Written by Robert Klein, MD on August 28, 2019
No doubt, the sun is as necessary to our survival as air, water, and companionship. It alleviates light deprivation syndromes, promotes Vitamin D metabolism and healthy bones, and, simply put, just feels good. However, problems associated with exposure to the sun’s ultraviolet (UV) radiation include not only sunburn (thermal burn injury), but also cataracts, skin cancer, dehydration, and, in extreme conditions, heat stroke.
Body temperature is, in part, controlled by evaporation of fluid off your skin. You’ve probably noticed that when you are perspiring on a hot day, if a breeze comes along you feel cooler. The breeze has increased the evaporation of perspiration off your skin, transferring your body heat to the environment.
However, skin with deep partial thickness or grafted full-thickness burns lacks sweat glands and will not perspire. Areas of nonburned skin must carry the evaporative burden and under extreme conditions will even perspire excessively. If you have had a massive burn injury and have little skin area capable of perspiring, you may be at increased risk for heat stroke in extremely hot conditions and should, when possible, avoid extreme heat. When in the heat, be sure to drink plenty of fluids and wear light clothing.
Follow this camper’s example. Carry plenty of water with you as you enjoy the outdoors this summer. (Photo courtesy of Mid-Atlantic Burn Camp)
Burn-injured skin that is still healing or has been recently grafted is red, swollen, and friable. The redness is due to increased capillary formation that is under inadequate neurogenic control and is constantly in a state of “blushing.” Until a tough keratin layer is formed on the surface, water evaporation will be higher than normal. This state of increased evaporation can result in loss of body fluids and dehydration. So during this stage of recovery, you should be especially careful in the sun and carry plenty of fluids with you.
The most common sun-related problem for people who’ve experienced a thermal burn injury is sunburn. Remember, sunburn is also a thermal burn. Overexposure to UV rays can make your skin red, tender, swollen, and possibly even blistered. Partially healed and recently grafted skin will be extremely sensitive to even short periods of sun exposure. If such skin is re-injured, it may blister, break down, become infected, and possibly scar. It is generally recommended that burned and healing skin should be out of the sun’s direct exposure for 4 to 6 months. After that, you should gradually increase your exposure.
Once again, prevention is key. Total avoidance of the sun is unnecessary and impossible, but be cautious and avoid extremes by remebering the following:
When your shadow is shorter than your height, usually from 11 am until 4 pm, the sun will be hottest.
Don’t assume that cloudy days are safe; about 80% of the sun’s UV rays may penetrate the clouds.
Winter is not necessarily safe either; wind and reflected sun off snow and ice can both cause skin damage.
Beaches and pools are particularly high-risk areas for sunburn, because people generally wear less clothing in these settings and stay for long periods of time. Reflected UV rays off the water, sand, or poolside can inflict severe sun damage to the skin, especially healing skin.
Some antibiotics, anti-seizure medications, and acne preparations can render skin, especially healing skin, photosensitive. Be sure to check with your physician or pharmacist about potential problems.
Come on in the water’s fine, but be sure to apply your sunscreen first. (Photo courtesy of Mid-Atlantic Burn Camp)
Besides a dose of common sense, what else can be done to protect your skin? The first step is to liberally apply sunscreen 30 minutes before exposure so the cream can begin to be absorbed; then re-apply every 2 hours. Water-resistant preparations should be reapplied after emerging from the water. Remember, higher sun protective factor (SPF) numbers offer more protection.
Don’t rely on clothing to block UV rays. Its protective value varies greatly with fabric, color, and tightness of weave. However, clothing designed especially to do so can block up to 90% of rays, even when wet. To purchase such protective clothing, try your local sporting goods store or websites such as Solumbra by Sun Precautions and Coolibar Sun Protective Clothing. Sun Precautions and Coolibar Sun Protective Clothing are two companies that sell colorful, fashionable, and lightweight apparel that effectively protects the skin.
Your burn center staff should be able to provide you with additional information, based on your injury and the local climate, on how to enjoy the outdoors without being harmed. Now go and enjoy the summer!
Dr. Robert L. Klein is a professor of surgery at Northeastern Ohio Universities College of Medicine and emeritus chairman of the department of surgery and medical director of the regional burn center at Children's Hospital Medical Center of Akron, OH.