What is it?

A sunburn happens when your skin gets too much sun without being properly protected. It often only affects the top layer of skin (first-degree) but can sometimes damage deeper layers causing blisters (second-degree). Even though sunburns generally heal, they can cause damage over time. Repeated sunburns increase your risk for developing skin cancer or scarring over time, so it is important to protect your skin from the sun every day.

Symptoms/Risks

Signs of a sunburn include redness, swelling and pain over the affected area. The area is often warm to the touch and will peel over time. If the sunburn burns deeper layers of the skin, it can cause blisters to form, which can sometimes become infected with bacteria.

Your risk of sunburn is higher if:

1. An athlete spends long hours outside, especially between 10 a.m. and 2 p.m. when the sun is at its peak, even on cloudy days
2. Not enough sunscreen is applied while outdoors
3. An athlete’s skin tone is lighter, which can burn more easily
4. The person is on medications that increase sensitivity to sunlight, such as antibiotics (doxycycline) or acne medication (isotretinoin)

Sports Medicine Evaluation & Treatment

Sunburns do not require any imaging or laboratory test to diagnose. Your doctor will likely ask questions about recent exposures and perform a detailed skin exam.

If you think you have a sunburn, it is important to take steps to treat it as soon as possible:

1. Avoid the sun while your skin is healing. If you will be outside, make sure to cover the sunburn with sunscreen and sun-protective clothing.
2. Apply fragrance-free moisturizing cream to help the area heal twice per day after cleansing. It is important to apply moisturizer every day and reapply after bathing.
3. Ibuprofen can help ease swelling and pain; use it according to the package instructions.
4. Drink plenty of water. A sunburn causes water to escape from your skin.
5. If your skin blisters, avoid touching these areas to protect the blisters from breaking open. Large blisters may require drainage by a healthcare provider.

If you have a large area of sunburn or signs of infection (e.g., fevers, chills, headache, or yellow fluid draining from any blisters) it is important to seek medical care immediately.

Injury Prevention

1. Apply a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher:
   1. At least 15 minutes before going outdoors.
   2. Be sure to apply to important areas such as the nose, ears, face, etc.
   3. Reapply every 2 hours, especially if you are swimming or sweating.
   4. Use sunscreen even on cloudy days because harmful UV rays from the sun can still reach your skin!
2. Wear sun-protective clothing, which includes light-colored long-sleeved shirt and pants with ultraviolet protection factor (UPF).
3. Minimize your time being outside during the sun’s peak hours, which are between 10 a.m. and 2 p.m.

Return to Play

It may take several days before a sunburn is fully healed, typically 5-10 days for first-degree burns and two weeks for second-degree burns.

1. Avoid an immediate return to play if you experience fevers, chills, or other signs of infection until they are fully resolved.
2. For sunburns that cause blistering, return to play after the blisters are gone to avoid worsening the burn.
3. For milder sunburns, you may return to play with enough coverage of the area using sunscreen and sun-protective clothing.

AMSSM Member Authors
M. Atef Kotob, MD, and Christopher Hogrefe, MD

References
McStay CM, Elahl E. Sunburn. Background, Pathophysiology, Etiology. Medscape.com. https://emedicine.medscape.com/article/773203-overview Published November 12, 2019. Accessed September 12, 2020.
Lloyd EC, Rodgers BC, Michener M, Williams MS. Outpatient burns: prevention and care [published correction appears in Am Fam Physician. 2012 Jun 15;85(12):1127]. Am Fam Physician. 2012;85(1):25-32.
Robinson JK. Sun Exposure, Sun Protection, and Vitamin D. JAMA. 2005; 294:1541-43.
Young AR, Tewari A. Sunburn. UpToDate. https://www.uptodate.com/contents/sunburn Published August 2020. Accessed September 12, 2020.