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EJ40
1.3.3 Sunburn
Grading & Level of Importance: A
ICD-11
Synonyms
Solar dermatitis.
Epidemiology
Very often to be observed during leisure time and vacation in sun rich areas, i.e. when no or inappropriate sun protection is available or used.
Definition
Acute toxic photo- dermatitis caused by electromagnetic radiation in UVB range (280-320 nm). Unphysiologically high UVA doses can elicit an erythema too.
Aetiology & Pathogenesis
Acute dermatitis caused by erythematogenic doses of UVB radiation, more common in fair-skinned patients (Fitzpatrick skin types I-II). More severe cases result in release of proinflammatory cytokines (IL-6) and prostaglandins (PGE2), leading to systemic symptoms.
Signs & Symptoms
Short after overexposure to UVB prickling, itching and burning. Depending on dose and exposure time and latitude within 12 to 24 hours erythema. In severe courses with blistering and pain. Fever.
Localisation
In areas exposed to light.
Classification
1st degree: burning, erythema, desquamation.
2nd degree: blisters, weeping, crusts.
Rarely 3rd degree: necrosis.
Laboratory & other workups
Unremarkable. Increased CRP.
Dermatopathology
Apoptosis and necrosis of epidermal keratinocytes. Langerhans cell dysfunction and decrease in numbers. Edema. Submicroscopically mutations by cyclobutan dimers.
Course
Highly variable clinical appearance (just as in acute dermatitis): erythema, vesicles or blisters, weeping, crusts, scales. When severe, fever and malaise. Complete spontaneous healing.
Complications
Frequent sunburns, especially in childhood, lead to increased numbers of melanocytic naevi and an increased risk of malignant melanoma later in life.
Diagnosis
By case history and clinical picture.
Differential diagnosis
Prevention & Therapy
Within the first 12 hours nonsteroidal anti-inflammatory drugs and class 3 antihistamines with effects on leucotrienes combined. Cooling topical agents (lotions, cold creams), wet dressings, later topical or systemic corticosteroids. Fluid.
Special
Solar injury to brain with complications and edema need hospitalization especially in children.
Differential Diagnosis
Podcasts
Tests
- Which of the following answers is associated with an increased risk for dermatitis solaris?
- Which treatments are appropriate for sunburn?
- Which therapy is appropriate for sunburn?
- Which clinical feature is not seen with sunburn?
- Which statements apply to sunburn?
- When is the risk of sunburn raised?
- What is required to diagnose severe sunburn?
- Which treatments are appropriate for sunburn?
- Statement 1 After a sunburn, UV exposure should be avoided until complete healing has occurred
- Statement 1 Widespread sunburn with blisters should be treated in the hospital
- After what time interval does sunburn reach its maximum clinical severity?
- Which therapy is appropriate for sunburn?
- Which clinical feature is not seen with sunburn?
- Which statements apply to sunburn?
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