Heath Notes

Sunburn

Everyone should enjoy some sunshine but too much sun can spoil the fun—and cause permanent damage to your skin. According to research or other evidence, the following self-care steps may help you shield yourself:

Block harsh rays
Prevent sunburn by wearing protective clothing, by frequently applying sun block with a high sun protection factor (SPF), and by staying in the shade when the rays are strongest

Apply topical antioxidants
Try formulas containing 2% vitamin E, 5% vitamin C, 0.02% to 0.05% selenomethionine, 1% to 2.5% melatonin, and/or 10% green tea polyphenols to boost the protection from traditional sunscreens

Add tomatoes to your meals
Gain the protective benefits of the antioxidant lycopene by consuming tomato-based foods and drinks

Supplement with antioxidants
Fortify your body with antioxidants that defend against harmful ultraviolet rays; take a daily supplement containing 2,000 to 3,000 mg of vitamin C, 1,000 to 2,000 IU of vitamin E, 6 mg of natural beta-carotene, and 6 mg of lycopene during periods of high sun exposure

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or pharmacist. Continue reading the full Sunburn article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

About Sunburn

Sunburn is damage to the skin resulting from excessive exposure to the sun’s ultraviolet rays. Depending on the strength of these rays and the degree of skin pigmentation, sunburn to unprotected skin can occur with as little as a few minutes or as long as several hours of exposure. Unlike other types of burn, sunburn is not fully apparent until hours after exposure. Severe sunburn should be evaluated and treated by a doctor. Frequent sunburn contributes to wrinkling and aging of the skin and increases the risk of skin cancer.

Product ratings for Sunburn

Science Ratings	Nutritional Supplements	Herbs
	Vitamin C (oral, in combination with vitamin E)
	Beta-carotene Lycopene Melatonin (topical, in combination with vitamins C and E) Proanthocyanidins Vitamin C (topical, in combination with vitamin E)	Green tea Polypodium leucotomos
		Aloe
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

What are the symptoms?

Reddening of the skin is the hallmark of sunburn, and the skin may become swollen as well. Pain in the area develops over several hours and may persist for days. Blistering and fever can occur with severe sunburn. After a few days, sunburned skin will peel.

Dietary changes that may be helpful

Tomatoes contain lycopene and other antioxidants that might help protect the skin from sunburn, and tomato-based products have been tested for protective effects against exposure to ultraviolet light in a laboratory. A preliminary study tested a tomato drink processed in a manner designed to increase the absorption of its antioxidants.¹ After determining the amount of skin reddening produced by a dose of ultraviolet light, volunteers consumed 250 ml twice a day of this drink, which provided 8.2 mg of lycopene per day plus additional amounts of other carotenoids. After 12 weeks, the same amount of ultraviolet exposure resulted in significantly less reddening. A controlled trial found that 40 grams per day of tomato paste providing 16 mg per day of lycopene for 10 weeks also protected against burning by ultraviolet rays.²

Lifestyle changes that may be helpful

Staying out of the sun when it is strongest, wearing protective clothing, and frequently applying sun block with a high sun protection factor (SPF) are all recommended for avoiding sunburn.

Other therapies

People suffering from sunburn should avoid further exposure until symptoms improve. Cold water compresses made from gauze or thin cloth may soothe inflamed tissue and ease the pain.

Vitamins that may be helpful

Antioxidants may protect the skin from sunburn due to free radical–producing ultraviolet rays.³ Combinations of 1,000 to 2,000 IU per day of vitamin E and 2,000 to 3,000 mg per day of vitamin C, but neither given alone, have a significant protective effect against ultraviolet rays, according to double-blind studies.⁴ ⁵ ⁶

Oral synthetic beta-carotene alone was not found to provide effective protection when given in amounts of 15 mg per day or for only a few weeks’ time in larger amounts of 60 to 90 mg per day, but it has been effective either in very large (180 mg per day) amounts or in smaller amounts (30 mg per day) in combination with topical sunscreen.⁷ ⁸ ⁹ ¹⁰ ¹¹

