Excess sun exposure can cause both chronic and acute symptoms. Chronic exposure to the sun causes skin cancer, photoaging, and other lesions (e.g. actinic keratosis). Acute exposure to ultraviolet radiation (UV) can cause sunburn, which can be painful and damaging. A severe reaction to sun exposure is sometimes called “sun poisoning”. Sun poisoning is a term used to describe a very severe sunburn, rash from sun exposure, and other systemic symptoms.
This article provides an overview of sun poisoning, risk factors, prevention strategies, and treatments for healthcare professionals to educate their patients.
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What is Sun Poisoning?
Sunburn can range from mild to severe:
- Mild Sunburn: A mild sunburn appears as redness and slight discomfort, often resolving in a few days.
- Severe Sunburn: This can result in a partial-thickness burn, causing blisters, intense pain, and systemic symptoms (e.g., chills, fever).
Sun poisoning is a severe reaction to excessive sun exposure, often involving:
- Partial-thickness burns
- Rashes triggered by sunlight.
- Systemic symptoms like headache, nausea, fever, chills, and dizziness.
Sun poisoning can cause several skin reactions, including polymorphous light eruption and solar urticaria.
Polymorphous light eruption (PLE) is a skin condition caused by an immune reaction to sun exposure. This condition develops in two stages
- UV Exposure: Sunlight changes a component in the skin, making it appear "foreign" to the immune system.
- Immune Response: T-cells react to the change, causing inflammation.
- Symptoms:
- Red, itchy bumps on areas like the chest, arms, lower legs, and feet (rarely the face).
- Rash develops hours to days after sun exposure and lasts a few days if sun exposure is avoided.
- Seasonal Occurrence: PLE often occurs in spring and summer, and the rash develops hours to days after sun exposure.
- Outcome: This rash often lasts for a few days and then resolves if sun exposure is avoided. PLE does not typically cause long-term scarring.
Solar urticaria is another skin rash that can develop from sun poisoning. This condition is chronic and has a genetic component. It usually does not cause acute illness, but it can diminish a patient's quality of life and is not cosmetically desirable. Solar urticaria is not fully understood, but it is similar to an allergy to sunlight.
- Mechanism:
- UV exposure activates chromophores (compounds in the skin and blood), triggering the release of histamine by mast cells.
- Symptoms:
- Red, itchy, swollen papules (raised area <1cm) within a few minutes of UV exposure.
- Severe cases may include trouble breathing and fainting
Symptoms of Sun Poisoning
Sun poisoning can cause signs and symptoms throughout the body, including:
If excess UV exposure results in a partial-thickness burn with blisters covering large areas of the body, fluid resuscitation may be required. For severe severe burns with widespread blistering, it’s important to promptly seek emergency burn care.
If systemic symptoms such as dizziness, shortness of breath, and fainting are present, immediate medical attention is necessary. Similarly, if rashes like solar urticaria or polymorphous light eruption cause severe discomfort or fail to resolve, consult a healthcare professional for proper evaluation and treatment.
Causes and Risk Factors
The most significant risk factor for sun poisoning is prolonged sun exposure, especially between the hours of 10 am and 2 pm. This is the time of day when the sun’s rays are most intense. Excess sun exposure can also occur in tanning beds because artificial ultraviolet light is intentionally strong to promote tanning.
Certain skin types are more susceptible to sunburn. Fitzpatrick skin types define different risk levels:
- Type 1: Light Caucasian skin that burns easily and does not tan.
- Type 2: Light Caucasian skin that burns often and tans minimally.
- Type 3: Caucasian skin that sometimes burns and tans moderately.
- Type 4: Olive skin tone, burns rarely, and tans easily.
- Type 5: Medium brown skin, burns rarely.
- Type 6: Dark brown or black skin, rarely burns.
Types 1-3 are the greatest risk for sun poisoning, but all skin types can experience skin damage from UV radiation. Polymorphic light eruption is more likely to occur in females ages 20-40 and in high-altitude areas. Solar urticaria and sunburn can be triggered by some medications like atorvastatin (a blood pressure medication), tetracycline (an antibiotic), and oral contraceptives (birth control).
Diagnosing Sun Poisoning
Take a look at the following algorithm to help identify sun poisoning:
Diagnostic Steps
Patient Presents with Sun Exposure Symptoms
↓
Is the skin red and uncomfortable but without blisters or systemic symptoms (e.g., headache, fatigue)?
- Yes → Mild Sunburn: Manage with cooling and hydration.
- No → Continue ↓
Are there blisters or systemic symptoms (e.g., headache, fatigue)?
- Yes → Severe Sunburn: Medical care recommended.
- No → Continue ↓
Is there an itchy rash or red, itchy bumps?
- Yes → Itchy Rash:
- Solar Urticaria: Avoid sun exposure and treat symptoms.
- Polymorphic Light Eruption (PLE): Avoid sun exposure, and consider medical care if severe.
- No → Continue ↓
Are there high fever, nausea, vomiting, confusion, blurred vision, or dehydration?
