Topical Corticosteroids in the Treatment of Acute Sunburn

Abstract

Patients: Twenty healthy volunteers with Fitzpatrick skin types I (highly sensitive, always burns easily, tans minimally) through III (sun-sensitive skin, sometimes burns, slowly tans to light brown).Intervention: Seven 34-cm 2 areas were marked on the upper aspect of the back of each participant. An untreated area was tested to determine UV sensitivity. Two areas were treated with excess amounts (2 mg/cm 2 ) of either a moderate-potency corticosteroid or a highpotency corticosteroid 30 minutes before UV-B exposure as controls. Six or 23 hours after exposure to radiation, the remaining areas were treated with the 2 corticosteroid preparations. Main Outcome Measures:The sunburn improvement factor (SIF) was determined by the following equation: SIF=MED (minimal erythema dose) on treated skin/ MED on nontreated skin. An SIF greater than 1 indicated an effect of topical corticosteroids in sunburn relief. Results:The SIFs in the areas treated with either topical corticosteroid 30 minutes before UV-B exposure or high-potency corticosteroid 6 hours after UV-B exposure were significantly different from SIFs in areas that received no treatment (SIF 1.1-1.7; PϽ.05). Only the median SIF of 1.7 in the areas treated with high-potency corticosteroid 30 minutes before UV-B exposure was clinically relevant. The areas treated 23 hours after UV-B exposure and the areas treated with a moderate-potency corticosteroid 6 hours after UV-B exposure showed no significant reduction in redness. Conclusion:Treatment with topical moderate-potency or high-potency corticosteroids does not provide a clinically useful decrease in the acute sunburn reaction when applied 6 or 23 hours after UV exposure.

Placebo controlled, crossover validation study of oral ibuprofen and topical hydrocortisone-21-acetate for a model of ultraviolet B radiation (UVR)-induced pain and inflammation

“…There is contradictory evidence for the effects of corticosteroids for the treatment of UVR-induced skin reactions. Mid- or high-potency steroids showed reduction of acute sunburn symptoms when applied before UVR exposure but not when applied 6 hours or later after UVR exposure 6,8. The lack of effects seen in this study may either be related to the fact that the first treatment was applied immediately after UVB radiation and not before, or because of the low potency of hydrocortisone per se or as used in this study.…”

“…Inflammation and pain related to UVR-induced sunburn was introduced by Bickel et al1 for the evaluation of analgesic effects and is now more broadly used as a simple pain model using three times the minimal erythema dose (MED) to evaluate the efficacy of NSAIDs but can also be used for corticosteroids 6–8…”

Topical hydrocortisone, clobetasol propionate, and calcipotriol do not increase photocarcinogenesis induced by simulated solar irradiation in hairless mice

“…Less cell turnover would result in sustained pigmentation compared to the mice who received only UV‐irradiation. It has been reported that corticosteroids can reduce the erythemic and melanogenic effects of acute UV exposure, but little is known about their effect on melanocytes (28,29). We also observed persistence in pigmentation during a treatment pause in a previous murine study that used tacrolimus and pimecrolimus topical treatments (13,15).…”

The wound/burn guidelines – 6: Guidelines for the management of burns

“… There are only expert opinions concerning the usefulness of topical steroid preparations for the treatment of burns, and the evidence level is VI. On the other hand, there are three RCT (including double‐blind trials) suggesting that topical steroid preparations showed no anti‐inflammatory effect on the skin that has sustained physical damage including burn . However, we noted that expert opinions suggesting the usefulness of topical steroid preparations for the treatment of first‐ or second‐degree burns are predominant and that topical steroid preparations have been used widely for the treatment of burns in Japan. Yamanaka et al .…”

“…174 Pederson et al however, performed a double-blind RCT by artificially creating first-degree burns or SDB in healthy volunteers and compared the anti-inflammatory effect between clobetasol propionate and placebo according to the severity of pain and erythema and reported no significant difference between the two groups. 175 Faurschou et al 176 examined the effects of an topical steroid preparation on sun burn (ultraviolet B irradiation) in 20 healthy volunteers but observed no clinical usefulness when it was applied after irradiation. Also, Matsumura et al carried out a double-blind trial concerning the effects of betamethasone valerate/gentamycin sulfate on fresh second-degree burns using gentamycin sulfate as a control drug.…”