History and exam
Key diagnostic factors
common
presence of risk factors
Key risk factors include Fitzpatrick skin type, photo-sensitising medication, intentional tanning, and lack of or improper use of sunscreen.
sun exposure
Factors such as previous exposure, daytime exposure, and knowledge of risks should be determined.
lack of sun protection
Factors such as sun protection methods, clothing worn, and knowledge of risks should be determined.
skin discomfort
Skin tightness and a burning sensation are characteristic features.
pruritus
Pruritus and tenderness are common, as is the sensation of increased warmth radiating from the skin.
skin tenderness
Pruritus and tenderness are common, as is the sensation of increased warmth radiating from the skin.
sensation of warmth
Pruritus and tenderness are common, as is the sensation of increased warmth radiating from the skin.
erythema
Erythema localised to sun-exposed areas is the hallmark of sunburn. Signs and symptoms of sunburn may begin 2 to 4 hours after severe ultraviolet over-exposure. Erythema peaks by 12 to 24 hours, but pain, discomfort, and other symptoms may have a longer time course.
Other diagnostic factors
common
chronic actinic damage
Photo-distributed freckling and lentigos, with or without diffuse scaly erythematous actinic keratoses, indicate chronic actinic damage due to repeated over-exposure to ultraviolet radiation. Individuals are at higher risk of photo-ageing and skin cancer.
uncommon
malaise, fever, chills, nausea, headache
These systemic manifestations can be associated with severe sunburn.
oedema
Oedema and vesicles/bullae may also be present. Most sunburns resolve with desquamation.
vesicles/bullae
Oedema and vesicles/bullae may also be present. Most sunburns resolve with desquamation.
Risk factors
strong
Fitzpatrick skin type I-III
Skin phototypes may be utilised to classify an individual's risk from both acute and chronic ultraviolet (UV) exposure. These categories are determined by an individual's inherent pigmentation, tendency to burn, and ability to tan.[1] Individuals with skin types I to III and those who are particularly fair-skinned or have red or blond hair consistently exhibit the highest rates of sunburn prevalence, as well as the greatest risk for developing long-term effects of sun exposure, such as skin cancer and photo-ageing.[7][17]
photo-sensitising medications
Both topical and systemic retinoids may decrease tolerance to ultraviolet radiation. Photo-toxic reactions are associated with amiodarone, doxycycline, griseofulvin, non-steroidal anti-inflammatory drugs (NSAIDs), and fluoroquinolones, among others.[14]
intentional tanning
lack of or improper use of sunscreen
injudicious sun exposure
Other means of exposure include patterns of outside activity during peak hours 10 a.m. to 4 p.m., failure to use sun-protective clothing, and purchase of poor-quality sunscreen.
age under 6 months
Children aged younger than 6 months are prone to sunburn and should be kept out of direct strong sunlight.[21]
immunosuppression
Immunosuppression related to disease or drugs may reduce resistance to sun-related skin problems.[21]
history of skin cancer
People with a family history of skin cancer may be at higher risk, even if they have darker skin than the family member who had cancer.[21]
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