Sunscreen for Face After Burn Injury: Ultimate Protection Guide

The sun offers numerous benefits, yet it emits three types of ultraviolet (UV) light that can harm your skin. This damage is linked to skin cancer, including melanoma, squamous cell carcinoma, and basal cell carcinoma, as well as eye problems like cataracts and macular degeneration. Areas of healed burns, donor sites, and skin grafts are particularly vulnerable to sun exposure. Protecting these sensitive areas, especially your face, with sunscreen for face and other sun safety measures is crucial for recovery and long-term health.

Sun Exposure and Your Burn Injury

Sensitivity of Burned Skin

Burned skin, even after healing, and skin grafts can become exceptionally sensitive to sunlight. They are prone to sunburn much more quickly and intensely than uninjured skin, even with brief sun exposure. This heightened sensitivity can persist for a year or longer following a burn injury. Furthermore, certain medications, such as antihistamines like cetirizine and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, can further increase your skin’s sensitivity to the sun.

Pigmentation Changes

Skin color comes from melanin, a pigment in your skin. Second-degree burns and deeper injuries often initially cause pigment loss because melanin is located in the epidermis, the outermost skin layer. As healing occurs, pigmentation may return, but this process is unpredictable. Newly healed skin often appears pink and lacks pigment, regardless of your original skin tone. As the scar matures, normal pigmentation might return, become darker than before (hyperpigmentation), or remain lighter (hypopigmentation). Deeper injuries lead to a slower pigmentation recovery. Predicting color differences in mature scars is challenging. Some individuals experience lighter skin (hypopigmented), while others develop darker skin (hyperpigmented) compared to the uninjured skin in the area.

Ultraviolet light from the sun can interfere with pigment recovery. Tanned recently healed skin might not fade as the surrounding tan does. In burns requiring skin grafts, the grafted area may darken more than the surrounding uninjured skin. The exact cause is unknown, but sun protection is advised for at least a year post-burn to prevent permanent pigmentation changes in burned skin.

Individuals with Darker Skin Tones

Even if you have never experienced sun sensitivity or sunburn before, burned or grafted skin becomes susceptible to sunburn and pigmentation changes. Sun exposure won’t necessarily increase pigmentation in scar areas that have less pigment than the surrounding skin.

How to Protect Your Skin from Sun Exposure

Resuming normal activities like walking, outdoor games, hiking, swimming, biking, and gardening after a burn injury is important and encouraged. However, if you plan to spend significant time outdoors, combining sun protection methods is the best way to care for your skin. Dermatologists recommend a multi-faceted approach: sun avoidance, protective clothing, and applying sunscreen for face and body to minimize UV exposure and combat sun damage.

Avoid the Sun

Complete sun avoidance while staying active is nearly impossible, but you can control when you are outdoors. The sun’s intensity peaks between 10 a.m. and 4 p.m., or when your shadow is shorter than your height. Don’t be deceived by clouds; up to 80% of harmful UV rays can penetrate cloud cover. Also, be aware that surfaces like sand, water, snow, and ice reflect UV rays, increasing exposure. Certain types of UV light are stronger at higher altitudes. Limiting sun exposure during peak hours and being mindful of your environment are crucial for preventing sun-related skin damage. Seek shade whenever possible when spending time outdoors.

What about tanning beds? Avoid tanning beds as they emit similar or even greater amounts of cancer-causing UV light. The pigmentation they cause may also become permanent in healing scars.

Protective Clothing

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

Tighter Weave = More Protection: Densely woven fabrics like denim and wool offer more protection compared to thin fabrics like linen.
Loose Fit is Better: Loose-fitting garments provide greater protection than tight or stretched clothing.
Dry Fabric is Superior: Wet fabrics offer less protection than dry ones.
Synthetic and Semi-Synthetic Materials: These generally offer more protection than bleached or refined cottons.
Darker Colors Offer More Shielding: Darker clothing provides better UV protection.
Specialized Sun-Protective Clothing: Sporting goods stores and online retailers offer specialized sun-protective clothing made with fabrics containing UV-blocking or absorbing chemicals. These items are labeled with an Ultraviolet Protection Factor (UPF). UPF 30 or higher is recommended for specialized garments.

Other Protection Options

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

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

Sunscreens

Sunscreens are your third line of defense and should be used in combination with protective clothing and sun avoidance strategies. Sunscreen’s ability to protect you from harmful sun rays is measured by the Sun Protection Factor (SPF). SPF indicates how much longer it takes for sunscreen-protected skin to burn compared to unprotected skin. Generally, higher SPF values provide greater sunburn protection.

