Burns and Sunscreen

Question 1

When doing a patient assessment for burns, what should be considered?

Answer 1

Burn depth
-Superficial (1st degree), superficial partial thickness or deep partial thickness (2nd degree), full thickness (3rd degree)
-Self treat or refer?
Location (face, ears, arms, hands, feet?)
Burn surface area (the larger the burn, the more severe is the fluid loss)
Causative agent
-Chemical? Electrical? Thermal? Radiation?
-The higher the temperature and the longer the exposure, the more damage to the skin
Pre-burn medical status (immunocompromised? diabetic?)

Question 2

What are the different causes of burns?

Answer 2

Thermal (flames, flaming liquids, flammable liquids (gel candles), hot objects (irons), hot gases (steam)
Chemical (caustic, acids, phenols)
Radiation (sun, UV lamps, microwaves, lasers, radioactive)
Electrical (home appliances, lightning, work place)

Question 3

Describe 1st degree burns

Answer 3

Affects the epidermis (outer layer)
Typically occurs with a sunburn
Appearance: dry, red blanches with pressure, pink/redness at burn site, pain that lasts from 48-72 hours, no blisters, mild skin peeling
Time to heal: 3 to 6 days

Question 4

Describe 2nd degree burns

Answer 4

Superficial partial thickness: affects the epidermis and upper sections of the dermis
Appearance: moist weeping red blisters, blances with pressure, painful
Time to heal: 7 to 20 days
Deep partial thickness: affects the deeper dermis (damages hair follicles and granular tissue)
Appearance: wet or waxy, red patchy areas, larger blisters, pain with pressure
Time to heal: 21 days or more

Question 5

Describe 3rd degree burns

Answer 5

Destroys the dermis and damages muscle, bone and subcutaneous tissue
Appearance: dry and leathery appearance to the skin, waxy white, gray or black or brown areas, some swelling to the burn area, painless to touch (nerve endings have been destroyed)
Time to heal
-Depends on the area, depth of the burn and severity of the burn area
-Never is over 2% of the total body surface area is affected

Question 6

When should a patient be referred for a burn?

Answer 6

Burns where the skin is thinner (face, ears, eyelids, inner arm areas, groin)
Children under the age of 2 and adults over the age of 55 (thinner skin)
Chemical burns, electrical burns or inhalation burns
Burns with more than a few blisters/large blisters, large areas of blistering
Medical conditions that put patient at risk for infection (diabetes, immunocompromised, HIV)

Question 7

How should thermal burns be treated?

Answer 7

Remove heat source (minimizes damage to skin)
Cool area up to 30 minutes with tepid water (prevents further damage to the skin)
Cover loosely with non-stick sterile gauze if area is open or damaged (decreases risk of infection)
Leave blisters intact (decreases risk of infection)

Question 8

How should chemical burns be treated?

Answer 8

Cleaning or removing caustic agent
Remove clothing that has been exposed to agent
Irrigate with copious amounts of water (lukewarm or cool)
Refer ASAP

Question 9

How should electrical burns be treated?

Answer 9

Remove from source of electricity (if safely possible)

Call 911 or transport ASAP

Question 10

What is the general first aid of burns?

Answer 10

Cool area with cool water (not cold) for 10-30 minutes in cool water (compresses, irrigations, immersion)
Gently cleanse area with mild soap/water or sterile water (if necessary)
Apply dressing to promote moist wound healing and protect from further trauma (if necessary)
Pain relief (if necessary)

Question 11

What is the UV index?

Answer 11

Predicts the strength of the sun’s daily UV rays (higher number = stronger the suns rays = increased risk of burning)
UV index of 3 or more is reported
UV index sun protection charge from Environment Canada

Question 12

What are risk factors for sunburn?

Answer 12

Skin types (fair skin, red heads, freckles increase risk)
Family history (melanoma is higher risk with history of blistering sunburns as a child)
Medications (photosensitizing medications)
Ozone depletion (increased UV radiation penetrating through ozone layer increases risk)
Long term exposure to UV radiation (outdoor workers)

Question 13

Describe phototoxicity

Answer 13

Incidence: common
Mechamism: not immunological, chemically induced reaction that occurs when a drug absorbs UV light
Onset: minutes to hours following exposure
Appearance: appears as an exaggerated sunburn, reaction is limited to sun-exposed skin, may or may not be itchy

Question 14

Describe photoallergy

Answer 14

Incidence: rare
Mechanism: result of an immune response (UV light triggers reaction to the allergen)
Onset: 1-3 days after contact
Appearance: Inflammation of the skin in sun exposed areas that can spread to non-exposed areas (red and itchy reaction)

Question 15

What is photoaging?

