Kathy Oxtoby looks at how pharmacists can support people to protect themselves against sunburn and stay safe in the sun…

As UK summers become warmer - with last July reaching record temperatures - it’s more important than ever to protect the skin and avoid sunburn.

Sunburn is skin damage caused by ultraviolet (UV) rays ¹. It usually causes the skin to become red, sore, warm, tender, and occasionally itchy for about a week. The skin will normally start to flake and peel after a few days and will usually fully heal within seven days ¹.

But sunburn can have more serious consequences. “The danger goes far beyond any short-term pain, redness and discomfort, because after the sunburn fades, lasting damage remains,” says the Skin Cancer Foundation ². “Sunburn accelerates skin aging and is a leading cause in the majority of cases of basal cell carcinoma, squamous cell carcinoma, and melanoma, the deadliest form of skin cancer,” the Foundation says.

At the heart of our skin’s reaction to ultraviolet (UV) radiation - part of the natural energy produced by the sun - is melanin. “It provides pigmentation to your skin, eyes, and hair, and absorbs UV rays and protects your cells from sun damage. Its protective effect against UV rays is achieved by its ability to absorb the rays, reducing their penetration into the epidermis,” says Amish Patel, managing director of Hodgson Pharmacy in Kent.

Some people are more prone to sunburn than others. Skin type determines our susceptibility, and people with fair skin run the greatest risk ². “But although dark skin may not burn as quickly, it can still burn,” says Mr Patel.

A vast range of sunscreen products are available, providing different levels of protection against the sun’s rays. “Sunscreens are very sophisticated formulas to reduce damage caused by UVB, UVA and high energy visible light,” says Dr Mary Sommerlad, a consultant dermatologist and British Skin Foundation spokesperson. 

She explains SPF stands for ‘sun protection factor’, and gives an indication of how much longer an individual can stay in the sun without being burnt by UVB waves. “An SPF of 30 means your skin takes thirty times longer to burn or develop redness than without the SPF,” she says.

UVA waves can penetrate glass and water and are associated with developing pigmentation issues and wrinkles. UVA star ratings give an indication of how much protection from UVA waves a sunscreen gives, says Dr Sommerlad. “The rating is out of five stars - the more stars, the more UVA protection,” she says.

Among the public there is a worrying lack of understanding about the degree of sun protection different products provide, research by the Royal Pharmaceutical Society into sunscreen use has found. In particular, many are unaware that the SPF rating alone displayed in sunscreen labelling does not guarantee good all-round protection from potential sun damage.

In the 2015 survey of 2,000 adults, just 8 per cent of those surveyed knew that the SPF rating on the product label refers to protection from UVB rays only – and does not also include protection from harmful UVA rays – typically indicated by the separate UVA ‘star’ rating.

More than 80 per cent said they either thought the SPF was an indication of levels of protection from both UVB and UVA (56 per cent) or they simply did not know what the rating stood for (25 per cent).

The RPS wants to see one uniform measure for all sun protection products, so pharmacists can provide easy to understand advice on the effectiveness of products and how they should be used.

As to which sunscreen to stock, Mr Patel believes pharmacists’ “primary duty” is to advise patients on staying safe, “therefore, I would suggest stocking higher SPF products such as SPF 30 and SPF 50”.

“Some sunscreens offer both a physical and chemical protection against UV rays. These offer the best protection of all. However, for those patients seeking a tan, SPF 30 may be most suited, but with counselling on staying safe in the sun,” he says.

“A good pharmacy should have a selection of sunscreens,” says Dr Sommerlad. She recommends stocking sunscreen suitable for children, those that contain iron oxide for those with the skin condition melasma, sunscreens that a gel finish or dry touch, and those which contain antioxidants.

Mr Patel says it is “very much a case or trial and error in finding a sunscreen that most suits the patients skin”. “The vast majority will not have any issue with the most common sunscreens,” he says.

People with eczema or atopic dermatitis are advised to use sensitive sun formulations that are hydrating and contain ceramides, or niacinamide as it is soothing, advises Dr Sommerlad.

Those with sensitive skin can use hydrating sunscreens, while those with freckles could look for a sunscreen with antioxidants, she says.

However, sunscreen is “just one part of protection from sunburn”, she advises, and in addition, she says to “wear a wide brimmed hat, sunglasses with UV protection, long light sleeves, stay in the shade and avoid deliberate sunbathing”. 

Mr Patel says to avoid peak heat between 11am-3pm, spend time indoors in cooler areas or in the shade, stay hydrated and frequently re-apply sunscreen.

Sunburn blisters “are best managed like any burn and blister”, says Mr Patel. He advises to cool the burn, and if the burn is painful, to consider analgesics such as paracetamol or ibuprofen.

The burn should be kept well moisturised, and products containing aloe vera or vitamin E are particularly good are speeding up the healing process, he says.

“If the burn blisters, do not pick at the blister. The blister will burst, and when it does, it should be managed like any wound - to be kept clean and covered. Continue to protect the skin until it is fully healed,” he advises.

In rare cases patients may be allergic to the sun - a condition known as ‘solar urticaria’. Mr Patel explains it is characterised by an itchy rash or hives that appear on skin exposed to the sun.

“Patients are best advised to use a high SPF product, wear UV protective clothing, and avoid being in the sun,” he says. While there is no cure, the allergic reaction can be managed with antihistamines, and patients can be referred to their GP for long term management of the condition, he says.

Increasingly, patients are seeking advice from pharmacy about skin conditions, including sun protection, says Mr Patel, “and it’s important for pharmacists to advise them on the long term benefits of using sunscreen to protect against the sun, and skin cancer.”

References

1. NHS Inform (2022) Sunburn.

https://www.nhsinform.scot/illnesses-and-conditions/injuries/skin-injuries/sunburn#:~:text=Sunburn%20is%20skin%20damage%20caused,fully%20heal%20within%207%20days

2. Skin Cancer Foundation (2023). Sunburn & Your Skin. https://www.skincancer.org/risk-factors/sunburn/