What is the recommended treatment for friction blisters?

Treatment of Friction Blisters

For friction blisters, the recommended treatment is to leave blisters intact when possible, but when they are large or in functionally problematic areas, pierce them with a sterile needle to drain the fluid while preserving the blister roof as a natural protective covering. 1, 2

Initial Management

• Blisters should generally be left intact whenever possible as this helps prevent secondary bacterial infection 1, 2
• For large blisters or those in functionally problematic areas (such as the sole of the foot), pierce the blister with a sterile needle to release fluid while preserving the blister roof 1, 2
• When draining a blister, select a site that allows drainage by gravity and keep the bisel of the needle facing upward 2
• Apply gentle pressure with sterile gauze to facilitate drainage and absorb fluid 2
• Do not remove the blister roof as it serves as a natural biological dressing 1, 2

Wound Care After Drainage

• Clean the area gently with an antimicrobial solution 2
• Apply a mild emollient such as 50% white petroleum and 50% liquid paraffin to support the skin barrier function 2
• Cover painful eroded areas with a low-adhesion dressing held in place with soft elasticated viscose 1
• For extensive erosions, consider antiseptic baths or soaks with potassium permanganate or antiseptic-containing bath oils to dry the lesions and prevent infection 1

Prevention of Infection

• Monitor for signs of infection, as this is a significant risk with open blisters 2
• Perform daily cleansing with antibacterial products to reduce colonization 2
• Change dressings using aseptic technique 2
• If clinical signs of infection appear, obtain bacterial and viral cultures from the erosions 2
• Apply topical antimicrobials for short periods when appropriate 2

Prevention of Friction Blisters

• Wear properly fitting shoes that are broken in gradually 3, 4
• Consider doubling up on socks to reduce friction 4
• Apply protective padding over potential blister formation sites 3, 4
• Use drying foot powders and non-slip insoles 3
• Apply lubricants judiciously to reduce friction 5, 4
• Address any underlying biomechanical foot defects that may predispose to blister formation 3

Follow-up Considerations

• For blisters covering less than 10% of body surface area that are asymptomatic, observation and local wound care may be sufficient 2
• Document the number and location of blisters daily to monitor disease progression 2
• Consider adhesive tape rather than wide area fixation dressing for treatment, as it has been associated with better healing outcomes and higher satisfaction 6

Common Pitfalls to Avoid

• Do not apply ice directly to blisters as it can cause tissue ischemia 1
• Avoid removing the blister roof as this increases infection risk and delays healing 1, 2
• Do not use wide area fixation dressings as primary treatment, as they are associated with delayed healing compared to adhesive tape 6