Natural sources of beta-carotene or other carotenoids have been more consistently shown to protect against sunburn. One controlled study found that taking a supplement of natural carotenoids (almost all of which was beta-carotene) in daily amounts of 30 mg, 60 mg, and 90 mg gave progressively more protection against ultraviolet rays.¹² In another controlled study, either 24 mg per day of natural beta-carotene or 24 mg per day of a carotenoid combination of equal amounts beta-carotene, lutein, and lycopene helped protect skin from ultraviolet rays.¹³ A preliminary study compared synthetic lycopene (10.1 mg per day), a natural tomato extract containing 9.8 mg of lycopene per day plus additional amounts of other carotenoids, and a solubilized tomato drink (designed to increase lycopene absorption) containing 8.2 mg of lycopene plus additional amounts of other carotenoids. After 12 weeks, only the two tomato-based products were shown to give significant protection against burning by ultraviolet light.¹⁴

Still other trials have tested combinations of several antioxidants. One preliminary study found that a daily combination of beta-carotene (6 mg), lycopene (6 mg), vitamin E (15 IU), and selenium for seven weeks protected against ultraviolet light.¹⁵ However, a double-blind trial of a combination of smaller amounts of several carotenoids, vitamins C and E, selenium, and proanthocyanidins did not find significant UV protection compared with placebo.¹⁶ Similarly, in a controlled trial, a combination of selenium, copper, and vitamins was found to be ineffective.¹⁷

It should be noted that while oral protection from sunburn has been demonstrated with several types of antioxidants, the degree of protection (typically less than an SPF of 2) is much less than that provided by currently available topical sunscreens. On the other hand, these modest effects will provide some added protection to skin areas where sunscreen is also used and will give a small amount of protection to sun-exposed areas where sunscreen is not applied. However, oral protection from sunburn is not instantaneous; maximum effects are not reached until these antioxidants have been used for about eight to ten weeks.¹⁸ ¹⁹

Proanthocyanidins (OPCs) are a group of flavonoids found in pine bark, grape seed, and other plant sources. In a preliminary trial, volunteers were supplemented with Pycnogenol, an extract of French maritime pine bark rich in OPCs, in the amount of 1.1 mg per 2.2 pounds of body weight per day for the first four weeks, and 1.66 mg per 2.2 pounds of body weight per day for the next four weeks.²⁰ Compared with ultraviolet sensitivity before supplementation, the lower amount of Pycnogenol was found to significantly increase the amount of ultraviolet rays necessary to cause sunburn, and the higher amount was significantly more effective than the lower amount.

Antioxidants have also been studied as topical agents for protection against sunburn. Animal studies have found sunscreen-like effects from topical application of a vitamin C and vitamin E combination, and a controlled human study reported ultraviolet protection from the use of a lotion containing 0.02% to 0.05% of the selenium-containing amino acid known as selenomethionine.²¹ ²² The topical use of the hormone melatonin has been shown to protect human skin against ultraviolet rays in double-blind research.²³ ²⁴ A double-blind human trial tested topical vitamins C and E and melatonin, alone and in combinations, and found the highest degrees of protection from combination formulations containing 2% vitamin E, 5% vitamin C, and 1% to 2.5% melatonin.²⁵ Other studies in which topical antioxidants were applied after ultraviolet exposure have found no benefits.²⁶ ²⁷

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful

Green tea (Camellia sinensis) contains polyphenols that have antioxidant and anti-inflammatory activity, and animal and preliminary human studies have suggested that these polyphenols, when given orally or used topically, can protect skin against ultraviolet rays.²⁸ ²⁹ ³⁰ ³¹ In a small, controlled human study, topical application of green tea extracts containing from 2.5 to 10% polyphenols significantly reduced the amount of burning from exposure to ultraviolet rays, with the 10% solution exerting the greatest protective effect.³²

Extracts of Polypodium leucotomos (PL), a fern native to Central and South America, have antioxidant and anti-inflammatory activity.³³ Several preliminary human studies have reported that a 50:1 PL extract in amounts of either 7.5 mg per 2.2 pounds of body weight or 1,080 mg given orally on the evening before and on the day of testing reduces the burning effect of ultraviolet rays.³⁴ ³⁵ ³⁶ Placebo-controlled research is needed to verify these protective effects.

