What is the best way to care for a patient with a friction blister?

Management of Friction Blisters

Immediate Wound Care

For intact friction blisters that are painful or interfering with function, puncture at the base with a sterile needle to facilitate gravity drainage, then apply gentle pressure with sterile gauze to absorb fluid, but critically preserve the blister roof as it acts as a natural biological dressing. 1

Key Principle: Preserve the Blister Roof

• Never remove the blister roof - it reduces infection risk and promotes re-epithelialization by serving as a natural biological barrier 1
• For small, asymptomatic blisters, leave them completely intact if possible to prevent secondary bacterial infection 2
• If the blister is large or located on weight-bearing areas (like the sole of the foot), pierce it with a sterile needle at the base to allow gravity drainage while keeping the roof in place 2, 1

Topical Treatment Application

• Clean the affected area gently with antimicrobial solution, taking care not to cause further trauma 1
• Apply petrolatum-based antibiotic ointment, which accelerates healing and eliminates bacterial contamination within 16-24 hours 1
• Alternatively, plain petrolatum-based products support barrier function and reduce water loss 1

Dressing Selection

• Cover with a low-adhesion, non-adherent dressing (such as Mepitel or Atrauман) held in place with soft elasticated viscose 2, 1
• Change dressings using aseptic technique 1
• For friction blisters specifically, adhesive tape is more effective than wide area fixation dressings, showing better healing rates (64.7% vs 48.1%), lower dropout rates (4.0% vs 11.7%), and higher patient satisfaction 3

Daily Monitoring and Infection Prevention

• Perform daily washing with antibacterial products to reduce bacterial colonization 1
• Monitor daily for signs of infection including increased erythema, purulent discharge, fever, or worsening pain 1
• Drain intact blisters early and maintain the blister roof to minimize patient discomfort and reduce secondary infection risk 4

Pain Management

• Administer over-the-counter analgesics such as acetaminophen or NSAIDs for pain control 1

Common Pitfalls to Avoid

• Do not deroofed blisters unnecessarily - this increases pain and infection risk 4
• Avoid wide area fixation dressings for routine friction blister treatment as they delay healing and have lower effectiveness compared to adhesive tape 3
• Do not use antibiotics routinely - there is no evidence they influence blister healing 4