Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

all patients

1st line – supportive treatments

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1st line – 

supportive treatments

Supportive treatment promotes skin healing.

Despite widespread use, emollients have been subject to limited study in relation to their efficacy in sunburn treatment. Emollients have not been shown to decrease recovery time from acute sunburn.[16]

Petrolatum may retain heat, leading some to argue against its use in acute burns, although occlusive ointments have been demonstrated to speed wound healing.[14]

Aqueous creams may ameliorate desquamation and pain associated with therapeutic radiation.[30]

There is no clinical evidence to support the use of aloe vera over other emollients, as aloe vera has been shown to produce no significant improvement in post-exposure erythema or healing and may be associated with contact dermatitis.[31][32] However, given its limited side effect profile and symptomatic benefits, this treatment should be reserved for a second-line intervention.

Symptomatic measures, such as cool compresses or baths ± colloidal oatmeal to promote skin cooling and reduction in inflammation, are widely employed. Limited evidence is available for these interventions.

Primary options

emollient topical: apply to the affected area(s) three times daily

Plus – ongoing prevention + sunscreen

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Plus – 

ongoing prevention + sunscreen

Treatment recommended for ALL patients in selected patient group

Despite controversy, sunscreen remains the most frequently used method of prevention of sunburn across all age groups.[36] UVB radiation is the primary cause of sunburn. UVB and UVA radiation (including UVA2, blocked by most sunscreens, and UVA1, blocked by select sunscreens) can contribute to skin cancer and skin aging. Therefore, for most purposes, any broad-spectrum UVA/UVB sunscreen is sufficient to protect against sunburn, provided that it is used properly. However, many commercially available sunscreens do not provide full UVA protection.

The best sunscreen agents target the entire spectrum of UVA and UVB radiation. These include the inorganic physical ultraviolet (UV) blocker zinc oxide and the organic chemical UV-absorbing sunscreens avobenzone and ecamsule.[37] Titanium dioxide is also widely used as an inorganic UV blocker but has a decreased spectrum of UVA blocking compared with zinc oxide.

Because organic sunscreens can be absorbed, zinc oxide is generally recommended for protection of young children.

Controversy over the potential of micronised zinc oxide to generate superoxide anions has so far not been supported by in-vivo studies demonstrating that superoxide anions can penetrate the stratum corneum to cause damage.

The use of protective apparel such as long-sleeved shirts (tightly woven material provides best UV protection) and wide-brimmed hats should be encouraged. Clothing with UV protection ratings as well as laundering agents such as bis-ethylhexyloxyphenol methoxyphenyl triazine that improve a fabric's ability to shield the skin from sunlight are commercially available.[40]

Consider – analgesics/topical anaesthetics

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Consider – 

analgesics/topical anaesthetics

Additional treatment recommended for SOME patients in selected patient group

Analgesia can alleviate sunburn-related discomfort and systemic symptoms.

Non-steroidal anti-inflammatory drugs (NSAIDs) are thought to be effective in treating sunburn reactions via their inhibition of prostaglandin inflammatory mediators.

Although studies have shown systemic and topical NSAIDs can decrease ultraviolet-induced erythema, these reductions are typically mild and transient and require use of the medicine before or immediately after exposure.[16][29]

Pramocaine is a topical anaesthetic that can be used second line, although it may cause contact dermatitis.[33]

Primary options

indometacin: 25 mg orally (immediate-release) three times daily when required, maximum 200 mg/day

OR

ibuprofen: 300-400 mg orally every 6-8 hours when required, maximum 2400 mg/day

OR

paracetamol: 500-1000 mg orally every 4-6 hours when required, maximum 4000 mg/day

Secondary options

pramocaine topical: (1%) apply to the affected area(s) three times daily when required

Consider – aluminium acetate compresses

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Consider – 

aluminium acetate compresses

Additional treatment recommended for SOME patients in selected patient group

Aluminium acetate compresses should be applied twice daily prior to application of emollients for 15 to 30 minutes.

Aluminium acetate is astringent with antiseptic properties. It can be used to help dry and heal areas of blistering.

Consider – consider hospitalisation + intravenous fluids

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Consider – 

consider hospitalisation + intravenous fluids

Additional treatment recommended for SOME patients in selected patient group

Very young children with greater than 10% body surface area (BSA) coverage and adults with greater than 15% to 25% BSA blistering and those with systemic symptoms should be considered for hospitalisation for intravenous fluids and supportive care.[34][35]

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Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

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