Facial Sunblock: Protecting Your Skin After a Burn Injury

The sun, while beneficial in many ways, emits ultraviolet (UV) radiation that can be harmful to your skin. This radiation is linked to skin cancers like melanoma, squamous cell carcinoma, and basal cell carcinoma, as well as eye problems such as cataracts and macular degeneration. Scars from burns, donor sites, and skin grafts are particularly vulnerable to sun damage.

Sun Exposure and Your Burn Injury

Sensitivity of Burned Skin. Skin that has healed from burns and skin grafts can become extremely sensitive to sunlight. It can burn more easily than uninjured skin, even with brief sun exposure. This heightened sensitivity can last for a year or even longer after the burn injury. Certain medications, such as antihistamines like cetirizine and nonsteroidal anti-inflammatory drugs like ibuprofen, can also increase sun sensitivity.

Pigmentation Changes. Skin color comes from melanin. Second-degree burns and deeper injuries affect skin pigmentation because melanin is found in the epidermis, the outermost skin layer. After a burn, the skin may initially lose pigmentation. While pigmentation can return during healing, this process is unpredictable. Newly healed skin often appears pink and without pigment, regardless of your original skin tone. As the scar matures, normal pigmentation might return, become darker (hyperpigmented), or remain lighter (hypopigmented). Deeper injuries typically lead to slower pigmentation recovery. It’s difficult to predict the final skin color after the scar has fully matured. Some individuals will experience lighter skin (hypopigmentation), while others will have darker skin (hyperpigmentation) in the burned area compared to their pre-injury skin tone.

Ultraviolet light (sunlight) can affect pigment recovery. Tanning in newly healed skin may not fade at the same rate as a tan on uninjured skin. In burn areas requiring skin grafts, the grafted skin may become darker than the surrounding uninjured skin. The exact cause of this is unknown, but it’s recommended to protect burn-injured skin from the sun for at least a year to minimize permanent pigmentation changes and uneven skin tone.

For Individuals with Darker Skin. Even if you’ve never had sun sensitivity or sunburns before, burned or grafted skin becomes susceptible to sunburn and pigmentation changes. Sun exposure won’t necessarily increase pigmentation in scar areas that are already lighter than the surrounding skin.

How to Protect Your Skin from Sun Exposure? Resuming normal activities outdoors, such as walking, hiking, swimming, cycling, and gardening, is important after a burn injury. However, extended time outdoors necessitates careful skin protection. Dermatologists recommend a multi-faceted approach combining sun avoidance, protective clothing, and sunblock to minimize sun/UV exposure and combat sun damage.

Sun Avoidance

Complete sun avoidance isn’t practical for an active lifestyle, but you can control when you’re outdoors. The sun is strongest between 10 a.m. and 4 p.m., or when your shadow is shorter than your height. Don’t be fooled by clouds; up to 80% of harmful UV rays penetrate cloud cover. Be aware that surfaces like sand, water, snow, and ice reflect UV rays, increasing exposure. UV intensity also increases at higher altitudes. Limiting sun exposure during peak hours and being mindful of reflective surfaces are crucial for preventing sun damage. Seek shade when spending time outdoors.

What about tanning beds? Avoid tanning beds as they emit UV radiation comparable to, or even stronger than, the sun, increasing cancer risk. Tanning beds can also cause pigmentation issues in healing scars that may not fade.

Protective Clothing

Wearing protective clothing is an effective way to shield your skin from the sun after burn healing. Not all fabrics offer equal protection. Consider these factors when selecting sun-protective clothing:

• Tightly woven fabrics offer greater protection. Denim and wool provide more shielding than thin fabrics like linen.
• Loose-fitting clothing is more protective than tight or stretched garments.
• Wet fabrics offer less protection than dry ones.
• Synthetic and semi-synthetic materials generally protect better than bleached or refined cottons.
• Darker colored clothing provides more UV protection.
• Specialized sun-protective clothing, treated with UV-blocking or absorbing chemicals, is available at sports stores and online. These garments are labeled with an Ultraviolet Protection Factor (UPF) rating. It is recommended to choose specialized clothing with a UPF of 30 or higher.

