Sunburn is an acute skin inflammation following overexposure to UV radiation. Redness (erythema), warmth, oedema (accumulation of fluid), and tenderness to the touch are characteristic of sunburn, with pain and blistering characteristic of severe sunburn. Whole of body sunburn may result in systemic symptoms such as headaches and nausea.
Sunburn is influenced by a variety of factors, including skin type, skin hydration, age and anatomical site (skin thickness and previous UV exposure). Environmental factors include UV wavelength and dose, geographical factors (altitude, latitude, time of day), presence of UV reflective surfaces (e.g. snow, water) and climatic factors (wind, temperature, humidity).
UV radiation: wavelength and dose
Sunburn is a product of total UV radiation dose and is equally likely to result from both a high UV dose and from exposure to lower levels of UV radiation over an extended period of time. The smallest dose, causing a perceptible erythema (reddening of the skin) 24 hours after exposure, is referred to as the minimal erythema dose (MED). The standardised measurement of an erythemogenic dose of UV radiation is the standard erythema dose (SED). One SED is equivalent to an exposure of 100J/m2 and is independent of skin type. Therefore the same exposure dose in SED that causes erythema in fair skin may have no effect on darker skin. Although UVB is a thousandfold more effective in producing sunburn than UVA, because solar energy reaching the earth is primarily UVA (315 – 400nm), it also has an important contribution to sunburn and other harmful effects of UV radiation. Shorter wavelengths of UVA (315-340nm) are more erythemogenic than the remainder of the UVA waveband.
Although sunburn can occur in both fairly and darkly pigmented individuals, skin type determines how susceptible an individual is to sunburn. Moderately pigmented skin requires 3-5 times the exposure, and darkly pigmented skin up to 30 times the exposure, compared with the amount of time required to induce sunburn in those with fair pigmentation. As defined by the Fitzpatrick skin phototype classification (see Table 1), skin types IV-VI are unlikely to experience sunburn following excess UV radiation exposure.
Table 1: Fitzpatrick skin phototypes I-VI  (as adapted by ARPANSA)
|I||Always burns, never tans (pale white skin)|
|II||Always burns easily, tans minimally(white skin)|
|III||Sometimes mild burn, tans about average (light brown skin)|
|IV||Rarely burns, tans more than average (with ease) (moderate brown skin)|
|V||Rarely burns, tan more than average (with ease) (dark brown skin)|
|VI||Never burns (deeply pigmented dark brown or black skin)|
Sunburn duration is also a function of skin type. Immediate UVB-induced sunburn can occur in individuals with skin types I and II, but usually the sunburn response is delayed until six to 24 hours after exposure. Therefore, it is at this 24-hour endpoint that sunburn is clinically defined. UVB-induced sunburn may last for one to two weeks for fair skin types I and II, while for skin type V individuals it may disappear as soon as three days after exposure. UVA sunburn shows immediately, fading then reappearing after six hours and peaking at 24 hours, or even longer.
Sunburn may be followed by desquamation (skin peeling) and, depending on skin type, tanning. Certain medications - including some antibiotics, antihistamines, cardiovascular drugs, diuretics, antidiabetic drugs, and antidepressants - can increase photosensitivity, which makes people more susceptible to sunburn.
Sunburn in Australia
Sunburn can occur in as little as 15 minutes on a fine January day in Australia. Since UVR passes easily through water, swimming in either the sea or open-air pools offers little protection against sunburn.
The latest national data for adolescents and adults show that approximately one in four adolescents and one in six adults were sunburnt on a summer weekend when they were outdoors. There has been no significant change in the level of weekend sunburn during peak UV radiation times among adolescents from 2003 – 2017, and no improvement in sunburn rates among adults from 2013-14 to 2016-17 (currently 17%).
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