What is the recommended treatment for an intact blister?

Management of Intact Blisters

For intact blisters without signs of infection, the recommended approach is to leave the blister intact, keep the area clean, and protect it with a non-adherent dressing to promote natural healing. 1

Assessment and Decision-Making

When evaluating an intact blister, consider:

• Size and location of the blister
• Presence of infection signs (increasing redness, warmth, pain, or red streaks)
• Likelihood of rupture based on location and patient activities
• Underlying cause (friction, burn, etc.)

Treatment Algorithm

For Small, Intact Blisters Without Signs of Infection:

1. Leave the blister intact

   • The intact roof serves as a natural biological dressing 1, 2
   • Provides protection against infection
   • Reduces pain and promotes healing

2. Clean the area

   • Gently cleanse with antimicrobial solution 1
   • Daily washing with antibacterial products can decrease bacterial colonization 1

3. Apply appropriate dressing

   • Use a non-adherent dressing to protect the blister 1
   • Apply a bland emollient (such as 50% white soft paraffin and 50% liquid paraffin) to support barrier function 1
   • Avoid adhesive dressings that can damage new epithelial cells 1

4. Pain management

   • Provide appropriate analgesia as needed (acetaminophen or NSAIDs) 1

For Blisters at High Risk of Rupture or With Signs of Infection:

If the blister shows signs of infection or is likely to rupture due to location or size:

1. Consider controlled drainage

   • The Initiative Chronic Wounds (ICW) consensus recommends removing the blister roof when there are clinical signs of infection 1
   • If draining is necessary, use aseptic technique to puncture the blister at its edge 2
   • Keep the overlying skin as a biological cover 3, 2

2. Apply antimicrobial treatment

   • For infected blisters, follow the Infectious Diseases Society of America recommendations for oral antibiotics 1:
     • 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

3. Proper wound care after drainage

   • Apply a moist wound environment with appropriate dressings to promote epithelialization 1
   • Consider hydrocolloid dressings for deroofed blisters to provide pain relief 2

Monitoring and Follow-up

• Monitor for signs of worsening infection (increasing redness, warmth, pain, pus, or red streaks) 1
• Seek medical attention if:
  • Signs of infection develop
  • The blister is large (>30% BSA)
  • The blister involves mucous membranes 1

Important Considerations and Pitfalls

• Avoid home remedies or applying substances that may introduce infection or delay healing 1
• Do not use tetracyclines (such as doxycycline) in children under 8 years of age 1
• Consider tetanus immunization status in traumatic wounds to prevent tetanus infection 1
• Avoid adhesive dressings directly on the blister as they can damage new epithelial cells 1
• Be cautious with blood-filled blisters as they may have higher complication rates if surgically incised 4

Prevention Strategies

For recurrent friction blisters:

• Ensure properly fitted shoes and appropriate socks (acrylic or polyester-wool combinations) 2
• Consider closed cell neoprene insoles for foot blisters 2
• Gradually increase activity intensity to allow skin adaptation 2