What is the treatment for blisters on the tongue?

Treatment for Blisters on the Tongue

Apply white soft paraffin ointment to the tongue and lips every 2 hours as foundational treatment, combined with warm saline mouthwashes and benzydamine hydrochloride rinse for pain control, while determining the underlying cause to guide specific therapy. 1

Immediate Supportive Care (All Cases)

Barrier Protection and Moisturization

• Apply white soft paraffin ointment every 2 hours to protect the tongue surface and maintain moisture 1, 2
• This serves as the foundational treatment regardless of the underlying cause 2

Oral Hygiene and Pain Management

• Clean mouth daily with warm saline mouthwashes to reduce bacterial colonization and promote healing 1, 2
• Use benzydamine hydrochloride rinse or spray every 2-4 hours, particularly before eating, for effective pain relief 1, 2
• For inadequate pain control, apply viscous lidocaine 2% (15 mL per application) directly to affected areas 2
• Consider oral analgesics like paracetamol/acetaminophen taken 20 minutes prior to eating 1

Direct Blister Management

Intact Blisters

• Pierce intact blisters at the base with a sterile needle (bevel up), selecting a site where fluid drains by gravity 1, 3
• Cleanse with antimicrobial solution before and after piercing 1
• Apply gentle pressure with sterile gauze to facilitate drainage and absorb fluid 1, 3
• Leave the blister roof in place - it acts as a biological dressing and should not be removed 1, 3

Ruptured Blisters

• Apply plain petrolatum ointment to any open erosions left after the blister has popped 4
• Use mucoprotectant mouthwash (e.g., Gelclair) three times daily for ulcerated surfaces 2

Cause-Specific Treatment

Autoimmune Blistering (Pemphigus Vulgaris)

• Apply topical corticosteroids: betamethasone sodium phosphate 0.5 mg in 10 mL water as rinse-and-spit four times daily, or clobetasol propionate 0.05% cream mixed with Orabase directly to lesions 1, 2
• For recalcitrant cases, use topical tacrolimus 0.1% ointment twice daily 1, 2
• Severe cases require systemic immunosuppression managed by dermatology 1

Suspected Infection

• For bacterial infection: use 0.2% chlorhexidine digluconate oral rinse twice daily 1
• For candidal involvement (particularly with angular cheilitis): nystatin oral suspension 100,000 units four times daily for 1 week, or miconazole oral gel 5-10 mL held in mouth after food four times daily 1, 2
• Take bacterial and fungal cultures if secondary infection is suspected 2

Benign Hemorrhagic Blisters (Angina Bullosa Haemorrhagica)

• No specific treatment required - these blood-filled blisters heal spontaneously within 7-10 days 5, 6, 7
• Drainage can be performed for patient comfort, but lesions resolve without intervention 5
• Identify and remove local trauma sources (sharp tooth cusps, ill-fitting dental work) 7

Critical Pitfalls to Avoid

• Never use alcohol-containing mouthwashes - they cause additional pain and irritation to blistered tissue 1, 2
• Do not chronically use petroleum-based products alone - they promote mucosal dehydration and increase secondary infection risk 1, 2
• Avoid debriding blisters except in specialized burn centers for severe conditions like Stevens-Johnson syndrome 1

When to Escalate Care

• Reevaluate diagnosis if no improvement after 2 weeks of appropriate treatment 1, 2
• Urgent dermatology referral required for suspected autoimmune blistering diseases (pemphigus vulgaris) requiring immunosuppression 1
• Immediate specialist care necessary for extensive mucocutaneous involvement suggesting Stevens-Johnson syndrome, including urgent ophthalmology referral if ocular symptoms present 1
• Consider underlying systemic conditions (diabetes, immunosuppression, nutritional deficiencies) in persistent cases 2, 8