What is the recommended management for burn blisters?

Burn Blister Management

Burn blisters should be left intact and loosely covered with a sterile dressing to improve healing and reduce pain. 1

Management Approach for Burn Blisters

Initial Assessment and Blister Management

• Leave blisters intact: The American Heart Association and American Red Cross guidelines clearly recommend keeping burn blisters intact as this improves healing and reduces pain (Class IIa, LOE B) 1
• Cover with sterile dressing: Loosely cover burn blisters with a sterile dressing to protect the area while maintaining the integrity of the blister 1
• Large blister management: For larger blisters that are particularly troublesome or interfere with function (such as on the sole of the foot):
  • Decompress by piercing with a sterile needle to release fluid
  • Leave the blister roof intact as it serves as a biological dressing 1, 2

Wound Care Principles

• Cooling the burn: Apply cold tap water (15°C to 25°C) as soon as possible after injury for up to 30 minutes 1, 2
• Avoid ice application: Do not apply ice directly to burns as it can cause tissue ischemia (Class III, LOE B) 1
• Antiseptic measures: For extensive areas of erosion, consider antiseptic-containing baths or soaks to prevent infection 1
• Dressing selection: Use non-adherent dressings for painful eroded areas (e.g., Mepitel or Atrauman) 1, 2

Evidence Quality and Considerations

The recommendation to leave burn blisters intact is supported by multiple guidelines and studies. The American Heart Association guidelines provide a Class IIa, LOE B recommendation, indicating moderate-quality evidence supporting this approach 1. This is further supported by the British Association of Dermatologists' guidelines 1.

While some research has suggested that burn blister fluid may contain components that could inhibit healing 3, the clinical evidence and guidelines consistently support leaving blisters intact for improved outcomes. The protective function of the intact blister roof appears to outweigh potential negative effects of the fluid.

Special Considerations

Infection Prevention

• Monitor for signs of infection (increasing pain, redness, swelling, discharge, or fever)
• Do not administer systemic antibiotics prophylactically 2, 4
• Only use antibiotics when there are clinical signs of infection 2

Pain Management

• Offer appropriate analgesia prior to any blister procedure 2
• Use a validated pain assessment tool at least once daily 2

When to Seek Medical Attention

Immediate medical attention is required for burns:

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

By following these evidence-based recommendations, you can optimize healing outcomes and minimize complications in the management of burn blisters.