Ask a Dermatologist: All About Sunburns

Ever since I heard that it was Coco Chanel who popularized the tanning of one’s skin for the purposes of beauty in the 1920s, I’ve been pissed at her. First, the sun is really bad for skin! And second, I’m super pale. This vanilla/chocolate swirl of emotions quite nicely illustrates my altruistic/narcissistic personality and is why I consider sunburn effects somewhat of a guilty pleasure.

I avoid them as much as I can, Mom. Promise! But when they happen I’m not that mad about it. Ya know? Because I’m going to look so good in a week!

This is all Coco’s fault.

Unfortunately, ignorance in the sun damage department is the polar opposite of bliss. So I decided to ask Dr. Melinda Longaker, a dermatologist who thinks you should wear more sunscreen, all my burning questions. Pun 100% intended.

So what’s actually happening to my skin when I get a tan or a sunburn?

Let me start by saying that all tanning is bad for your skin. It represents your skin’s response to an injury from the sun. It is your skin’s attempt to protect you! A tan is an injury. There is no “healthy tan,” unfortunately!

But a sunburn is much worse: the ultraviolet rays have actually killed cells in the top and deeper layers of the skin. The upper layers eventually are shed in sheets or flakes. The sheets are what people see with peeling. Those sheets are epidermal cells that have formed more quickly than normal due to the injury and are all stuck together.

The deeper skin cells, on the other hand, stay put with damaged DNA. While some of them get repaired by our bodies, others can get missed — especially with additional burns and tanning — and result in skin cancer.

Is it true I can get a sunburn on a cloudy day?

There are two main types of ultraviolet rays: UVA and UVB. A-rays are there even on a cloudy day. They penetrate deeper into the skin than B-rays and cause aging (memory device! A=aging). UVB rays are strongest on hot sunny days, but are also always there. B-rays cause sunburns (B=burn). Both of these rays damage the DNA in our skin — which is something people don’t commonly seem to realize.

So while you can get a sunburn on a cloudy day, the bigger (or more unexpected) risk is deeper cell damage from the A-rays.

If I looked at sunburned skin under a microscope would it terrify me and make me never go outside again?

When you get a sunburn, the redness, pain and swelling are all signs of inflammation. You would see this under the microscope as dilated blood vessels, fluid between the cells and, if you get a blistering sunburn (which is actually a second-degree burn!), you will see the top layer of skin separated from the bottom with fluid.

But I promise, the permanent DNA damage you CAN’T see is far scarier.

Does that mean it’s possible for one bad sunburn to haunt me forever?

Unfortunately, one blistering sunburn is a risk factor for melanoma. But don’t freak out! It’s just increased risk. There’s no sense worrying about what you did or what happened in the past. The key is not repeating it or adding to the damage. I tell everyone that it is never too late to start protecting their skin.

There is no judgement in my book about the past. I was burned a lot as a kid and tried unsuccessfully to tan in high school, only to then become a dermatologist! My philosophy is start protecting now.

Go to the beach and have fun, but wear a broad-spectrum sunscreen of 30 or higher with two hours of water resistance. And on a daily basis, wear a high SPF sunscreen on whatever will stick out of your clothes. Find a really great sunscreen that you love because you have to do it every day — just like brushing your teeth.

So am I carrying around all the sunburns of my childhood? Are they affecting me today?

Well, your skin will age faster than if you hadn’t gotten burned as a kid and you might have a higher chance of getting skin cancer, but all the more reason to be extra vigilant going forward.

Find a dermatologist and see her once a year no matter what. Don’t expect your primary care MD to be able to pick up a skin cancer on you. Some might, but it’s better to see someone who is specially trained.

Is vulnerability to sun damage inversely related to pigmentation? As in: the darker the skin the less vulnerable?

Exactly. What determines how damaging the sun is to a person is the amount of melanin in the skin. Melanin acts as a natural sunscreen. Fair-skinned people (blonds, redheads, blue- or green-eyed) have the least melanin and are the most susceptible to sun damage — both its aging and skin cancer risks. Darker-skinned people have some natural protection in the form of melanin — but it’s not total sunscreen! They can still burn and develop accelerated skin aging (wrinkles, dark spots) from the sun.

