What is the treatment for vesicular eruptions (blisters)?

From the Guidelines

To treat bad blisters, it is essential to prioritize leaving them intact if possible, and if not, drain them by piercing the edge with a sterile needle and leaving the skin intact, as recommended by the most recent guidelines 1. When treating bad blisters, the primary goal is to prevent infection and promote healing.

• Clean the area gently with mild soap and water
• Apply an antiseptic like hydrogen peroxide or povidone-iodine
• For intact blisters, leave them unpopped as the skin provides a natural barrier against infection
• Cover the blister with a sterile bandage or specialized blister pad to protect it from further friction
• Change the dressing daily or when it becomes wet or dirty If a blister is large, painful, or in an area where it's likely to rupture,
• Drain it by sterilizing a needle with alcohol, gently puncturing the edge of the blister, pressing the fluid out, and leaving the skin intact, as suggested by 1
• After draining, apply an antibiotic ointment like Neosporin or Polysporin and cover with a bandage
• Take ibuprofen (400-600mg every 6-8 hours) or acetaminophen (500-1000mg every 6 hours) for pain, considering the advice on pain control from 1 It is crucial to watch for signs of infection, including increased redness, warmth, swelling, pus, or red streaks extending from the blister, which require medical attention, as emphasized by 1. Preventing future blisters is also vital, and this can be achieved by
• Wearing properly fitting shoes
• Wearing moisture-wicking socks
• Applying petroleum jelly to areas prone to friction The guidelines from 1 provide the most recent and highest quality recommendations for treating bad blisters, prioritizing morbidity, mortality, and quality of life as the outcome.

From the FDA Drug Label

Directions adults and children 2 years of age and older: clean the affected area apply a small amount of this product (an amount equal to the surface area of the tip of a finger) on the area 1 to 3 times daily may be covered with a sterile bandage children under 2 years of age: ask a doctor

To treat bad blisters, clean the affected area and apply a small amount of bacitracin (TOP) product, equivalent to the surface area of the tip of a finger, 1 to 3 times daily. The area may be covered with a sterile bandage. For children under 2 years of age, it is recommended to ask a doctor 2.

From the Research

Treatment of Bad Blisters

• Draining intact blisters and maintaining the blister roof is suggested to result in the least patient discomfort and may reduce the possibility of secondary infection 3.
• Treating deroofed blisters with hydrocolloid dressings provides pain relief and may allow patients to continue physical activity if necessary 3.
• There is no evidence that antibiotics influence blister healing 3.
• A study comparing topical antibiotic ointments, a wound protectant, and antiseptics for the treatment of human blister wounds contaminated with Staphylococcus aureus found that contaminated blister wounds treated with a triple antibiotic ointment healed significantly faster than wounds treated with any antiseptic and those receiving no treatment 4.
• However, another study found that simultaneous contact allergy to neomycin, bacitracin, and polymyxin can occur, highlighting the need for caution when using these antibiotics 5.
• A comparison of wide area fixation dressing versus adhesive tape for friction blister treatment found that adhesive tape was more effective and resulted in higher satisfaction 6.

Prevention of Blisters

• Wearing foot socks composed of acrylic can result in fewer foot blisters in runners 3.
• A thin polyester sock, combined with a thick wool or polypropylene sock that maintains its bulk when exposed to sweat and compression, can reduce blister incidence in Marine recruits 3.
• Recent exposure of the skin to repeated low intensity frictional forces can result in adaptations, including cellular proliferation and epidermal thickening, which may reduce the likelihood of blisters 3.
• Closed cell neoprene insoles may also reduce the incidence of foot blisters 3.

Considerations for Treatment

• The use of antiperspirants with emollients and drying powders does not appear to decrease the probability of friction blisters 3.
• Moist skin can increase the frictional forces that lead to blister development, while very dry or very wet skin can decrease these forces 3.
• Blisters are more likely to occur in skin areas with a thick horny layer held tightly to underlying structures, such as the palms of the hands or soles of the feet 3.