Should I debride (remove dead tissue) or aspirate (withdraw fluid with a needle) a burn blister?

Management of Burn Blisters: Leave Intact

Burn blisters should be left intact as this improves healing and reduces pain. 1

Evidence-Based Approach to Burn Blister Management

The American Heart Association (AHA) provides clear guidance on the management of burn blisters in their 2010 guidelines, which has been maintained in subsequent updates:

• Leave burn blisters intact because this improves healing and reduces pain (Class IIa, LOE B) 1
• Loosely cover burn blisters with a sterile dressing to protect them 1
• Do not apply ice directly to burns as it can produce tissue ischemia (Class III, LOE B) 1

Rationale for Leaving Blisters Intact

The recommendation to leave burn blisters intact is based on several important considerations:

1. Protection: The intact blister serves as a biological dressing
2. Pain reduction: Intact blisters provide a protective barrier that reduces pain
3. Improved healing: Evidence shows better healing outcomes when blisters remain intact
4. Infection barrier: The intact epidermis helps prevent bacterial contamination

Wound Care for Burn Blisters

When managing burn blisters:

• Gently clean the area with warm or room temperature water 2
• Apply a greasy emollient such as 50% white soft paraffin with 50% liquid paraffin over the area 1, 2
• Cover with a non-adherent dressing (such as Mepitel or Telfa) 1, 2
• If necessary, large blisters may be decompressed by piercing and aspiration of fluid while leaving the skin intact 1

Special Considerations

When to Seek Medical Attention

Seek immediate medical attention for burns that are:

• On the face, hands, feet, or genitalia
• Full-thickness (third-degree)
• Covering >10% total body surface area (TBSA) in children
• Covering >20% TBSA in adults 2

Conflicting Evidence

While the AHA guidelines clearly recommend leaving blisters intact, some research presents alternative viewpoints:

• A 1993 study suggested that burn blister fluid might inhibit reepithelialization and recommended debridement 3
• More recent research indicates that the fluid in blisters contains proteins, cytokines, and immunoglobulins that may have both pro-inflammatory and healing properties 4

Despite these conflicting findings, the consensus from guidelines and more recent evidence supports leaving blisters intact in most cases.

Common Pitfalls to Avoid

• Do not apply ice directly to burns - this can worsen tissue damage 1
• Do not apply butter, oil, or home remedies to burns
• Do not break blisters intentionally - this increases infection risk
• Do not use adhesive dressings directly on blisters or burns
• Do not delay seeking medical attention for severe burns

Conclusion

Following the AHA guidelines, burn blisters should be left intact and covered with a sterile dressing to promote optimal healing and reduce pain. While some research suggests potential benefits to debridement in specific circumstances, the strongest and most current evidence supports preserving the integrity of burn blisters in most cases.