Should you burst burn blisters?

Do Not Burst Burn Blisters

Burn blisters should be left intact and loosely covered with a sterile dressing because this improves healing and reduces pain. 1

Why Burn Blisters Should Remain Intact

• Intact blisters serve as a natural biological dressing that protects the wound from contamination and infection 1
• Keeping blisters intact reduces pain during the healing process 1
• The American Heart Association and American Red Cross guidelines specifically recommend leaving burn blisters intact 1

First Aid for Burns with Blisters

1. Immediate cooling:

   • Cool thermal burns immediately with clean running water (15° to 25°C) 1
   • Continue cooling until pain is relieved 1
   • Avoid applying ice directly to burns as it can cause tissue ischemia 1
   • Cool for approximately 5-20 minutes 1

2. After cooling:

   • Loosely cover the burn blister with a sterile dressing or clean cloth 1
   • Do not puncture, burst, or debride the blister 1
   • Keep the blister intact to maintain the protective barrier 1

3. Pain management:

   • Over-the-counter pain medications like acetaminophen or NSAIDs can be used for pain relief 1

When to Seek Medical Attention

• Burns involving the face, hands, feet, or genitalia 1
• All full-thickness (third-degree) burns 1
• Large partial-thickness burns (>10% body surface area in adults, >5% in children) 1
• Signs of inhalation injury (soot around nose/mouth, difficulty breathing) 1
• Signs of infection (increasing pain, redness, swelling, or discharge) 1

Common Pitfalls to Avoid

• Do not burst the blister: Despite some conflicting research suggesting potential benefits of debridement 2, current guidelines from major organizations consistently recommend leaving blisters intact 1
• Do not apply ice directly: This can cause further tissue damage 1
• Do not use topical antibiotics on intact blisters: These should only be used on open wounds 1
• Do not delay cooling: Immediate cooling is essential to limit burn progression 1
• Do not forget to remove jewelry: Burned tissue swells, so remove jewelry before swelling occurs 1

Special Considerations

• Monitor children being cooled with running water for signs of hypothermia 1
• For small partial-thickness burns with broken blisters, after cooling, it may be reasonable to apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera with a clean non-adherent dressing 1
• While some research suggests that burn blister fluid may contain components that could inhibit healing 2, the protective benefit of intact blisters outweighs these theoretical concerns according to current guidelines 1