Other Protection Options

Sunglasses and wide-brimmed hats are additional protective measures. Consider these recommendations:

• Choose sunglasses that provide 99% or 100% UV protection and fully cover your eyes and eyelids.
• Hats should have a brim of at least 3 inches wide around the entire circumference to protect the neck, ears, and face. Baseball caps do NOT adequately protect the face and neck from sunburn.
• Hats with fabric drapes at the back of the neck offer enhanced protection.

Sunscreen and Facial Sunblock

Sunscreen and especially facial sunblock are your third line of defense and should be used in combination with protective clothing and sun avoidance strategies. Sun Protection Factor (SPF) measures a sunscreen’s ability to protect against sunburn. Generally, a higher SPF value indicates greater sunburn protection.

Sunscreens come in various forms: gels, sprays, creams, and sticks. Gels are effective for hairy areas, while creams are better for the face and dry skin. Sticks are convenient for around the eyes and lips. Aerosol sunscreen application requires careful attention to ensure complete skin coverage, avoid inhalation, and prevent application near heat, flames, or smokers. Some sunscreens contain alcohol, which can dehydrate newly healed or grafted skin. Some facial creams and cosmetics, like foundations, include sunscreen. While convenient, these products require frequent reapplication for optimal sun protection.

Some insect repellents also contain sunscreen. The American Academy of Dermatology recommends applying these products separately. Insect repellent should be used sparingly and as needed, while sunscreen requires frequent and generous application.

Related Fact Sheets

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Itching Skin After a Burn Injury

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Wound Care After a Burn Injury

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Scar Care After a Burn Injury

Sunscreen vs. Sunblock: What’s the Difference? Sunscreen is more common and works by filtering the sun’s UV rays, preventing most, but not all, from penetrating the skin. Sunblock, on the other hand, physically blocks and reflects the sun’s rays. Most sunblocks contain titanium dioxide or zinc oxide, making them thicker and often opaque upon application. Many products marketed as sunscreens are actually a combination of both. For facial application, especially on sensitive post-burn skin, mineral-based facial sunblocks containing zinc oxide or titanium dioxide are often recommended as they are gentler and provide broad-spectrum protection.

Can I Use Tanning Lotion? No. Tanning lotions often have very low SPF (Sun Protection Factor), typically SPF 4 or 5, which is insufficient to protect your skin from sun damage, particularly after a burn injury.

Studies show that people often apply sunscreen incorrectly, resulting in inadequate protection. These sunscreen and facial sunblock tips will help prevent sunburn and sun damage:

• Apply facial sunblock and sunscreen every day, even on cloudy days.
• Use a facial sunblock or sunscreen with SPF 30 or higher. For sensitive facial skin, especially post-burn, SPF 30-50 is generally recommended.
• Choose a broad-spectrum facial sunblock and sunscreen to protect against both UVA and UVB rays.
• Reapply facial sunblock and sunscreen every two hours when outdoors.
• Use water-resistant facial sunblock and sunscreen, especially if swimming or sweating.
• A generous amount of facial sunblock and sunscreen is needed to cover all exposed skin. For the face, typically a nickel-sized amount is sufficient, but adjust based on face size and product instructions.
• Do not expose babies under 6 months to direct sunlight. Sunscreen use is generally not recommended for infants under 6 months due to increased risk of side effects like rash.
• For babies over 6 months, the American Academy of Pediatrics recommends applying sunscreen to small areas of skin (like face and back of hands) where clothing protection is insufficient. Zinc oxide or titanium dioxide-based products are often less irritating for babies.
• Apply facial sunblock and sunscreen 30 minutes before sun exposure to allow absorption.
• Reapply every two hours, and immediately after swimming, heavy sweating, or toweling off. This applies even to water-resistant products.
• Protect your lips with a lip balm with SPF 30 or higher. Reapply frequently. Avoid products containing petrolatum, as they do not offer sun protection.
• Don’t forget to apply facial sunblock and sunscreen to your ears, feet, back of hands, neck, and bald spots on the scalp.
• Facial sunblocks specifically formulated for the face are often non-comedogenic (won’t clog pores) and may be preferable to other products for facial use, especially if you are prone to acne.
• Moisturizers with SPF are available and provide both hydration and sun protection. Choose moisturizers with SPF 30 or higher and ensure they are suitable for facial use, especially if you have sensitive or burn-injured skin.