Topical aloe (Aloe vera) is often recommended for soothing burns, but only one preliminary human study involving sunburn has been published, and applying aloe gel after ultraviolet exposure had no effect on reddening of the skin.³⁷ No research has investigated whether applying aloe gel before ultraviolet exposure might be more effective.

Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.

Holistic approaches that may be helpful

None

References
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2. Stahl W, Heinrich U, Wiseman S, et al. Dietary tomato paste protects against ultraviolet light-induced erythema in humans. J Nutr 2001;131:1449–51.

3. Fuchs J. Potentials and limitations of the natural antioxidants RRR-alpha-tocopherol, L-ascorbic acid and beta-carotene in cutaneous photoprotection. Free Radic Biol Med 1998;25:848–73.

4. Werninghaus K, Meydani M, Bhawan J, et al. Evaluation of the photoprotective effect of oral vitamin E supplementation. Arch Dermatol 1994;130:1257–61.

5. Fuchs J, Kern H. Modulation of UV-light-induced skin inflammation by D-alpha-tocopherol and L-ascorbic acid: a clinical study using solar simulated radiation. Free Radic Biol Med 1998;25:1006–12.

6. Eberlein-Konig B, Placzek M, Przybilla B. Protective effect against sunburn of combined systemic ascorbic acid (vitamin C) and d-alpha-tocopherol (vitamin E). J Am Acad Dermatol 1998;38:45–8.

7. McArdle F, Rhodes LE, Parslew RA, et al. Effects of oral vitamin E and beta-carotene supplementation on ultraviolet radiation-induced oxidative stress in human skin. Am J Clin Nutr 2004;80:1270–5.

8. Garmyn M, Ribaya-Mercado JD, Russel RM, et al. Effect of beta-carotene supplementation on the human sunburn reaction. Exp Dermatol 1995;4:104–11.

9. Wolf C, Steiner A, Honigsmann H, et al. Do oral carotenoids protect human skin against UV erythema, psoralen phototoxicity, and UV-induced DNA damage? J Invest Dermatol 1988;90:55–57.

10. Mathews-Roth MM, Pathak MA, Parrish J, et al. A clinical trial of the effects of oral beta-carotene on the responses of human skin to solar radiation. J Invest Dermatol 1972;59:349–53.

11. Gollnick HP, Hopfenmuller W, Hemmes C, et al. Systemic B-carotene plus topical sunscreen are an optimal protection against harmful effects of natural UV-sunlight. Eur J Dermatol 1996;6:200–5.

12. Lee J, Jiang S, Levine N, Watson RR. Carotenoid supplementation reduces erythema in human skin after simulated solar radiation exposure. Proc Soc Exp Biol Med 2000;223:170–4.

13. Heinrich U, Gartner C, Wiebusch M, et al. Supplementation with beta-carotene or a similar amount of mixed carotenoids protects humans from UV-induced erythema. J Nutr 2003;133:98–101.

14. Aust O, Stahl W, Sies H, et al. Supplementation with tomato-based products increases lycopene, phytofluene, and phytoene levels in human serum and protects against UV-light-induced erythema. Int J Vitam Nutr Res 2005;75:54–60.

15. Cesarini JP, Michel L, Maurette JM, et al. Immediate effects of UV radiation on the skin: modification by an antioxidant complex containing carotenoids. Photodermatol Photoimmunol Photomed 2003;19:182–9.

16. Greul AK, Grundmann JU, Heinrich F, et al. Photoprotection of UV-irradiated human skin: an antioxidative combination of vitamins E and C, carotenoids, selenium and proanthocyanidins. Skin Pharmacol Appl Skin Physiol 2002;15:307–15.

17. La Ruche G, Cesarini JP. Protective effect of oral selenium plus copper associated with vitamin complex on sunburn cell formation in human skin. Photodermatol Photoimmunol Photomed 1991;8:232–5.

