What is the recommended management for blisters?

Management of Blisters

The recommended management for blisters depends on the type, location, and symptoms, with the general approach being to leave uncomplicated blisters intact, drain painful or large blisters while preserving the roof, and remove the roof only when infection is present or in certain burn cases. 1

Assessment and Classification

Before treatment, assess:

• Cause of blister (friction, burn, disease)
• Size and location
• Presence of pain or pressure
• Signs of infection
• Underlying medical conditions

Treatment Algorithm

1. Uncomplicated Blisters

• For small, intact blisters without pain: Leave the blister intact as the roof provides natural protection 1
• For painful blisters, especially on palms and soles:
  • Cleanse area with antimicrobial solution
  • Aseptically drain fluid using sterile needle
  • Preserve the blister roof as a biological dressing
  • Apply non-adherent dressing 2, 1

2. Ruptured Blisters

• Without infection signs: Leave remnants of blister roof in place
• With infection signs: Remove remnants of blister roof completely
• Apply sterile wound dressing in both cases 1

3. Burn Blisters

• For second-degree superficial burns or deeper:
  • Remove blister roof completely
  • Consider aspirating fluid for reapplication to wound (emerging technique)
  • Apply appropriate burn dressing 2, 1

4. Pain Management

• Offer analgesia before beginning any procedure
• Consider over-the-counter pain relievers like acetaminophen or NSAIDs 3

Prevention Strategies

For friction blisters, particularly common in athletes and active individuals:

• Ensure properly fitting shoes that are broken in gradually
• Use protective padding over blister-prone areas
• Apply drying foot powders
• Use non-slip insoles
• Address biomechanical foot defects 4, 5

Warning Signs for Medical Attention

Seek medical care if:

• Signs of infection develop (increasing redness, warmth, pain, pus, red streaks)
• Blisters cover large areas (>30% body surface area)
• Blisters involve mucous membranes 3

Special Considerations

• The management approach should be tailored based on blister etiology
• For recurrent blisters, investigate and address underlying causes
• Daily washing with antibacterial products can decrease colonization and prevent infection 3
• Antiseptic baths may help with extensive areas of erosion 3

Pitfalls to Avoid

• Avoid home remedies or applying substances that may introduce infection
• Don't remove blister roofs unnecessarily as they provide natural protection
• Don't ignore signs of infection which require prompt treatment
• Avoid tight or ill-fitting footwear that can cause friction blisters 3, 6

The most recent evidence from 2022 supports this individualized approach to blister management based on specific characteristics rather than a one-size-fits-all strategy 1.