Frequently Asked Questions About Sunscreen and Facial Sunblock Use

• Will I ever be able to wear short sleeves and shorts safely again? We understand that wearing long sleeves and pants can be uncomfortable in warm weather. You can wear short sleeves and swimwear if you use facial sunblock and sunscreen and limit your time in the sun, especially during peak hours. Prioritize facial sunblock as the face is highly exposed.
• What should I do if I have a reaction to a facial sunblock or sunscreen (e.g., rash)? Stop using the product immediately and try another with different ingredients. Mineral-based facial sunblocks are often less irritating for sensitive skin. If the reaction persists, consult your doctor or healthcare provider.
• How long does facial sunblock and sunscreen last before it expires? The FDA reports that sunscreens are effective for 3 years. Many products have an expiration date printed on the container. If there’s no date, write the purchase date on the container and discard it after 3 years. If the consistency or texture of the facial sunblock or sunscreen changes, discard it.
• What is PABA-free facial sunblock and sunscreen? PABA stands for para-aminobenzoic acid and related chemicals. PABA sunscreens, used in the early 1940s, absorbed UVB rays. PABA has largely been removed from sunscreens due to reports of allergies and adverse reactions. PABA-free sunscreens do not contain PABA or related substances. Most modern facial sunblocks are PABA-free.
• Are facial sunblocks and sunscreens with higher SPF more effective than those with lower SPF? No sunscreen blocks 100% of the sun’s rays. SPF 30 facial sunblock and sunscreen blocks 97% of UVB rays when used correctly. Higher SPF doesn’t mean you can use less product or reapply less frequently. All facial sunblocks and sunscreens should be applied liberally every two hours or as directed, regardless of SPF value.
• Can facial sunblock and sunscreen cause cancer? Recent studies have shown no link between sunscreen use and melanoma (a type of skin cancer). In fact, regular use of facial sunblock and sunscreen is recommended to prevent skin cancer.
• Are facial sunblock and sunscreen toxic? Sunscreens undergo extensive testing to ensure they are not harmful to humans. The safety of sunscreen chemicals is based on studies in humans, though not specifically in burn survivors. Mineral facial sunblocks are generally considered very safe for most individuals.
• Does facial sunblock and sunscreen cause vitamin D deficiency? Theoretically, facial sunblock and sunscreen could hinder vitamin D formation by blocking UVB rays, necessary for vitamin D synthesis. However, no studies have shown negative health consequences or differences in vitamin D levels in regular sunscreen users compared to non-users. Maintain a healthy diet rich in vitamin D (fatty fish, cheese, egg yolks, beef liver, and vitamin D-fortified milk and yogurt).
• Am I more prone to skin cancer after a burn? There is limited information about skin cancer risk in healed burn injuries. • When should I be concerned about skin cancer? Perform a full-body skin self-exam on your birthday each year to check for changes, itching, or bleeding. If you have a burn wound that doesn’t heal or frequently reopens, consult your doctor or healthcare provider.

Other Resources:

Authors

The fact sheet “Sun Protection After Burn Injury” was originally prepared by Dr. Nicole S. Gibran and Registered Nurses Gretchen J. Carrougher, Maria Caceres, and Cathie Cannon in collaboration with the Model Systems Knowledge Translation Center (MSKTC). It was reviewed and updated by Gretchen J. Carrougher in collaboration with the MSKTC.

Source: The health information in this factsheet is based on research findings and professional consensus and has been reviewed and approved by an editorial team of experts from the Burn Injury Model Systems. As research about sun exposure after burn injury is limited, this factsheet was prepared using studies and information for the general population.

Disclaimer: This information is not intended to replace professional medical advice. Consult your healthcare provider for specific medical concerns or treatment. The content of this factsheet was developed under a grant (number 90DP0012) from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). It was updated under a grant from NIDILRR (90DPKT0009). The content of this factsheet does not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the Federal Government.

Recommended Citation: Carrougher, G. J., Gibran, N. S., Caceres, M., & Cannon, C. (2023). Sun Protection After Burn Injury. Model Systems Knowledge Translation Center (MSKTC). https://msktc.org/burn/factsheets/sun-protection-after-burn-injury.

Copyright © 2023 Model Systems Knowledge Translation Center (MSKTC). May be freely reproduced and distributed with appropriate source attribution. Permission is required for inclusion in materials offered for a fee.