What is the treatment for blisters?

Treatment for Blisters

The recommended treatment for blisters is to clean the area with an antimicrobial solution, pierce the blister at its base using a sterile needle, drain the fluid while leaving the blister roof intact as a biological dressing, and apply a non-adherent dressing if necessary. 1

Initial Management

1. Clean the area:

   • Use an antimicrobial solution to clean the blister and surrounding skin 1
   • This reduces the risk of infection when draining the blister

2. Drainage procedure:

   • For painful or pressure-bearing blisters (especially on palms and soles):
     • Pierce the blister at its base with a sterile needle
     • Gently apply pressure with sterile gauze to facilitate drainage
     • Keep the blister roof intact as it serves as a biological dressing 1
   • For uncomplicated blisters without pressure pain:
     • Leave the blister intact 2
   • For ruptured blisters:
     • Without signs of infection: leave remnants of blister roof
     • With signs of infection: remove remnants of blister roof 2

3. Post-drainage care:

   • Apply a bland emollient such as 50% white soft paraffin and 50% liquid paraffin 1
   • Cover with a non-adherent dressing if necessary (e.g., plain petrolatum ointment with bandage, or low-adhesion dressings like Mepitel or Atrauman for painful areas) 1
   • Apply cold compresses intermittently for the first 24-48 hours to reduce swelling 1

Pain Management

• Provide analgesia before beginning painful procedures 1
• Consider over-the-counter pain relievers like acetaminophen or NSAIDs if needed 1
• Avoid direct ice application to prevent tissue damage 1

Infection Prevention

• Daily washing with antibacterial products can decrease colonization 1
• For extensive areas of erosion, antiseptic baths or soaks (e.g., potassium permanganate) may help dry lesions and prevent infection 1
• Monitor for signs of secondary infection (increasing erythema, warmth, purulence, or fever) 1
• If infection occurs, consider oral antibiotics (e.g., cephalexin 500mg four times daily for 7-10 days) 1

Special Considerations

For Burn Blisters

• In burns of grade 2a or higher, chemical burns, or unclear burn depth: remove the blister roof 2
• For second-degree superficial burns: puncture in a sterile way and keep overlying skin as biological cover 3

For Inflammatory Blisters (e.g., Bullous Pemphigoid)

• These require specific treatment targeting the underlying autoimmune condition
• May include medium to high-potency topical corticosteroids, oral antihistamines, or systemic immunosuppressants depending on severity 4, 1

Prevention Strategies

• Wear properly fitted shoes and socks to minimize friction 5, 6
• Use protective padding over potential blister sites 6
• Apply drying foot powders for moisture control 6
• Consider non-slip insoles to reduce friction 6
• Gradually break in new footwear 6

Common Pitfalls to Avoid

• Do not remove the blister roof unnecessarily as it provides natural protection against infection
• Avoid home remedies or applying substances that may introduce infection or delay healing 1
• Avoid using alcohol-containing products on damaged skin as they can cause further irritation 1
• Do not ignore blisters that show signs of infection or are associated with systemic conditions
• Be cautious with prolonged use of high-potency topical corticosteroids as they can cause skin atrophy, telangiectasia, and striae 1