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Scalp oedema after sunburn

BMJ 2013; 347 doi: (Published 20 November 2013) Cite this as: BMJ 2013;347:f6703

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Re: Scalp oedema after sunburn

I was surprised to see this picture with the accompanying script. It is in fact a very good illustration of superficial epidermal sunburn after shaving of the protective layer of hair. The true message should be one of prevention of the burn by
adequate use of a sun-block.

The use of oral steroids to treat oedema from a burn is quite inappropriate.

The clinical signs are quite striking and easily explained by a knowledge of the anatomy of the scalp. The "fluctuant boggy mass" is oedema in the sub-cutaneous tissue. In this area the skin is closely united to the galea aponeurotica by firm fibro-fatty superficial fascia (Greys Anatomy 33rd Edition 1962 p. 578). This prevents oedema diffusing to the deeper layer of loose cellular tissue. At the line of the frontalis muscles the fluid can disperse more easily as seen at the lower brow area. It is also clear that the nose and cheek skin is erythematous and somewhat swollen which fits with the diagnosis of sunburn.

The clear message here is that knowledge of anatomy is sadly lacking amongst the younger members of the medical profession. This is not surprising as most modern textbooks of anatomy hardly mention skin (the largest organ of the body).

To advocate prescribing oral steroids for sunburn is totally contraindicated for this benign self-limiting condition.

Competing interests: No competing interests

16 December 2013
Arthur MacG Morris
Hon Senior Lecturer in Medicine
Medical School, St Andrews University
North Haugh, St Andrews