Most cases of sunburn are classified as first degree burns, which can be treated at home with the above advice and staying out of the sun for awhile. However, extreme sun exposure can also cause second and third degree burns, which need medical attention and treatment. Second degree sunburn is characterized by blistered and wet looking skin, redness and damage to the entire epidermis and upper layers of the dermis. Third degree sunburn is characterized by flayed and dry looking skin, dark red or ashen color and destruction of the entire epidermis and most of the dermis. Skin sensation is usually diminished with third degree burns.  Second degree sunburns heal within 10–21 days, typically without any scarring. Third degree sunburns often need skin grafts to heal and always leave scarring.  Other reasons to see a doctor after a sunburn include symptoms of dehydration (see above) or heat exhaustion (heavy sweating, faintness, fatigue, weak but rapid pulse, low blood pressure and headache).  For children, as a general guideline, seek medical attention if a blistering sunburn covers 20% or more of their body (a child's whole back, for example). . Moderate-to-severe sunburn typically involves skin blistering, which is a natural protective reaction of your body. If you notice blisters form on your sunburned skin, don't pick at them or break any. Blisters contain your natural body fluid (serum) and form a protective layer over the burned skin. Breaking blisters also increases the risk of infection. If you have minimal blistering on accessible body parts (like your forearms, for example) then cover them with dry, absorbent bandages. However, if you have lots of blistering and its on your back or other inaccessible areas, then get your doctor to care for them. Your doctor will likely apply some antibiotic cream and dress the blisters properly with sterile bandages to limit the risk of infection, minimize scarring, and promote healing.  Change the bandages one to two times daily (if accessible), but remove them carefully so as to minimize further damage. Also, change the bandage immediately if it gets accidentally wet or dirty. When the blisters do break open, apply an antibiotic ointment to the area and cover loosely with another clean bandage. One or more blistering sunburns in childhood or adolescence doubles the risk of developing melanoma (a form of skin cancer) later in life. If your sunburn is particularly severe and involves blistering and flaying of the skin, then your doctor may recommend and prescribe silver sulfadiazine cream (Thermazene 1%). Silver sulfadiazine is a powerful bactericidal that kills bacteria and other potentially infectious agents on burned skin. It's usually applied once or twice a day, but do not use it on the face as it can cause grayish discoloration on skin. When applying the cream, wear gloves and apply a thick layer, but make sure to remove any dead and flaky skin first. Always keep the silver sulfadiazine cream covered with sterile bandages.  Colloidal silver solution, which can be purchased at many health food stores or made at home, is also a powerful antibiotic and much less expensive and problematic than silver sulfadiazine cream. Pour some colloidal silver into a sterile spray bottle and mist it over your burned skin, then let it dry before covering with bandages. If your doctor thinks widespread infection is a strong possibility due to your severe sunburn, he/she might prescribe a short-course of oral antibiotics to be on the safe side. Be aware that some antibiotics can cause photo sensitivity worsening chances of sunburn again — make sure you are staying out of the sun. If your sunburn is severe enough, your doctor may recommend oral steroid therapy (pills) for several days in order to combat the inflammation and pain.
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