Prevention of sunburn involves:
Individuals should be advised to seek shade or reduce exposure to sunlight, particularly in the summer months and between 10:00 AM and 4:00 PM when sunlight intensity is greatest. (Young & Tewari, 2021)
When possible, try to schedule outdoor activities for other times. If unable to do that, limit time in the sun and seek shade when possible (Sunburn, 2020).
Wearing clothes is important for sun protection (Baron, 2021). Protective clothing such as long sleeves and broad-brimmed hats should be worn outdoors (Young & Tewari, 2021). The degree of protection provided by clothes is defined by the ultraviolet protection factor (UPF), which indicates how effective a fabric is at blocking out solar UV radiation (Baron, 2021). Factors that contribute to the UPF rating of a fabric are:
- Color (darker colors are generally better)
- Composition of the yarns (cotton, polyester, etc.)
- Condition (worn and faded garments may have reduced ratings)
- Finishing (some fabrics are treated with UV-absorbing chemicals)
- Moisture (many fabrics have lower ratings when wet)
- Stretch (more stretch lowers the rating)
- Tightness of the weave or knit (tighter improves the rating)
The UPF classification is certified by national and international organizations (e.g., American Sun Protection Association, Skin Cancer Foundation). The categories are UPF:
- 15 to 24 for good protection
- 25 to 39 for very good protection
- 40 to 50 for excellent protection
A garment's photoprotective capacity may also be enhanced by washing with detergents containing optical whitening agents (Baron, 2021). Shrinkage from repeated washing and drying may improve the UPF.
Avoid Sun Tanning and Tanning Beds (Sunburn, 2020)
Getting a base tan does not decrease the risk of sunburn. Intentional tanning by using UVA tanning beds does not protect against the risk of sunburn (Young & Tewari, 2021). Although suberythemal repetitive exposure to UVA increases skin pigmentation (immediate tanning due to oxidation and redistribution of existing melanin), they do not increase melanin production and provide little or no photoprotection against subsequent UV exposures.
Liberal Use of Broad Spectrum Sunscreens
Sunscreens are topical preparations containing filters that reflect or absorb radiation in the UV wavelength range. Broad-spectrum sunscreens are generally combinations of sunscreen products that absorb both UVA and UVB radiation (Baron, 2021).
Broad-spectrum sunscreens with a sun protection factor (SPF) 30 or higher should be regularly used when performing outdoor activities, e.g., recreational, work, sports etc., in sunny weather, especially in regions with high insolation levels (Young & Tewari, 2021). Apply water-resistant sunscreen and lip balm with an SPF of 30 or greater and broad-spectrum protection against UVA and UVB rays (Sunburn, 2020).
Sunscreens should be applied 15 to 30 minutes before sun exposure to allow the formation of a protective film on the skin and reapplied at least every two hours and after swimming or sweating (Young & Tewari, 2021). It is recommended to wait for at least a few minutes (ideally, 10 to 20) following sunscreen application before dressing (Baron, 2021). In the US, the US Food and Drug Administration (FDA) requires the SPF to remain the same before and after water immersion, with the terms "water-resistant" and "very water-resistant," meaning that the SPF is maintained after 40 or 80 minutes of activity in water or sweating, respectively (Young & Tewari, 2021)
Sunscreens demonstrate a reduction in sun damage, squamous cell carcinomas, melanomas, and photoaging if used appropriately (Young & Tewari, 2021). If an individual is also using insect repellent, the sunscreen should be applied first. The American Academy of Dermatology does not recommend insect repellent with sunscreen products (Sunburn, 2020).
The FDA requires all sunscreen to retain its original strength for at least three years (Sunburn, 2020). Check the sunscreen labels for directions on storing and expiration dates. Throw away sunscreen if it has expired or is more than three years old.
