Treatment of Blisters
Blisters should generally be left intact when possible to prevent secondary bacterial infection, but large or painful blisters in functional areas may be drained by piercing with a sterile needle while preserving the blister roof as a biological dressing. 1, 2
Initial Assessment and Management
- Blisters act as a natural protective barrier against infection and should generally be left intact if they are small and not causing discomfort 1
- For large blisters or those in functionally important areas (like fingers or soles of feet), consider drainage while preserving the blister roof 2
- Avoid excessive trauma to the skin by using soft silicone tapes for any necessary attachments and avoiding adhesive materials 1
Drainage Procedure (When Necessary)
- Clean the affected area with an antimicrobial solution before any intervention 2
- Pierce the blister at its base with a sterile needle, selecting a site that allows gravity-assisted drainage 2
- Release the fluid while leaving the blister roof intact to serve as a biological dressing 1, 2
- Apply gentle pressure with sterile gauze to facilitate drainage and absorb fluid 2
Topical Treatment Options
- Apply antibiotic ointment (such as bacitracin) to the affected area 1-3 times daily to prevent infection 3, 4
- Cover with a sterile non-adherent dressing if needed, especially for larger blisters 1
- For painful areas, consider applying benzydamine hydrochloride (anti-inflammatory) before dressing 1
- Apply white soft paraffin ointment to maintain skin barrier function and reduce water loss 1, 2
Specific Situations
- For burn blisters: Loosely cover with a sterile dressing but leave blisters intact as this improves healing and reduces pain 1
- For extensive erosive areas: Consider antiseptic baths such as potassium permanganate or antiseptic-containing bath oils to dry lesions and prevent infection 1
- For painful eroded areas: Consider covering with low-adhesion dressings held in place with soft elasticated viscose 1
- For pressure-painful blisters (especially on palms/soles): Puncture the blister and leave the roof intact 5
Infection Prevention and Monitoring
- Monitor for signs of infection throughout the healing process 2
- Take swabs for bacterial and fungal culture from areas that appear infected (sloughy or crusted) 1
- Change dressings using aseptic technique to prevent contamination 2
- For infected blisters, consider removing the blister roof and applying appropriate antimicrobial treatment 5
Common Pitfalls to Avoid
- Do not apply ice directly to blisters as it can produce tissue ischemia 1
- Avoid removing the blister roof unnecessarily as it serves as a natural protective barrier 1, 2
- Do not use adhesive tapes or dressings that could cause further skin trauma 1, 2
- Avoid using antiseptics like povidone-iodine as primary treatment as they may delay healing compared to non-antimicrobial alternatives 6