For severe sunburn, especially with blistering, have patients apply 1% silver sulfadiazine (Silvadene Cream) b.i.d. (including after showering). Patients report less pain and faster healing. Of course, check for medication allergies before prescribing this treatment. — Elaine Lund, NP, MSN, Norwich, N.Y.

Application of silver sulfadiazine has been used for topical psoralen-induced partial-thickness sunburns that involved 6%-40% of total body-surface area in three children. The burns resulted from unsupervised sun exposure and all healed without infection or contracture (Burns. 2000;26:653-655). Silvadene Cream combines the beneficial properties and potential adverse systemic reactions of silver nitrate and sulfonamides. Since this topical compound can be systemically absorbed, it should not be used in patients who are allergic to sulfonamides (sulfa drugs), nor should it be used in infants younger than 2 months. Other medical conditions (e.g., blood problems, kidney disease, liver disease, and glucose-6-phosphate dehydrogenase deficiency) may also influence the decision to use Silvadene Cream. — Philip R. Cohen, MD (102-21)

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