What is the recommended treatment for blisters?

Recommended Treatment for Blisters

The recommended treatment for blisters depends on their condition: leave intact blisters in place if uncomplicated, puncture painful blisters while preserving the roof, and remove the blister roof only when there are signs of infection or when the blister is already ruptured. 1

Treatment Algorithm Based on Blister Condition

1. Intact Blisters

• Uncomplicated blisters without pain: Leave the blister intact 1, 2
• Painful blisters (especially on palms and soles):
  • Aseptically puncture the blister at its edge
  • Drain the fluid while preserving the blister roof as a biological dressing
  • Apply a sterile, non-adherent dressing 1, 2, 3

2. Compromised Blisters

• Already ruptured blisters without infection signs: Leave remnants of the blister roof in place 1, 2
• Blisters with signs of infection: Remove the blister roof completely 1, 2
• Burn blisters (2nd degree or higher): Remove the blister roof 2

Wound Care Protocol

Cleansing

• Gently clean the area with an antimicrobial solution 1
• Daily washing with antibacterial products to decrease bacterial colonization 1

Dressing Application

• Apply a bland emollient (e.g., 50% white soft paraffin and 50% liquid paraffin) 1
• Cover with a non-adherent dressing to maintain a moist wound environment 1
• For extensive areas of erosion, consider antiseptic baths or soaks (e.g., potassium permanganate) 1

Infection Management

• Monitor for signs of infection: increasing redness, warmth, pain, pus, or red streaks 1
• If infection develops, oral antibiotics may be necessary:
  • Dicloxacillin: 250 mg four times daily
  • Cephalexin: 250 mg four times daily
  • Clindamycin: 300-400 mg three times daily (if penicillin allergic)
  • Amoxicillin/clavulanate: 875/125 mg twice daily 1

Pain Management

• Provide appropriate analgesia as needed (acetaminophen or NSAIDs) 1
• Avoid home remedies that may introduce infection or delay healing 1

Special Considerations

Prevention Strategies

• Properly fitted shoes and athletic equipment 4, 5
• Protective padding over blister-prone areas 5
• Use of drying foot powders and non-slip insoles for friction blisters 5

When to Seek Medical Attention

• Large blisters (>30% BSA) or those involving mucous membranes 1
• Signs of infection development 1
• Tetanus immunization status should be evaluated in traumatic wounds 1

Evidence Strength and Considerations

The Initiative Chronic Wounds (ICW) consensus provides the most comprehensive and recent guidance on blister management, emphasizing that treatment should be tailored to the specific blister condition 1, 2. This approach is supported by research showing that preserving the blister roof when possible provides a natural biological dressing that promotes healing 3.

Research has shown that triple antibiotic ointments (neomycin, polymyxin B, bacitracin) can effectively eliminate bacterial contamination and promote faster healing in contaminated wounds 6, but should be reserved for cases with signs of infection rather than routine use.

A common pitfall in blister management is the unnecessary removal of intact blister roofs, which can delay healing and increase infection risk. Another mistake is failing to recognize signs of infection that would warrant more aggressive treatment and possibly systemic antibiotics.