Sunburn can be severe

It seemed absurd.

A week after spending three hours on the beach, reading a book in the summer sun, the skin on my lower legs was burnt, untouchable and showing no signs of improvement.

Worse, my ankles were swollen and feeling bruised. The blisters that didn't appear until three days after the initial burn had grown in size and area. I could only wear skirts that fell to my knee. Nothing could touch it but cold water and it hurt to walk and stand.

My legs felt stiff and painful in the morning, resulting in what must have been a comical sight for my housemates. I staggered down the hall to the bathroom, yelping all the way.
"How could all this be only a little sunburn?" I wondered.

Upon seeing the blisters, my horrified boss suggested I make a visit to the doctor.

I spent a lot of time scouring Google for sunburn treatment suggestions during my week of pain, but none of the descriptions convinced me of the trouble I was in. Everything I read lead me to believe things should improve shortly: Just keep up the liquid intake, cool water baths, and aloe vera gel application, and it'll turn into a tan and peel in a day or two. It didn't, and the pain got worse.

So I went to the urgent care at the University of Washington Medical Center.

A nurse practioner marvelled at the protective powers of sunblock--my otherwise exposed face and arms had been slathered in the stuff and survived the ordeal unscathed--and told me, yes, it was a pretty nasty burn and it probably had a secondary infection to boot.

"It's a good thing you came in," she told me. "This wouldn't get better on its own."

The medical assistant cleaned and dressed the wounds with non-adhesive pads and rolls of gauze and showed me how to apply Silvadene, the heavy-duty burn cream known to some as a "miracle." She laughed when I told her I'd been trying to use aloe.

The nurse practioner prescribed antibiotics for the infection and sent me home.

A few days later, the blisters were gone, the burn was healing and the pain was comparatively undetectable. At last, I could shower again.

Medical treatment for sunburns is not uncommon, though to patients it seems like it would be. Many who suffer even second-degree burns that penetrate beneath the top layer of skin and bubble up with ugly blisters do not seek treatment under the assumption it should go away sooner or later.

But sometimes it's worse than that.

Kellie Tinnin, a 22-year-old from Yuma, Ariz. visited San Diego a few weeks ago with a girlfriend. They spent time on a sunny beach. She relied on the 15 spf in her makeup instead of applying another sunblock to her face.

"Careless sunblock application left me with first and second degree [burns] on my face," she explained.

In the time many sunburns should begin to heal, Tinnin's worsened.

She recalled: "My face was as red as a tomato, and after about a day and a half my forehead, cheeks, lips, etc. swelled. I could barely talk for two days and my face basically felt like it was going to fall off."

Several concerned people hold her she should see a doctor. She went to the local urgent care facility, where she was told she should "know better" and sent home.

Her own physician saw her the next day and diagnosed her first and second degree burns.

"[He] gave me burn cream, which helped so much."

Many of the websites that came up in my Google searches listed common symptoms associated with mild first and second-degree burns: redness, pain, itching, blisters, fever, moisture. The experience of a mild sunburn is common among those with light skin.

What was tricky on the Web sites was their insistentence that people exhibiting symptoms of a "severe" burn seek professional care. What did they mean by "severe?" I knew, for example, that my burn was far and away worse than any sunburn I'd ever had before, but was it "severe?"

My visit to urgent care made it clear that it was. And it took me a week to figure that out.

Tinnin had a similar experience. She admitted feeling embarrassed that she resembled a "tomato with legs and arms" for a week, but less for her appearance than carelessness.

"I was like, 'Ah, it won't happen to me,'" the beachgoer said, "[but] boy did it ever!"

Normal sunburns are unpleasant, but should not feel worse a week later than the day after. Usually a burn will appear one to six hours after sun exposure and peak in 24 hours.

Sources disagreed on whether or not the presence of blisters alone was enough to warrant medical care. Signs of infection, however, signal the need for a doctor's intervention.

Only one website I saw mentioned the "red and white streaks" of which to beware in this regard. I couldn't see mine, because they weren't part of the burn itself. The subtle marks appeared on healthy skin above the burn. I wouldn't have been able to identify them as such until the nurse practitioner pointed them out to me as evidence of infection.

Within five days, the cream had healed up my burns, the antibiotics removed those easy-to-miss red and white streaks and I could wear jeans again.

(for News Lab)