to vasodilation, edema, and pain which translates into the classically red, painful skin seen in a sunburn. Additionally, pare exposure to UVB causes an increment in chemokines such equally CXCL5 and activates peripheral nociceptors, which results in over-activation of the pain receptors of the peel.[8][ix]

Histopathology

There are major changes that occur at all levels of the skin that narrate the histology of sunburn, particularly in the epidermis and dermis. In the epidermis, loss of Langerhans cells and vacuolated keratinocytes were noted in sunburned pare cells. The dermis experienced vascular changes that could be seen within thirty minutes of exposure to radiation that included enlargement of endothelial cells and edema acquired by mast cell degranulation. Histamine and prostaglandin E2 levels rose 4-fold afterwards the exposure of UV radiations, providing evidence that histamine plays a part in a sunburn reaction of the skin. This was all reversed subsequently 24 hours from the exposure of UV radiation.[10]

History and Concrete

The history surrounding sunburn typically involves excessive exposure to the sun without sufficient protection. Near patients will state that they either forgot to employ sunscreen, forgot to reapply, did not expect to be out in the sun as long as they were, or did non wearable lord's day-protective habiliment.

On physical examination, there will exist various degrees of erythema and pain that are directly proportional to the severity of lord's day exposure. There may be areas of skin that are unaffected, especially those covered upward by bathing suits, hats, sunglasses, and other protective clothing. Skin may experience warm to the affect, edematous, or pruritic. If the sunburn is severe, patients may feel systemic symptoms such as nausea, fevers, and chills. If blisters are present, it may betoken a deeper, partial thickness burn.

Treatment / Management

The majority of sunburns will heal on their own without whatever farther intervention. However, patients tin can take the post-obit steps to treat their sunburns:

Avoid the sunday to avoid further peel harm
Use Not-steroidal anti-inflammatories to subtract hurting
Drink plenty of water to avoid dehydration
Apply topical creams such as aloe vera or hydrocortisone cream while avoiding local anesthetic creams
Absurd colloidal oatmeal baths may aid soothe the skin

If a patient presents with a severe sunburn that leads to large areas of blistering and massive fluid loss with electrolyte imbalances, the use of the Parkland formula for rehydration is indicated. Additionally, the patient should be transferred to a burn unit where specialty intendance tin can be provided.

4 mL ten (body surface surface area %) x weight (kg) = book of Ringer's lactate
Administrate 1-half of the solution for the beginning 8 hours. Give the remaining half for the next 16 hours.

Differential Diagnosis

The differential diagnosis for sunburn includes:

Autoimmune diseases: Systemic lupus erythematosus, dermatomyositis
Infections: Staphylococcal scalded skin syndrome, cellulitis, erysipelas
Idiopathic: Pityriasis rubra pilaris
Malignancies: Sezary syndrome, other cutaneous lymphomas, a cutaneous manifestation of internal malignancy
Mutual dermatologic diseases: Rosacea, acne, stasis dermatitis, seborrheic dermatitis
Solar reactions: Solar urticaria, phytophotodermatitis, photoallergic type IV sensitivity reactions, phototoxic reactions
Built: Ichtyotic weather condition

Pearls and Other Issues

Sunburns can range from mild to astringent based on the degree of exposure to the sun's ultraviolet rays. Prevention is piece of cake and straightforward. A broad-spectrum sunscreen with SPF of at least thirty should exist applied thirty minutes before sun exposure and every 90 minutes, later on that. Water resistant sunscreen should be considered and frequently reapplied when spending time in the water. Sun protective article of clothing should exist worn as an added bulwark. Direct exposure to the sun should be avoided between the hours of x AM and four PM.

Enhancing Healthcare Team Outcomes

Having a sunburn is a benign condition that commonly heals without further medical intervention. However, an increase in sunburn is directly related to an increase in pare cancer. Medical professionals that include nurses and pharmacists should take the time to educate patients on proper sun protection to help decrease the incidence of sunburn, and therefore decrease the adventure of skin cancer. Patients who have caused many blistering sunburns in the by would do good from a referral to a dermatologist for yearly skin exams.

