Sunburn is the transient inflammatory response of skin caused by excessive exposure to ultraviolet radiation (UVR). The rate of disease progression varies because each individual has different levels of sunburn susceptibility, resulting in different clinical courses. We report a case that deteriorated to a deep second-degree sunburn in a patient without risk factors. A 25-year-old woman with no underlying diseases visited our hospital with sunburn on both knees. She had worn black skinny jeans while watching soccer outdoors at around 2 PM for about an hour in typical early summer weather. Because of the young age of the patient, for aesthetical reasons, we performed a flap operation instead of a skin graft. The patient recovered without complications. The patient’s primary tissue injury was due to repetitive friction from the skinny jeans, with the UVR inducing a second-degree wound complication. Even though our patient lacked risk factors and had a common skin type, she suffered from sunburn in cloudy weather of early summer. This indicates sunburn and its initial treatment requires more attention than generally perceived. Prevention is particularly important, including staying out of the sun, wearing protective and well-ventilated clothing, avoiding tight clothing, and using sunscreen.
Sunburn is the transient inflammatory response of skin, with symptoms such as mild erythema, pain, edema and blistering [
A 25-year-old female patient was sent to our hospital from a local clinic because of sunburn wounds on both knees. On the day of her injury, she wore black skinny jeans (97% cotton, 3% spandex) and watched a soccer game outdoors at around 2 PM for about an hour. The maximum temperature of that day was 28.2°C. The patient reported that it was overcast at the time of the game. The patient found blisters on both knees in the evening and visited the local clinic the next day. According to the local clinic, blister formation, including in the dermis, was observed, and a silver sulfadiazine dressing was applied after aspiration. The next day, because blisters had formed again, they were removed, and a silver sulfadiazine dressing was maintained. As the wound gradually dried, the dressing method was changed to a foam dressing. However, the patient did not improve, and was transferred to our hospital. At initial admission, upon taking patient history and physical examination, she was evaluated to have Fitzpatrick skin type III, had no underlying disease except anemia, and had no history of drug use except applied prednicarbate for urticaria on the neck 2 weeks prior. When she first visited (post-burn day 8), the wound was covered with a dry yellow eschar (
Sunburn is caused by excessive exposure to ultraviolet radiation (UVR) from sunlight, tanning, or phototherapy. The UVR is mostly ultraviolet A (UVA; 315–400 nm) and ultraviolet B (UVB; 280–315 nm). UVB contributes over 80% of the erythemally effective energy and has the most effective wavelengths to cause sunburn [
Because the susceptibility to sunburn varies in each person, the course of the disease also differs by person. The individual’s susceptibility to sunburn is clinically important because it serves as a risk marker for melanoma and nonmelanoma skin cancer [
The diagnosis of sunburn is based on clinical findings and patient history. For clinical findings, the degree of pain and erythema and whether blistering exists are the basis of a diagnosis. History and evaluation include the duration, area, and degree of exposure and whether there was any history of photosensitizing drugs or topical photosensitizer use, phototherapy, or tanning. Photosensitizing drugs reduce the dose threshold for erythema and typically include anticancer drugs, antidepressants, antimicrobials, antiparasitic drugs, antipsychotic drugs, diuretics, hypoglycemic agents, nonsteroidal anti-inflammatory drugs, antihistamines, antihypertensive drugs, and oral contraceptives [
Jackson [
This case showed that sunburn can proceed to a deep second-degree without a specific known factor, and that sunburn can occur in ordinary early summer weather, even when the area is clothed. Though most sunburns are treated as first-degree or superficial second-degree, there are some deep seconddegree sunburns occasionally reported. As mentioned above, there are many factors that may contribute to the progression of the deep second-degree sunburn, but as in this case, such sunburns can occur even though the known key risk factors were not involved. We therefore need to examine sunburns and observe their initial treatment with more caution. In addition, more care should be given to prevent sunburn, including staying out of the sun, wearing protective and well-ventilated clothing, avoiding wearing tight clothing, and using sunscreen.
No potential conflicts of interest relevant to this article are reported.
Photograph at first visit. When she first visited (post-burn day 8), the wound was covered with eschar.
Intra-operation finding. We were able to confirm that the burn had progressed to the fat layer.
Post-operation photograph. Considering that she was a young female who wears skirts, leaving her knees visible, we elected to perform a flap operation instead of a skin graft.
Photograph at the 6-week follow-up visit. The patient had recovered without complications.