What is the treatment for blisters on pediatric fingers?

Treatment for Blisters on Pediatric Fingers

For pediatric finger blisters, the recommended treatment is to lance the blister with a sterile needle to drain fluid while leaving the blister roof intact, followed by application of emollients and non-adherent dressings. 1

Assessment and Initial Management

• Blisters should generally be left intact when possible as this helps prevent secondary bacterial infection 1
• When blisters are large or in functionally important areas like fingers, they should be pierced with a sterile needle to release fluid while preserving the blister roof as a biological dressing 1
• For pressure-painful blisters on fingers, puncturing while leaving the roof intact is specifically recommended 2
• Assess for signs of infection (increasing redness, warmth, pain, purulence) which would require additional treatment 3

Blister Drainage Procedure

1. Preparation:

   • Gently cleanse the blister with an antimicrobial solution, taking care not to rupture it 1
   • Consider providing pain medication before the procedure as many children report pain or burning sensation during blister care 1

2. Drainage technique:

   • Pierce the blister at its base using a sterile needle with the bevel facing up 1
   • Select a site where fluid will drain out by gravity to discourage refilling 1
   • For larger blisters, use a larger needle and pierce more than once 1
   • Gently apply pressure with sterile gauze to facilitate drainage and absorb fluid 1
   • Do not remove the blister roof (de-roofing) 1

3. Post-drainage care:

   • After fluid has drained, gently cleanse again with an antimicrobial solution 1

Wound Care and Dressing

• Apply a bland emollient such as 50% white soft paraffin and 50% liquid paraffin to support barrier function, reduce water loss, and encourage re-epithelialization 1
• Cover with a non-adherent dressing if needed 1
• For painful eroded areas, consider covering with a low-adhesion dressing such as Mepilex or Atrauman held in place with soft elasticated bandages 1
• Use tubular or gauze bandages to secure dressings rather than adhesive tape to prevent further skin trauma 1
• For children under 2 years, consult a doctor before applying topical antibiotics 4

Infection Prevention and Management

• Daily washing with an antibacterial product can decrease colonization 1
• Change dressings using aseptic technique 1
• If signs of infection develop, obtain bacterial and viral swabs 1, 5
• Consider topical antimicrobials for short periods if infection is present 1
• Systemic antibiotics should only be used if there are local or systemic signs of infection 3
• For infected blisters in children, amoxicillin + clavulanate is recommended as first-line therapy in most cases 3

Special Considerations

• If coexistent viral infection (like herpetic whitlow) is suspected, additional antiviral treatment may be necessary 5
• For friction blisters (common on fingers), prevention strategies include keeping skin dry and reducing repetitive friction 6
• For children with epidermolysis bullosa or other bullous diseases, specialized care protocols should be followed with dermatology consultation 1
• For blisters in the diaper area, use emollient for cleaning rather than water or commercial wipes 1

Follow-up Care

• Monitor for signs of healing versus infection
• Document the number and location of blisters to track progress 1
• Ensure parents understand proper home care techniques and when to seek further medical attention 1