What is the recommended wound care for a blister?

Wound Care for Blisters

For most blisters, leave them intact and cover with a sterile dressing; however, puncture large or pressure-painful blisters at the base with a sterile needle, drain the fluid while leaving the roof in place as a biological dressing, then apply petroleum-based ointment and a clean occlusive dressing. 1, 2

Initial Assessment and Decision Algorithm

The management approach depends on blister characteristics:

Leave Intact (No Intervention)

• Small, uncomplicated blisters without pressure pain should remain untouched 1, 3
• All burn blisters should be left intact when possible, as the intact blister acts as a natural biological barrier that protects against infection, reduces pain significantly, and improves healing outcomes 2
• Cover loosely with a sterile or clean nonadherent dressing 2

Puncture and Drain (Roof Remains)

• Large blisters or those causing pressure pain require drainage 1, 3
• Palmar and plantar blisters should be punctured due to pressure from weight-bearing 3
• Clean the blister gently with antimicrobial solution without rupturing it 1
• Pierce at the lowest point (base) with a sterile needle, bevel up, to facilitate gravity drainage 4, 1
• Apply gentle pressure with sterile gauze to wick fluid out 4, 1
• Never remove the blister roof—it serves as a natural biological dressing 1, 2

Complete Deroofing (Remove Roof)

• Ruptured blisters with clinical signs of infection require complete removal of the blister roof 3
• Burns of grade 2a or higher, unclear burn depth, or chemical burns require blister roof removal 3
• Apply antimicrobial therapy for short periods when appropriate 1

Post-Drainage Wound Care

After draining or if the blister ruptures spontaneously:

• Apply petroleum-based ointment (such as 50% white soft paraffin with 50% liquid paraffin) to support barrier function and reduce water loss 1
• Alternatively, apply petrolatum, antibiotic ointment (bacitracin, neomycin-polymyxin B-bacitracin), honey, or aloe vera 2
• Cover with a clean occlusive or nonadherent dressing to maintain a moist environment and prevent contamination 5, 2
• Change dressings using aseptic technique 1

Infection Prevention

• Perform daily washing with antibacterial products to decrease colonization 1
• Consider topical antibiotic ointment for superficial wounds if no allergies exist 5
• Triple antibiotic ointment (neomycin-polymyxin B-bacitracin) eliminates bacterial contamination within 16-24 hours and accelerates healing 6
• Apply a small amount (equal to fingertip surface area) 1-3 times daily 7
• Monitor for infection signs: progressive redness, increased pain, warmth, purulent discharge, foul odor, fever, or growing swelling 5
• Take bacterial and viral cultures from erosions showing clinical infection signs 1

Pain Management

• Use over-the-counter acetaminophen or NSAIDs (ibuprofen) for pain control 2
• Keeping blisters intact significantly decreases pain compared to debriding 2

Special Considerations for Burns

• Cool burn immediately with tap water at 15-25°C until pain relieved, ideally within 30 minutes of injury 2
• Never apply ice directly—this causes tissue ischemia and increases damage 2
• Remove jewelry before swelling occurs 2
• Burns involving face, hands, feet, or genitals require specialized burn center care 2
• Burns >10% body surface area (5% in children) require IV fluid resuscitation 2

Common Pitfalls to Avoid

• Never puncture or unroof blisters in the first aid setting for burns 2
• Avoid using antiseptics for initial irrigation—use water or sterile saline instead 5
• Do not insert objects into wounds 5
• Avoid applying ice or ice water directly to burns 2
• Do not delay cooling for burns—must be done within 30 minutes 2

Follow-Up and Monitoring

• Elevate the affected body part during the first days to reduce inflammation 5
• Document daily the number and location of new blisters to monitor disease progression 1
• Verify tetanus vaccination status for contaminated or penetrating wounds 5
• Use proper biosecurity measures including gloves and hand washing before and after care 5