Documentation of a Blister in a Progress Note
A blister should be documented as a fluid-filled elevation of the skin, specifying its size in centimeters, location, appearance (tense vs. flaccid), whether it arises on erythematous or normal-appearing skin, the condition of the blister roof (intact vs. ruptured), and any associated symptoms such as pain or pruritus. 1
Essential Physical Examination Elements
When documenting a blister, include the following specific characteristics:
Size and Distribution
- Measure and document the diameter in centimeters (not just "small" or "large") 2
- Calculate body surface area (BSA) involvement if multiple blisters are present, using standardized grading: <10% BSA (Grade 1), 10-30% BSA (Grade 2), or >30% BSA (Grade 3-4) 1
- Document the number and location of all blisters using anatomic landmarks 3
Blister Characteristics
- Describe the blister as tense or flaccid based on the degree of fluid distension 1
- Note whether blisters arise on erythematous, urticarial, eczematous, or normal-appearing skin 1
- Document the condition of the blister roof: intact, partially deroofed, or completely deroofed 3, 4
- Assess for dusky erythema or areas that feel painful to palpation, which may indicate more serious conditions 1
Associated Findings
- Document presence or absence of surrounding erythema, edema, or warmth 2
- Note any pustules, erosions, or areas of skin sloughing 1
- Record whether mucous membranes are involved (oral, ocular, genital, or perianal areas) 1
- Assess for signs of infection: increased warmth, purulence, odor, or surrounding cellulitis 2
Symptom Documentation
- Quantify pruritus intensity (none, mild, moderate, severe/intense) 1
- Document pain level and whether it feels like a sunburn 1
- Note any functional impairment or limitation of activities of daily living 1
Common Pitfalls to Avoid
Do not simply write "blister present" without measurements and descriptive details - this provides insufficient information for monitoring progression or determining appropriate treatment 3. Always specify the anatomic location precisely rather than vague terms like "on the foot" 1. Document whether the blister is under pressure or in a friction-prone area, as this affects management decisions 4, 5.
Additional Documentation Considerations
- For burn-related blisters, document the suspected burn depth (superficial second-degree vs. deeper) 6, 4
- If the blister has ruptured, note whether remnants of the blister roof remain 4
- Consider serial photography for monitoring progression, particularly when multiple blisters are present 1, 3
- Document any predisposing factors such as recent trauma, friction, new medications, or immunosuppression 1, 5