Sunscreens come in various forms: gels, sprays, creams, and sticks. Gels are effective for hairy areas, while creams work best for the face and dry skin. Sticks are convenient for around the eyes and lips. Regulations and standardization guidelines from the FDA do not fully apply to spray sunscreens. Ensure spray sunscreens thoroughly cover all exposed skin, avoid inhalation, and do not apply near heat, flame, or while smoking. Some sunscreens contain alcohol, which can dehydrate newly healed or grafted skin. Some facial creams and cosmetics, like foundations, contain sunscreen. While convenient, these products need frequent reapplication for optimal sun protection.

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

Sunscreen vs. Sunblock: What’s the Difference?

Sunscreen is more common. It filters the sun’s UV rays, preventing most, but not all, from penetrating the skin. Sunblock physically reflects sun rays and acts as a physical barrier. Most sunblocks contain titanium dioxide or zinc oxide, making them thicker and often opaque upon application. Many products marketed as sunscreens combine both sunscreen and sunblock ingredients.

Can I Use Tanning Lotion?

No. Tanning lotions often have a low SPF of only 4 or 5, which is insufficient to protect your skin from the sun.

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

Daily Use: Apply sunscreen every day of the year, even on cloudy days.
SPF 30 or Higher: Use a sunscreen with an SPF of 30 or higher.
Broad-Spectrum Protection: Choose a broad-spectrum sunscreen to protect against both UVA and UVB rays.
Reapply Every 2 Hours: Reapply sunscreen every 2 hours when outdoors.
Water-Resistant Sunscreen: Use water-resistant sunscreens, especially if swimming or sweating.
Generous Application: Generally, a palmful of sunscreen lotion is needed to cover all exposed body areas.
Babies Under 6 Months: Avoid direct sun exposure for babies under 6 months. Sunscreen is generally not recommended for this age group due to increased risk of side effects like rash.
Babies Over 6 Months: The American Academy of Pediatrics recommends sunscreen for babies over 6 months on small areas of skin (like face and back of hands) where clothing protection is insufficient. Zinc oxide or titanium dioxide products are generally less irritating.
Apply 30 Minutes Before Sun Exposure: Apply sunscreen 30 minutes before going outdoors to allow absorption.
Reapply After Water Activities: Reapply every 2 hours and immediately after swimming, heavy sweating, or toweling off. This applies even to water-resistant sunscreens.
Lip Protection: Protect your lips with a lip balm with SPF 30 or higher. Reapply frequently. Avoid vaseline-based products as they offer no sun protection.
Don’t Forget Key Areas: Remember to apply sunscreen to your ears, feet, back of hands, neck, and bald spots on the scalp.
Facial Sunscreen: Sunscreen for face specifically is often non-comedogenic (won’t clog pores) and may be preferable to other products for facial application.
Moisturizers with SPF: Moisturizers with sunscreen are available, providing both hydration and sun protection. Choose moisturizers with SPF 30 or higher.

Common Questions About Sunscreen Use

Will I ever be able to wear short sleeves and shorts safely again? We understand that wearing long sleeves and pants in hot weather can be uncomfortable. You can wear short sleeves and swimwear if you use sunscreen and limit your time in the sun.
What should I do if I have a reaction to sunscreen (e.g., rash)? Stop using the product immediately and try another sunscreen with different ingredients. If the reaction persists, consult your doctor or healthcare provider.
How long does sunscreen last before it expires? The FDA reports sunscreens are effective for 3 years. Many have expiration dates printed on the container. If there is no date, write the purchase date on the container and discard it after 3 years. If the consistency or texture changes, discard it.
What is PABA-free sunscreen? PABA stands for para-aminobenzoic acid and related chemicals. PABA sunscreens were used starting in the 1940s to absorb UVB rays. PABA has been phased out of most sunscreens due to reports of allergies and adverse reactions. PABA-free sunscreens do not contain this or related chemicals.
Are higher SPF sunscreens more effective than lower SPF ones? No sunscreen blocks 100% of the sun’s rays. SPF 30 blocks 97% of UVB light when used correctly. Higher SPF doesn’t mean you can use less or apply less frequently. All sunscreens should be applied liberally every two hours or as directed, regardless of SPF.
Can sunscreens cause cancer? Recent studies have shown no link between sunscreen use and melanoma (a type of skin cancer).
Are sunscreens 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 burn survivors.
Do sunscreens cause vitamin D deficiency? In theory, sunscreens could hinder vitamin D production by blocking UVB rays needed for synthesis. However, studies haven’t shown negative health consequences or vitamin D level differences between sunscreen users and non-users. A healthy diet rich in vitamin D (fatty fish, cheese, egg yolks, beef liver, and vitamin D-fortified milk and yogurt) is recommended.
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 worry 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.

Additional Resources:

Authors

This information 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 NIDILRR grant (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 proper source attribution. Permission is required for inclusion in materials for sale.