What is the best way to treat a blister?

Treatment of Blisters

Blisters should generally be left intact when possible, but when they are large or in troublesome locations, they should be pierced with a sterile needle to release the fluid while leaving the blister roof in place as a biological dressing. 1

Assessment and Decision Algorithm

1. Assess the blister:

   • Size: Small vs. large
   • Location: Is it in a functional area (e.g., sole of foot) causing pain?
   • Condition: Intact vs. already broken
   • Signs of infection: Redness, warmth, increased pain, purulent discharge

2. Treatment approach based on assessment:

For intact blisters:

• Small, non-painful blisters: Leave completely intact 2
• Large or painful blisters: Pierce and drain while preserving the roof 1
• Blisters in high-friction areas (palms, soles): Pierce to relieve pressure 1, 2

For draining a blister:

1. Gently cleanse the blister with an antimicrobial solution 1
2. Pierce the blister at its base with a sterile needle (bevel facing up) 1
3. Choose a location where fluid will drain by gravity to prevent refilling 1
4. Apply gentle pressure with sterile gauze to facilitate drainage 1
5. Do not remove the blister roof (leave it intact as a biological dressing) 1
6. Cleanse again with antimicrobial solution after draining 1
7. Apply a sterile, non-adherent dressing if needed 1

Special Considerations

Pain Management

• Offer analgesia before blister care procedures, as many patients report pain or burning during treatment 1
• For painful areas, consider covering with a low-adhesion dressing 1

Infection Prevention

• Monitor for signs of infection, which is a significant risk in open blisters 1
• Consider daily washing with an antibacterial product to decrease colonization 1
• For extensive or infected areas, use aseptic technique for dressing changes 1
• Apply topical antimicrobials for short periods if infection is suspected 1

For Burn Blisters

• Loosely cover burn blisters with a sterile dressing but leave blisters intact 1
• Do not apply ice directly to a burn blister; it can produce tissue ischemia 1
• Cool thermal burns with cold (15° to 25°C) tap water as soon as possible 1

Follow-up Care

• For blisters that have been drained, check regularly for signs of infection
• Change dressings as needed, maintaining sterile technique
• Document the number and location of blisters to track healing progress 1
• Apply bland emollients to support barrier function and encourage re-epithelialization 1

Prevention of Future Blisters

• For friction blisters: Ensure proper fit of shoes and equipment 3
• Consider acrylic socks or layered sock systems for athletes prone to foot blisters 3
• For those with recurrent blisters, investigate possible underlying conditions

The evidence strongly supports preserving the blister roof whenever possible, as this provides the best protection against infection and promotes optimal healing while reducing pain 1, 4. This approach is consistently recommended across dermatology and first aid guidelines.