Current literature documents the use of many pharmacologic agents in the management of acute sunburn. While numerous studies have been undertaken, there is no consensus on an algorithm for such treatment. We review the literature for an evidence-based approach to the management of sunburn. A MEDLINE search was conducted whereby all published articles related to sunburn or ultraviolet (UV)-induced erythema from 1966–2001 were evaluated. Studies and reviews were excluded if they were not conducted in human beings. The results of these studies are varying and often conflicting in terms of clinical effectiveness or feasibility. A total of 40 studies were reviewed. Fourteen out of the 40 studies addressed the actual treatment of sunburn (i.e. the application of a substance after the development of signs or symptoms). The majority concluded that either corticosteroids, NSAIDs, antioxidants, antihistamines or emollients were ineffective at decreasing recovery time. The remaining studies showed mild improvement with such treatments, but study designs or methods were flawed. Furthermore, regardless of the treatment modality, the damage to epidermal cells is the same. Given the lack of convincing data and consensus of opinion regarding sunburn management, the most effective and practical approach to acute sunburn is symptomatic treatment of UV light-induced symptoms, including erythema, pain and pruritus.
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The authors received no funding for the preparation of this manuscript. They have provided no information as to conflicts of interest directly relevant to the content of this review.
Rapaport MJ, Rapaport V. Preventive and therapeutic approaches to short- and long-term sun damaged skin. Clin Dermatol 1998; 16: 429–39PubMedCrossRefGoogle Scholar
Ferrini RL, Perlman M, Hill L. American college of preventive medicine practice policy statement: skin protection from ultraviolet light exposure. Am J Prev Med 1998; 14: 83–6PubMedCrossRefGoogle Scholar
Bickers DR. Photosensitivity and other reactions to light. In: Braunwald E, editor. Harrison’s principles of internal medicine. Vol. 15. New York: McGraw-Hill, 2001: 342–8Google Scholar
Hruza L, Pentland A. Mechanisms of UV-induced inflammation. J Invest Dermatol 1993; 100: 35S-41SCrossRefGoogle Scholar
Walsh L. Ultraviolet B irradiation of skin induces mast cell degranulation and release of tumor necrosis factor-alpha. Immunol Cell Biol 1995; 73: 226–33PubMedCrossRefGoogle Scholar
Gilchrest B, Soter N, Stoff J, et al. The human sunburn reaction: histologic and biochemical studies. J Am Acad Dermatol 1981; 5: 411–22PubMedCrossRefGoogle Scholar
la Ruche G, Cesarini J. Protective effect of oral selenium plus copper associated with vitamin complex on sunburn cell formation in human skin. Photodermatol Photoimmunol Photomed 1991; 8: 232–5PubMedGoogle Scholar
Eberlein-Konig B, Placzek M, Przybilla B. Protective effect against sunburn of combined systemic ascorbic acid (vitamin C) and d-alpha-tocopherol (vitamin E). J Am Acad Dermatol 1998 Jan; 38: 45–8PubMedCrossRefGoogle Scholar
Rhodes L, Durham B, Fraser W, et al. Dietary fish oil reduces basal and ultraviolet B generated PGE2 levels in skin and increases the threshold to provocation of polymorphic light eruption. J Invest Dermatol 1995; 105: 532–5PubMedCrossRefGoogle Scholar
Greenwald JS, Parrish JA, Jaenicke KF, et al. Failure of systemically administered corticosteroids to suppress UVB-induced delayed erythema. J Am Acad Dermatol 1981; 5: 197–202PubMedCrossRefGoogle Scholar
Sukanto H, Nater JP, Bleumink E. Suppression of ultraviolet erythema by topical steroids. Dermatologica 1980; 161: 84–8PubMedCrossRefGoogle Scholar
Vaananen A, Hannuksela M. UVB erythema inhibited by topically applied substances. Acta Derm Venereol 1989; 69: 12–7PubMedGoogle Scholar
Morison W, Paul B, Parrish J. The effects of indomethacin on long-wave ultraviolet-induced delayed erythema. J Invest Dermatol 1977; 68: 120–33CrossRefGoogle Scholar
Edwards Jr E, Horwitz S, Frost P. Reduction of the erythema response to ultraviolet light by nonsteroidal antiinflammatory agents. Arch Dermatol Res 1982; 272: 263–7PubMedCrossRefGoogle Scholar
Miller W, Ruderman F, Smith Jr J. Aspirin and ultraviolet light-induced erythema in man. Arch Dermatol 1967; 95: 357–8PubMedCrossRefGoogle Scholar
Anderson T, Peterson C, Hamilton T. Meclofenomate inhibition of UV-induced erythema: a randomized, placebo-controlled, double blind study. Photodermatology 1989; 6: 63–8PubMedGoogle Scholar
Hughes G, Francom S, Means L, et al. Synergistic effects of oral nonsteroidal drugs and topical corticosteroids in the therapy of sunburn in humans. Dermatology 1992; 184: 54–8PubMedCrossRefGoogle Scholar
Farr P, Diffey B, Humphreys F. A quantitative study of the effect of terfenadine on cutaneous erythema induced by UVB and UVC radiation. J Invest Dermatol 1986; 87: 771–4PubMedCrossRefGoogle Scholar
Werninghaus K, Meydani M, Bhawan J, et al. Evaluation of the photoprotective effect of oral Vitamin E supplementation. Arch Dermatol 1994; 130: 1257–61PubMedCrossRefGoogle Scholar
Gamryn M, Ribaya-Mercado J, Russel R, et al. Effect of beta-carotene supplementation on the human sunburn reaction. Exp Dermatol 1995; 4: 104–11CrossRefGoogle Scholar
Bangha E, Elsner P, Kistler G. Suppression of UV-induced erythema by topical treatment with melatonin (N-acetyl-5-methoxytryptamine): influence of the application time point. Dermatology 1997; 195: 248–52PubMedCrossRefGoogle Scholar
Schleider NR, Moskowitz RS, Cort DH, et al. Effects of emollients on ultraviolet-radiation-induced erythema of the skin. Arch Dermatol 1979; 115: 1188–91PubMedCrossRefGoogle Scholar
Farr P, Diffey B. A quantitative study of the effect of topical indomethacin on cutaneous erythema induced by UVB and UVC radiation. Br J Dermatol 1986; 115: 453–66PubMedCrossRefGoogle Scholar
Edwards Jr E, Edwards E. The effect of antihistamines on ultraviolet-light-induced erythema. Int J Dermatol 1983; 22: 540–1PubMedCrossRefGoogle Scholar
Schaffler K, Beckers C, Unkauf M, et al. Dimethindene maleate in the treatment of sunburn. Arzneimittel Forschung 1999; 49: 374–9PubMedGoogle Scholar
Moseley H, MacFadyen E, Ferguson M, et al. Reduction of UV-induced erythema in normal subjects by applying methimazole. Photodermatology 1989; 6: 32–6PubMedGoogle Scholar
Crowell J, Hilsenbeck S, Penneys N. Aloe vera does not affect cutaneous erythema and blood flow following ultraviolet B exposure. Photodermatology 1989; 6: 237–9PubMedGoogle Scholar
Bangha E, Elsner P, Kistler G. Suppression of UV-induced erythema by topical treatment with melatonin (N-acetyl-5-methoxytryptamine): a dose response study. Arch Dermatol Res 1996; 288: 522–6PubMedCrossRefGoogle Scholar
Driscoll MS, Wagner RF. Clinical management of the acute sunburn. Cutis 2000; 66: 53–8PubMedGoogle Scholar