Answer 15

Premature aging of skin caused by continuous exposure to UV light
Appearance: pigmented spots resembling freckles, age spots or liver spots, wrinkles and fine lines around the eyes and mouth, a loss of skin tone/elasticity, leathery skin texture
Regular application of sunscreens and reducing exposure are the best ways to prevent photoaging

Question 16

What should be taken into consideration when assessing a patient’s sunscreen needs

Answer 16

Patient requirements (outdoor worker, medical conditions, skin type, allergies)
Age (under 6 months = physical protection only; over 6 months = physical and sunscreens)

Question 17

How do you prevent sunburns in children under 6 months?

Answer 17

Avoid sun exposure when possible
Protective coverings (wide brimmed hats/neck protector, long sleeves, shade covers over strollers, swim suits with long sleeves/covers child)

Question 18

How do you prevent sunburns for children 6 months and older?

Answer 18

Avoid sun exposure when possible
Protective coverings (hats, long sleeves)
Physical sunblock (zinc) or sunscreen with SPF 30 or more

Question 19

How do you prevent sunburns for pregnant women?

Answer 19

No studies have been done but it appears to be safe in pregnancy
Minimum of SPF 30 with broad spectrum agent
Use physical barriers (hats, long sleeves)

Question 20

What are non-pharmacological prevention methods for sunburns?

Answer 20

Reduce exposure (particularly from 10am to 4 pm)
Stay in shade when possible
Wear clothing that covers legs, arms and head (cotton, linen, tightly woven fabrics)
Wear sunglasses (wrap around)
Wear a wide brimmed at (cover ears)
Protect children (long sleeves, hats, sunglasses, reduce exposure)

Question 21

What is required for a sunscreen to be approved?

Answer 21

SPF clearly indicated (CDA suggests SPF of at least 30)
Broad spectrum (UVA/UVB protectant)
Non-irritating or hypoallergenic
Non-comedogenic (won’t block pores)
Water resistant/sweat resistant
A statement that the sun may cause sunburn, premature aging of the skin and skin cancer
CDA Logo

Question 22

What are the different types of products available?

Answer 22

Physical block (zinc oxide)
Aminobenoic acids (PABA)
Benzophenones (oxybenzone)
Cinnamates (Parsol, cinoxate, octinoxate)
Salicylates (octyl salicylate, octisalate, homosalate)
Dibenzoylmethanes (avobenzone)
Mexoryl/tinosorb

Question 23

What are the different formulations available?

Answer 23

Lotions/creams (most common vehicle for delivery)
Water-based gels (easily washed away by swimming or seat; preferred by patients with acne or oily skin)
Sticks (preferred for small areas, like lips or nose)
Sprays (convenient but may not be applied correctly)

Question 24

Describe the general application of sunscreens

Answer 24

Apply liberally to the entire area that will be exposed to 15 to 30 minutes prior
Re-apply at least every 2 hours
Reapply after 40 to 80 minutes of swimming of excessive sweating
Reapply immediately after towel drying
Apply lip balms prior to exposure to sun to protect lips from burning
Wash hands after application to avoid rubbing sunscreen in the eyes

Question 25

What is the teaspoon rule?

Answer 25

1 tsp for front torso, back torso and each leg

1/2 tsp for head, neck and each arm

Question 26

What are the goals of treatment?

Answer 26

Prevent sunburn
Prevent reactions from medications
Provide pain relief resulting from a sunburn
Decrease the risk of infection from a sunburn
Prevent long term skin damage from exposure to the sun
Decrease/prevent the effects of photo-aging of the skin

Question 27

Describe the general treatment of sunburn

Answer 27

Cool tap water compresses/cool baths
-do not use ice (could freeze skin)
-20 minutes 4 to 6 times daily
-decreases swelling and blister formation
Drink plenty of fluids (rehydrate the body)
Pain management (acetaminophen/NSAIDs)
Moisturize (rehydrate skin and prevents friction from clothing)
Topical antibiotics (only if the skin is broken or patient is at high risk for infection)
Avoid further exposure

Question 28

What products are available for the treatment of sunburns?

Answer 28

Aloe vera gel (decreases some pain related to the burn and has a cooling effect, but the gel is alcohol based and can dry the skin out)
Protectants/moisturizers (petrolatum can be used to protect the burn from irritation and rehydrate the area and rehydrate the skin)
Topical anesthetics (temporary pain relief that lasts about 15 to 45 minutes)
Analgesics for pain (use NSAID, like ibuprofen, for the first 24 hours to decrease inflammation. Acetaminophen can be used if NSAIDs are not tolerated)

Question 29

What are the monitoring parameters for sunburns?

Answer 29

Monitor for the first 24 to 48 hours for worsening or improvement of area
Monitor for the first 48 hours for signs of infection and longer if blistered (redness, swelling, pain, coloured discharge. Refer to HCP if infected within 7 days or sooner)
Monitor for first 24 o 48 hours for pain relief or worsening
Consult physician if area does not improve or is worse after 7 days