18. Sies H, Stahl W. Nutritional protection against skin damage from sunlight. Annu Rev Nutr 2004;24:173–200 [review].

19. Sies H, Stahl W. Carotenoids and UV protection. Photochem Photobiol Sci 2004;3:749-52 [review].

20. Saliou C, Rimbach G, Moini H, et al. Solar ultraviolet-induced erythema in human skin and nuclear factor-kappa-B-dependent gene expression in keratinocytes are modulated by a French maritime pine bark extract. Free Radic Biol Med 2001;30:154–60.

21. Lin JY, Selim MA, Shea CR, et al. UV photoprotection by combination topical antioxidants vitamin C and vitamin E. J Am Acad Dermatol 2003;48:866–74.

22. Burke KE, Burford RG, Combs GF Jr, et al. The effect of topical L-selenomethionine on minimal erythema dose of ultraviolet irradiation in humans. Photodermatol Photoimmunol Photomed 1992;9:52–7.

23. Bangha E, Elsner P, Kistler GS. Suppression of UV-induced erythema by topical treatment with melatonin (N-acetyl-5-methoxytryptamine). Influence of the application time point. Dermatology 1997;195:248–52.

24. Bangha E, Elsner P, Kistler GS. Suppression of UV-induced erythema by topical treatment with melatonin (N-acetyl-5-methoxytryptamine). A dose response study. Arch Dermatol Res 1996;288:522–6.

25. Dreher F, Gabard B, Schwindt DA, Maibach HI. Topical melatonin in combination with vitamins E and C protects skin from ultraviolet-induced erythema: a human study in vivo. Br J Dermatol 1998;139:332–9.

26. Dreher F, Denig N, Gabard B, et al. Effect of topical antioxidants on UV-induced erythema formation when administered after exposure. Dermatology 1999;198:52–5.

27. Fuchs J. Potentials and limitations of the natural antioxidants RRR-alpha-tocopherol, L-ascorbic acid and beta-carotene in cutaneous photoprotection. Free Radic Biol Med 1998;25:848–73 [review].

28. Graham HN. Green tea composition, consumption, and polyphenol chemistry. Prev Med 1992;21:334–50.

29. Kim J, Hwang JS, Cho YK, et al. Protective effects of (-)-epigallocatechin-3-gallate on UVA- and UVB-induced skin damage. Skin Pharmacol Appl Skin Physiol 2001;14:11–9.

30. Katiyar SK. Skin photoprotection by green tea: antioxidant and immunomodulatory effects. Curr Drug Targets Immune Endocr Metabol Disord 2003;3:234–42 [review].

31. Katiyar SK, Perez A, Mukhtar H. Green tea polyphenol treatment to human skin prevents formation of ultraviolet light B-induced pyrimidine dimers in DNA. Clin Cancer Res 2000;6:3864–9.

32. Elmets CA, Singh D, Tubesing K, et al. Cutaneous photoprotection from ultraviolet injury by green tea polyphenols. J Am Acad Dermatol 2001;44:425–32.

33. Gonzalez S, Pathak MA. Inhibition of ultraviolet-induced formation of reactive oxygen species, lipid peroxidation, erythema and skin photosensitization by polypodium leucotomos. Photodermatol Photoimmunol Photomed 1996;12:45–56.

34. Middelkamp-Hup MA, Pathak MA, Parrado C, et al. Oral Polypodium leucotomos extract decreases ultraviolet-induced damage of human skin. J Am Acad Dermatol 2004;51:910–8.

35. Middelkamp-Hup MA, Pathak MA, Parrado C, et al. Orally administered Polypodium leucotomos extract decreases psoralen-UVA-induced phototoxicity, pigmentation, and damage of human skin. J Am Acad Dermatol 2004;50:41–9.

36. Gonzalez S, Pathak MA, Cuevas J, et al. Topical or oral administration with an extract of Polypodium leucotomos prevents acute sunburn and psoralen-induced phototoxic reactions as well as depletion of Langerhans cells in human skin. Photodermatol Photoimmunol Photomed 1997;13:50–60.

37. Crowell J, Penneys N. The effects of aloe vera on cutaneous erythema and blood flow following ultraviolet B (UVB) exposure. Clin Res 1987;35:676A [abstract].

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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires September 2008.

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