Photoclinic: Second-Degree Sunburn

After spending a day at the beach, a 12-year-old boy presented with a second-degree sunburn and blisters on his shoulders (A). According to his mother, he had used sunscreen. The child was not taking any medications. Except for a significant number of moles, his skin was normal. Bhagwan Das Bang, MD, of Opp, Ala, notes that because the majority of one's lifetime exposure to sunlight occurs by age 18 years, and because sunburn at any age increases the risk of melanoma, sun protection must be emphasized to patients and their parents. Advise parents to begin protecting their children from sun exposure early, preferably in infancy, and to continue year-round. The use of sunscreen with a sun protection factor (SPF) of at least 15 to 30, depending on skin type, that protects against both UV-A (responsible for phototoxic and photosensitive drug reactions) and UV-B is recommended. Advise parents to: •Apply a liberal amount of sunscreen 30 minutes before sun exposure. •Reapply sunscreen every 2 hours. •Use waterproof sunscreen when the child will be in the water, exercising, or sweating. In 1999, the American Academy of Pediatrics recommended that for infants younger than 6 months, sunscreen may be applied to areas such as the face and dorsa of hands that may not be adequately covered by clothing. The incidence of skin cancer--the most common, curable, and preventable form of cancer--is increasing rapidly because of increased longevity and exposure to UV light. Other risk factors for skin cancer include: •Fair skin and light eyes, red or blonde hair. •Tendency to burn easily and tan with difficulty. •Tanning. (This is unhealthful and can induce cancer as well as cause aging and wrinkling; there is no such thing as a healthy tan.) •Many moles (50 or more) and freckles. •A history of sunburn (2 or 3 times in childhood). •Family history of cancer. •Certain genetic disorders, such as xeroderma pigmentosa and erythropoietic protoporphyria. A typical sunburn--erythema that starts 2 to 6 hours after exposure to UV-B and peaks between 12 and 36 hours--resolves within 5 days. Cool compresses, refrigerated topical aloe, and hydrocortisone were applied to this patient's shoulders and back, and he was given ibuprofen for the pain. After a week, the sunburned area had begun to heal (B).