Friction-Induced Skin Lesions
A lesion caused by friction is called a friction blister or friction injury. 1, 2, 3
Terminology and Classification
The medical literature uses several terms to describe friction-induced skin damage:
- Friction blister: The most common term for fluid-filled lesions caused by repetitive friction forces on the skin 1, 4, 5
- Friction injury: A broader term encompassing all skin damage primarily caused by friction, including blisters, abrasions, and superficial wounds 2, 3
It is critical to distinguish friction injuries from pressure ulcers, as they are frequently misdiagnosed and require different management approaches. 2, 3 Friction injuries typically occur on fleshy prominences or areas exposed to repetitive friction rather than over bony prominences. 2
Mechanism and Characteristics
Friction blisters develop through the following process:
- Repetitive shearing forces between skin layers cause separation of the epidermis from the dermis 4
- Fluid accumulates in the resulting space, creating the characteristic blister appearance 1, 5
- The lesions appear as clear or blood-filled (if vessels are damaged) fluid collections under intact skin 1, 6
Common Locations
Friction injuries occur in predictable anatomic sites based on mechanical stress:
- Feet: Most common location, particularly in athletes, military personnel, and individuals with ill-fitting footwear 4, 5
- Hands: Seen with repetitive manual activities or tool use 7
- Intertriginous areas: Neck, anogenital regions, and areas where skin surfaces rub together, especially with maceration 1
- Prosthetic contact sites: Stump areas in amputees wearing prosthetics 6
- Equipment contact points: Unusual locations like the flank from climbing harnesses 5
Clinical Pitfall
Do not confuse friction injuries with pressure ulcers, moisture-associated skin damage, or intertriginous dermatitis. 2, 3 Friction injuries are not located over bony prominences and should not be staged or treated as pressure ulcers. 3 Accurate identification of the causative mechanism (friction versus pressure versus moisture) is essential for appropriate treatment and prevention strategies. 2