- Yes → Sun Poisoning: Urgent medical care is required.
Effective Treatments for Sun Poisoning
For mild sunburn or rash without systemic symptoms, treatment includes:
- Cool compress to soothe the skin
- Aloe vera gel to reduce discomfort and promote healing
- Oral hydration to replenish fluids
- Over-the-counter pain relievers to ease pain.
- Avoid further sun exposure to promote healing.
For blisters:
- Open blisters can be covered with moist gauze to prevent infection.
- Intact blisters should not be unroofed (“popped”) to avoid infection or other complications.
For severe sunburn or sun poisoning, medical treatment may involve:
- Intravenous hydration
- Corticosteroids to reduce inflammation.
- Antihistamines to manage symptoms of solar urticaria.
It is important to rest, keep hydrated, and monitor for signs of infection, such as fever, to ensure proper recovery.
Prevention of Sun Poisoning
Prevention is a very important aspect of sun protection. Recommendations for preventing sun poisoning include:
- Avoid sun exposure during peak hours between 10 a.m. and 2 p.m.
- Seek shade to avoid sun exposure.
- Sun-protective clothing, hats, and sunglasses can provide protection. Select clothing with an ultraviolet protection factor (UPF).
- Apply sunscreen that is broad-spectrum, water resistant, and has a sun protection factor (SPF) of at least 30.
- One ounce of sunscreen (a shot glass) is the recommended amount to cover the whole body.
- Reapply sunscreen after sweating, swimming, and after 2 hours of wear.
- Individuals with fair skin (Fitzpatrick types 1-3) and those taking certain medications (e.g. tetracycline) should take extra care to avoid sun exposure.
- Sun protection should be a life-long habit, taking precautions every day is important.
FAQs
Do I need sunscreen in the winter?
Sun protection is important every day of the year, even on cloudy days. UVA rays can penetrate through clouds, damaging the skin even when it is not sunny outside. Sun protection should be used in the winter because UV radiation can reflect off snow, causing greater damage to the skin.
Does a tan protect against sunburn?
There is no such thing as a healthy tan, darkening of the skin is a protective mechanism and a sign that the skin has been injured. A “base tan” does not provide effective sun protection and can give a false sense of security.
Can you get sun-poisoning on cloudy days?
Sun poisoning is a sign of prolonged UV exposure and excessive sun damage. While your skin can get damaged on a cloudy day, sun poisoning is more likely to occur when the UV index is high. However, sun protection and avoidance should be practiced on cloudy days and during every season.
Is sunscreen safe?
The FDA regulates sunscreen as an over-the-counter drug and its ingredients are monitored for safety. The current data does not show that any sunscreen ingredients are harmful to health. The FDA is requesting more studies on certain ingredients to evaluate their safety, but there is no current evidence that these ingredients are unsafe. It is still important to protect yourself from the sun using sunscreen, shade, and protective clothing and hats.
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Key Takeaways
- Excessive sun exposure can cause acute symptoms (sunburn, sun poisoning) and chronic damage (skin cancer, photoaging, actinic keratosis). Severe reactions like sun poisoning may include blisters, rashes, and systemic symptoms such as fever, nausea, and dehydration.
- Sun poisoning is characterized by severe sunburn, blisters, systemic symptoms (e.g., dizziness, chills), or rashes such as polymorphic light eruption (PLE) and solar urticaria. Any severe or systemic symptoms require prompt medical attention.
- Fitzpatrick skin types 1–3 (fair skin that burns easily) are at higher risk of sunburn and sun poisoning. Other risk factors include medication use (e.g., tetracycline, atorvastatin, oral contraceptives), high-altitude exposure, and prolonged UV exposure.
- Mild sunburn involves redness and discomfort without blisters or systemic symptoms. Severe cases involve blisters and systemic symptoms, while rashes (e.g., PLE, solar urticaria) may require specialized treatment. Severe dehydration or burns necessitate emergency care.
- Mild cases can be managed with cool compresses, aloe vera, hydration, and OTC pain relief. Severe cases may require IV fluids, corticosteroids, or antihistamines. Open blisters should be covered but not popped, and infection signs (e.g., fever) should be monitored.
- Prevention is Critical
- Avoid sun exposure during peak hours (10 a.m.–2 p.m.).
- Use broad-spectrum SPF 30+ sunscreen, reapplying every 2 hours.
- Wear sun-protective clothing (UPF-rated), hats, and sunglasses.
- Practice lifelong sun protection, regardless of season or weather conditions.
- Debunk Myths About Sun Protection
- Sunscreen is necessary year-round, even on cloudy days or in winter.
- A "base tan" does not provide adequate protection and signifies skin damage.
- FDA-regulated sunscreen ingredients are safe; protecting against UV damage is essential.
- Healthcare providers should educate patients about recognizing symptoms, mitigating risks, and adopting sun-safe practices.
- Patients should prioritize daily sun protection, monitor skin changes, and seek medical care for severe reactions or prolonged symptoms.
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