Trip Answers

Question answered:16/05/08

The CKS guideline on burns and scalds contains a clinical scenario on the management of epidermal burns in which it notes:

 

“Scenario: How should I manage epidermal burns (e.g. sunburn)
Advise the person of measures to provide symptomatic relief, for example:
Take a cool bath or shower.
Apply topical emollients.
Apply cold compresses.
Take simple analgesia (e.g. paracetamol or ibuprofen).
Advise the person to maintain adequate hydration.
Consider referral if there are signs or symptoms of heat exhaustion or heat stroke.

 

Clarification / Additional information
Signs and symptoms of heat exhaustion and heat stroke include:
High body temperature.
Fatigue, weakness, dizziness, fainting.
Nausea or vomiting.
Rapid pulse.
Headache, muscle cramps, myalgia.
Strange behaviour, irritability, agitation.
Impaired judgement, confusion, disorientation, hallucinations.”

 

It adds:

 

“These recommendations are pragmatic advice, based on expert opinion from the medical literature [Settle, 1996; Burns et al, 2004; Medical Letter on Drugs and Therapeutics, 2004; Dynamed, 2007].
There is a lack of evidence regarding the management of sunburn. No treatment has been shown to reduce the time to healing [Medical Letter on Drugs and Therapeutics, 2004].” [1]

 

The PatientPlus (Mentor) website offers the following information on the management of sunburn and heat exposure:

 

“Mild sunburn: 
Vast majority of sunburn is superficial and spontaneously resolves. Cool soaks
NSAIDs may be used. Topical diclofenac sodium has been shown to reduce pain and erythema.

 

Moderate: 
As per mild, and:
Oral NSAIDs and topical steroids have been reported to have a synergistic effect in reducing erythema. However, reviews of the literature have been less enthusiastic. One found that the overall opinion was that corticosteroids, NSAIDs, antioxidants, antihistamines or emollients were ineffective at decreasing recovery time. The remaining studies showed mild improvement with such treatments, but study designs or methods were flawed. Furthermore, regardless of the treatment modality, the damage to epidermal cells is the same.
Topical anaesthetics are not recommended.

 
Severe: 
Normal burns protocol (see http://www.patient.co.uk/showdoc/40001197/).” [2]

 

The Merck Manual recommends:

 

“Further exposure should be avoided until sunburn has completely subsided. Cold tap water compresses and oral NSAIDs help relieve symptoms, as may topical aloe vera. Topical corticosteroids are no more effective than cool compresses. Blistered areas should be managed similarly to other partial-thickness burns (see Burns: Initial treatment), with sterile dressings and topical bacitracin or silver sulfadiazine. Ointments or lotions containing local anesthetics (eg, benzocaine ) should be avoided because of the risk of allergic contact dermatitis. Early treatment of extensive, severe sunburn with a systemic corticosteroid (eg, prednisone 20 to 30 mg po bid for 4 days for adults or teenagers) may decrease the discomfort, but this use is controversial.” [3]

 

However, an American guideline issued last year, states:

 

“Recommendation 1
Methods to Reduce Inflammation
• Cooling, ice packs (Han, 2004)
• Nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen (Morgan, 2000)
• Topical corticosteroids (Duteil et al., 2002; Han, 2004)
• Systemic corticosteroids (not recommended) (Han, 2004)
(Grade of recommendation = A; Quality of Evidence = Good).” [4]

 

References
1. CKS. Burns and scalds. August 2007. (http://www.cks.library.nhs.uk/burns_and_scalds/management/detailed_answers/managing_epidermal_burns#-293087)
2. PatientPlus. Sunburn and heat exposure. August 2006. (http://www.patient.co.uk/showdoc/40001941
3. Merck Manual. Sunburn. August 2007.
(http://www.merck.com/mmpe/sec10/ch115/ch115d.html)
4. University of Texas, School of Nursing, Family Nurse Practitioner Program. Evaluation, management and treatment of sunburn in adults. Austin (TX): University of Texas, School of Nursing; 2007. (http://www.guideline.gov/summary/summary.aspx?doc_id=10862&nbr=5675&ss=6&xl=999)

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