Regardless of skin phototype, all individuals are subject to the potential adverse effects of UV radiation and benefit from sunscreen use (Baron, 2021). Sunscreens are beneficial for individuals with light skin (phototypes I, II, and III) who are more susceptible to acute sunburn and chronic (photoaging, skin cancer) adverse effects of excessive sun exposure. Light-skinned individuals should regularly use broad-spectrum sunscreens with an SPF of 30 or higher when performing outdoor activities in sunny weather, especially in regions with a high insolation level. Because individuals typically do not apply sunscreen in the recommended amount (approximately 1 to 1.5 ounces or 6 to 9 teaspoons per total body application), they may benefit from a higher SPF.
Sunscreen products with SPF 15 are generally recommended for daily use. Sunscreen-containing cosmetics (e.g., facial moisturizers, foundations) may improve photoprotection compliance. Most cosmetic products are formulated to provide an SPF of 15 to 30 and may or may not be labeled as a broad spectrum. Cosmetics providing broad-spectrum protection should be preferred to those containing only UVB filters.
The "Teaspoon Rule" (Baron, 2021).
Clinicians should instruct patients to adopt simple application techniques that ensure adequate amounts of sunscreen to the exposed areas. One of these is the so-called "teaspoon rule." It involves the application of:
- Approximately 1 teaspoon (visually measured) of sunscreen to the face and neck area
- A total of 2 teaspoons to the front and back torso
- 1 teaspoon to each upper extremity
- 2 teaspoons to each lower extremity
Benefits of Sunscreen
Skin cancers - There is evidence from observational studies and randomized trials that sunscreens prevent the development of actinic keratoses and squamous cell carcinomas (Baron, 2021). Clinicians counsel patients with sun-sensitive skin must type about sun protection because susceptibility to sunburn is a marker of genetic susceptibility to skin cancer and is associated with an increased risk of melanoma at all ages (Young & Tewari, 2021)
Photoaging- Skin damage from UV exposure accumulates over time. In fair-skinned individuals, a substantial amount of photodamage manifests by age 40. Sunscreens may prevent skin changes such as pigmentation and wrinkling attributable to chronic photodamage or photoaging (Chien & Kang, 2021).
Photodermatoses - Broad-spectrum sunscreens with high SPF are generally used to prevent photodermatoses, which can be elicited by either UVA or UVB (Elmets, 2022).
Protect Eyes - Sun damage to the eyes can happen all year long, especially in sunnier climates. UV-blocking sunglasses should be worn along with broad-rimmed hats when outside. Choose either 99% or 100% UVA and UVB protection or UV 400 protection sunglasses. UV rays also pass through clouds, so it is important to use sun protection even when cloudy. Check the UV rating on the label when buying new glasses. Never look at the sun directly, as this can cause severe damage to the retina even when cloudy. Darker lenses are not necessarily better at blocking UV rays. Wear sunglasses that fit close to the face or have wrap-around frames. Help children and the elderly to protect their eyes with hats and sunglasses.
Protect Infants and Young Children - Infants younger than six months should be kept out of direct sunlight. The American Academy of Pediatrics recommends using other forms of sun protection, such as shade or clothing (e.g., lightweight pants, long-sleeved shirts, brimmed hats) for babies under six months (Sunburn, 2020).
The American Academy of Dermatology recommends avoiding sunscreen products on infants younger than six months (Sunburn, 2020). Keep infants cool, hydrated, and out of direct sunlight. If sun protective clothing and shade are not available, sunscreen should be applied to infants and toddlers (Sunburn, 2020). A minimal amount of sunscreen with at least 15 SPF can be applied to small areas, such as the infant's face and the back of the hands (Baron, 2021).
Since infants have an immature skin barrier, sunscreen products should be non-irritating to the skin and eyes and have a low sensitization potential (Baron, 2021). Products containing physical blockers (titanium oxide, zinc oxide) should be used to cause less skin irritation (Sunburn, 2020). These products are preferred for infants and children because they offer broad-spectrum protection and have minimal irritation, sensitization, and skin penetration potential (Baron, 2021).
Awareness of Sun-sensitizing Medications - Some common prescription and over-the-counter drugs, including antibiotics, retinoids, and ibuprofen, make skin more sensitive to sunlight. A pharmacist or MD should inform the patient about the side effects of their medications (Sunburn, 2020).