Occasionally, a sunburn is severe plenty to warrant an inpatient admission to a hospital. This includes baking sunburns that lead to fluid losses and electrolyte imbalances. These patients will require intravenous rehydration with lactated Ringer's and may benefit from a transfer to a burn center.

Review Questions

Effigy

Sunburn. Contributed by DermNetNZ

Figure

Acute sunburn reaction in immature child with erythropoeitic protoporphyria. Contributed by DermNetNZ

References

1.: Guerra KC, Zafar N, Crane JS. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Aug xiv, 2022. Skin Cancer Prevention. [PubMed: 30137812]
2.: Holman DM, Ding H, Guy GP, Watson K, Hartman AM, Perna FM. Prevalence of Dominicus Protection Employ and Sunburn and Association of Demographic and Behaviorial Characteristics With Sunburn Among US Adults. JAMA Dermatol. 2018 May 01;154(5):561-568. [PMC free commodity: PMC5876912] [PubMed: 29541756]
3.: Azevedo M, Bandeira L, Luza C, Lemos A, Bandeira F. Vitamin D Deficiency, Skin Phototype, Sun Alphabetize, and Metabolic Take chances Among Patients with High Rates of Lord's day Exposure Living in the Tropics. J Clin Aesthet Dermatol. 2018 Aug;11(8):15-18. [PMC costless article: PMC6122513] [PubMed: 30214662]
four.: Conant L, Beck KM, Liao West. A Rapid and Price-Effective Device for Testing Minimal Erythema Dose. Dermatol Ther (Heidelb). 2018 Sep;8(3):483-489. [PMC free commodity: PMC6109034] [PubMed: 30097899]
5.: Heckman CJ, Chandler R, Kloss JD, Benson A, Rooney D, Munshi T, Darlow SD, Perlis C, Manne SL, Oslin DW. Minimal Erythema Dose (MED) testing. J Vis Exp. 2013 May 28;(75):e50175. [PMC costless article: PMC3734971] [PubMed: 23748556]
6.: Shih BB, Farrar Doc, Cooke MS, Osman J, Langton AK, Kift R, Webb AR, Berry JL, Watson REB, Vail A, de Gruijl FR, Rhodes LE. Fractional Sunburn Threshold UVR Doses Generate Equivalent Vitamin D and DNA Harm in Peel Types I-VI but with Epidermal DNA Damage Gradient Correlated to Skin Darkness. J Invest Dermatol. 2018 October;138(10):2244-2252. [PMC free article: PMC6158343] [PubMed: 29730334]
seven.: Lopes DM, McMahon SB. Ultraviolet Radiation on the Pare: A Painful Experience? CNS Neurosci Ther. 2016 February;22(ii):118-26. [PMC gratis article: PMC4833175] [PubMed: 26331607]
8.: Dawes JM, Calvo Thousand, Perkins JR, Paterson KJ, Kiesewetter H, Hobbs C, Kaan TK, Orengo C, Bennett DL, McMahon SB. CXCL5 mediates UVB irradiation-induced pain. Sci Transl Med. 2011 Jul 06;3(90):90ra60. [PMC gratis commodity: PMC3232447] [PubMed: 21734176]
9.: Bishop T, Marchand F, Immature AR, Lewin GR, McMahon SB. Ultraviolet-B-induced mechanical hyperalgesia: A function for peripheral sensitisation. Pain. 2010 Jul;150(1):141-152. [PubMed: 20478657]
10.: Gilchrest BA, Soter NA, Stoff JS, Mihm MC. The human sunburn reaction: histologic and biochemical studies. J Am Acad Dermatol. 1981 Oct;5(four):411-22. [PubMed: 7287956]