But, risk spectrum aside, skin cancer can happen to anyone. In fact, it’s often caught and diagnosed later in darker-skinned people because of the perceived lack of risk.

I’ve heard that vitamin C and/or retinol serums can reverse sun damage. Is that true? How much of that stuff is just marketing?

Retinol creams, vitamin C serums, etc., may soften fine lines or slightly fade age spots but the effects aren’t perfect and will go away as soon as you stop using them. Prevention is key.

Have you heard people say wearing high SPF sunscreen all the time can cause a vitamin D deficiency or at least hinder vitamin D intake in a real way? Is that absurd?

This vitamin D question drives me crazy! Vitamin D does not need to come from the sun. A healthy diet is the best way to get your vitamin D and there are perfectly great vitamin D supplements if your level is low (many MDs are now checking it as part of a standard panel).

There’s an old wive’s tale that rubbing yogurt on a sunburns heals it faster. True or false?

The old wive’s tale about putting yogurt on sunburns isn’t all that crazy. The protein in the yogurt may decrease the swelling and the coolness of the yogurt will soothe the burn. Taking some Ibuprofen will help, too.

If you don’t have yogurt, you can make cool compresses with milk. I like to combine whole milk with a lot of ice and then apply it to the burn with a soft washcloth. A little over the counter 1% hydrocortisone cream can also help if the burn is really uncomfortable.

These things really only make the symptoms feel better, not heal faster.

Why does my skin feel stiff and hot when I get a burn? Should I peel it or is that a bad idea? It’s so satisfying to peel it!

Your skin feels stiff and hot because it’s inflamed. Stiff due to swelling and hot due to the inflammation process. Scrubbing off the sheets is probably better than peeling because you won’t injure neighboring normal skin (kind of like what happens when you pull off a hangnail).

If you get blisters, it’s okay to take a sterile needle and prick the surface and press out the fluid before putting Aquaphor and a bandage on the area. Don’t take off the blister, though (that would be gross anyway) because it’s a natural bandage!

What’s one thing you find yourself telling your patients over and over?

When I tell people to wear sunscreen every day I often get: “But I always wear sunscreen when I’m going to be out in the sun.” But people are in the sun far more often than they know, even if they’re indoors and near a window! So my best advice is just to apply sunscreen every single day rather than making a decision every morning: “Am I going to be in the sun today?”

I also often hear, “Yes, I do wear sunscreen, it’s in my makeup!” But makeup is almost never enough. You need a shot glass full of actual sunscreen covering your body if you want the protection the sunscreen says it offers (i.e. SPF 50).

If you are fair skinned, you need to apply actual sunscreen to your face before you apply your makeup or you’re unfortunately kidding yourself.

Again, it should be like brushing your teeth! A daily habit.

Should all of us be thinking about skin cancer more than we are?

Yes. 1 out of 5 people will get skin cancer in their lifetime. Most are what I call “nuisance” skin cancers — you don’t die from them but they leave a scar, which isn’t so great when it’s on your nose or below your eye (my beloved Anderson Cooper once had to report with a bandage on his cheek).

More rare, but deadly, is melanoma. If not caught early it is one that can actually kill you. It is the second most common cancer in young women between 15 and 29 .

Any sun damage rumors you want to put to bed?

I hear that question about vitamin D deficiency a lot, as well as suspicions around chemicals in sunscreen. Sometimes I think people want to believe there is some sort of sunscreen conspiracy.

When I see articles like “10 things doctors don’t want you to know!” I get so confused. Believe me, doctors do not get together and discuss things the public must never know! We just know the sun causes skin cancer and sunscreens have not been shown to cause cancer in humans.

If you are worried, cover up. There are some cute sun protective hats and tops out there. (Try Cabana Life!) (Although Leandra will probably disagree on the cute part.)

Is there anything else you wish people better understood about sun damage?

That it’s never too late to start protecting your skin! Both from cancer and more visible damage. If I could go back to my 20s and 30s and be even more careful (SPF 50 every day, hats, etc.), my skin would look so much better and healthier today.

When I see someone with beautiful 30-year-old skin I hope they’ll really take care of it because when they are 40 or 50 not only will their chances of skin cancer be dramatically reduced, but they’ll look so much better than someone who didn’t!

Collage by Emily Zirimis.


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