Internal Medicine

0521779407-19 CUNY1086/Karliner 0 521 77940 7 June 6, 2007 17:50

1390 Subarachnoid Hemorrhage (SAH) Sunburn

the aneurysm is corrected; approximately 90% of pts survive after

bleeding from an AVM; focal deficit more likely among survivors of

SAH from AVM than aneurysm

SUNBURN

JEFFREY P. CALLEN, MD

history & physical

History

■Outdoor activities or tanning bed use

➣Photosensitizing medications – i.e., sulfonamides, thiazide di-

uretics, tetracyclines, psoralens, NSAIDs

➣Topical photosensitizers – e.g., coal tar extracts, lime juice

➣Ultraviolet light (UVL) radiation increases with altitude

➣Reflection from sand, snow, water of UVL

Signs & Symptoms

■Warmth, pain, itching on sun-exposed areas

■Blistering may occur with severe sunburns

■Sharply demarcated areas of involvement

■Inflammation

➣Appears within 2–4 hours

➣Peaks at 12–24 hours

➣Abates slowly over several days

■Daily sun exposure is additive and a “tan” does not protect well

against sunburn

■UVA tanning (tanning beds/salons) is only mildly protective against

UVB-induced erythema

tests

■None are needed

differential diagnosis

■Photosensitivity diseases – polymorphous light eruption, lupus ery-

thematosus, dermatomyositis, photoallergic dermatitis

management

What to Do First

■Assess the severity of the sunburn – is there vesiculation?

■Assess the role of medications as a factor in the photosensitivity.