Doctors do not like the words “sun poisoning”. The pharmacist in Split told me so while she was looking at my shoulders, and then she treated me for it anyway. It is not a diagnosis. It is what people say when a sunburn stops being a skin problem and starts making them ill, and there is no better name for that, so it stays.
The day it happened to me was cloudy, and that is the detail to put first, because it is why I stayed out. 6 hours on a friend’s boat, grey sky, a breeze, no sunscreen because it did not feel like sun. By dinner my shoulders were bright red. By midnight I was shivering under a duvet in a hot room with a headache, and I could not keep water down. The burn was bad. The night was the thing nobody had warned me about.
What A Normal Sunburn Looks And Feels Like
A normal sunburn is miserable and it is also boring. It comes up over the evening, looks worst the next morning, hurts for 2 or 3 days, and starts to peel around day 4 or 5. There might be a few small blisters on the worst spots, the tops of the shoulders or the nose. Apart from the skin, you feel fine. You eat, you sleep once you find a way to lie, and your temperature is normal.
That is a burn. It needs the basics listed further down and nothing else. I had had a dozen of them before Croatia and thought I knew what I was dealing with.
Signs A Sunburn Has Become Sun Poisoning
The difference is not how red you are. It is whether the rest of your body has joined in. A burn over a big enough area, the whole back, both legs, or shoulders and chest together, sends enough inflammation into the blood and loses enough fluid through the skin that you become ill in the ordinary sense.
- Shivering and a temperature. This is the main one. A burn does not give you a fever; sun poisoning does.
- A headache that painkillers do not shift, sometimes with a stiff neck.
- Feeling sick, being sick, or not keeping water down.
- Dizzy on standing, a fast heartbeat, a dry mouth, hardly needing the toilet.
- Blisters across a wide area rather than in spots, and swelling of the face, hands or feet, which can appear a full day after the burn.
A large blistered burn with a fever is sun poisoning. The same burn with confusion or fainting is an ambulance, because heat exhaustion is then sitting on top of the burn, and the 2 together are dangerous in a way neither is on its own.
I had the fever, the headache and the vomiting, and no confusion. The pharmacist said that was the only reason I was leaving with sachets and cream rather than being sent to the hospital in town.
Sun Rash And Medicine Burns That Get Mistaken For Sun Poisoning
The first is a rash, not a burn. Some people get an itchy, bumpy, sometimes blistered rash on the arms and chest a day after the first strong sun of the year, with no real burn under it, through sunscreen, every year. The medical name is polymorphous light eruption, and it is closer to an allergy to sunlight than to damage from it. An antihistamine and a steroid cream help it more than aloe does, and it comes back the following spring whatever you do.
The second is a burn that was far worse than the sun deserved. If 40 minutes gave you what 4 hours normally would, look at anything you started taking recently. Doxycycline, the antibiotic for acne and travel, is the well known one; I know 3 people who have burned through a T shirt on it. Some blood pressure tablets, high dose ibuprofen or naproxen, retinoid creams and St John’s wort do it too. The burn is treated the same way. The pharmacist needs to know so they can tell you to stay out of the sun for the rest of the course.
Home Treatment For A Bad Sunburn
Aloe is in the title because it is what everybody reaches for. It is fine, and it is the least important thing on this list.
- Water, far more than seems reasonable, and better with a pinch of salt and sugar in it or a rehydration sachet from the chemist. Most of the headache and grogginess of a bad burn is dehydration, and I only stopped feeling poisoned after I managed to hold down 2 sachets an hour apart.
- Ibuprofen, if you can take it, for the first 2 days. Started early, it eases the inflammation as well as the pain.
- Cool showers, not cold, 10 minutes at a time, as often as you want. Never ice on the skin, which adds a cold injury to the hot one.
- Moisturiser on damp skin after each shower. Plain and unscented, or aloe from the fridge, which does nothing clever and feels very good.
- Blisters left alone. The roof of a blister is the best dressing there is. If one bursts, rinse it with water and cover it with a non stick pad.
- Out of the sun for 3 days, and that includes the window seat on the bus.
What Not To Put On It
- Butter, oil or petroleum jelly on a fresh burn. They hold the heat in.
- Numbing sprays with benzocaine or lidocaine. They sting and set off allergies on broken skin.
- Anything scented or alcohol based, for 2 weeks.
- Fingers. Peeling it early is satisfying and the skin under it is not ready.
I did 2 of those 4 and paid for both.
When A Sunburn Needs A Doctor The Same Day
- A temperature of 38 °C or above, or the shivers.
- Blisters over a large area, or any blisters on the face, hands, feet or around the underwear line.
- Vomiting, or not keeping fluids down for more than a few hours.
- Dizziness, fainting, a racing pulse or confusion.
- Any child with a fever after a burn, and any baby under 1 with a blister.
- Later in the week: pus, spreading redness, red streaks, or a burn that hurts more on day 4 than on day 2, which means infection.
A doctor cannot undo the burn. What they can do is put the fluid back in, dress the blistered areas properly, and stop a bad burn turning into an infected or heat struck one.
How Long Sunburn And Sun Poisoning Take To Heal
A bad burn: 3 days of pain, peeling by day 5, normal skin by 2 weeks. Sun poisoning: the fever goes in a day or 2 once the fluids are back in, the blisters take a week to dry, and the new skin underneath stays pink and thin for a month. New skin burns in about a quarter of the time the old skin did, which is how people manage to do the whole thing twice in one holiday.
Mine came off in sheets. A friend still has a photo of one of them and sends it to me every June. The lesson had nothing to do with cream. Cloud at sea is not shade, and shivering with a headache after a day outside means the burn has stopped being a skin problem, and it is worth listening to that sooner than I did.
Written from a bad fortnight rather than a medical degree. Fever, vomiting, fainting or confusion after a burn means a doctor the same day.
