What treatment is recommended for blisters on hands after a long shower?

Management of Blisters on Hands After Long Shower

Leave the blisters intact and immediately begin aggressive moisturization with bland emollients, avoiding hot water and harsh soaps to prevent further irritant contact dermatitis. 1

Immediate Blister Care

Do not rupture or deroof the blisters - the blister roof serves as a natural biological dressing that reduces infection risk and promotes healing. 1, 2

• If blisters are large, painful, or interfering with hand function, pierce them at the base with a sterile needle (bevel up) to drain fluid while leaving the roof intact 1, 2
• Apply gentle pressure with sterile gauze to facilitate drainage 1, 2
• Gently cleanse with lukewarm water and antimicrobial solution before and after drainage 1, 2

Skin Barrier Restoration

Apply bland emollient immediately and frequently - use 50% white soft paraffin with 50% liquid paraffin to all affected areas to restore barrier function and reduce transcutaneous water loss. 1, 3, 4

• Apply moisturizer immediately after any hand washing or water exposure 1
• At night, apply thick moisturizer followed by cotton or loose plastic gloves to create an occlusive barrier 1
• Consider "soak and smear" technique: soak hands in plain water for 20 minutes, then immediately apply moisturizer to damp skin nightly for up to 2 weeks 1

Addressing the Underlying Cause

Avoid hot water completely - washing hands with very hot water is a known risk factor for inducing and worsening irritant contact dermatitis. 1

• Use only lukewarm or cool water for hand washing 1
• Pat dry gently without rubbing 1
• Limit shower duration and water temperature going forward 1

Topical Steroid Consideration

Apply hydrocortisone 1% cream 3-4 times daily to affected areas if conservative measures fail - this addresses the inflammatory component of irritant contact dermatitis. 5

• Hydrocortisone is FDA-approved for temporary relief of itching associated with minor skin irritations, inflammation, and rashes due to detergents and soaps 5
• Apply to affected areas not more than 3-4 times daily 5
• If no improvement after 7 days or condition worsens, seek dermatology consultation 1

Infection Prevention

Monitor for signs of infection including increased redness, warmth, purulent drainage, or worsening pain. 1, 3

• Do not apply topical antibiotics prophylactically 3, 4
• If infection develops, obtain bacterial cultures before starting systemic antibiotics 1, 3
• Change any dressings using aseptic technique 1, 3

Common Pitfalls to Avoid

• Never apply ice directly to blisters or irritated skin 1
• Avoid deroofing blisters as this increases infection risk and pain 1, 2, 4
• Do not use antibacterial soaps - they are unnecessary and may worsen irritation 1
• Avoid products with fragrances, dyes, or allergenic preservatives that can further irritate compromised skin 1