What should a provider do for an adult patient with no significant medical history and an open blister without a specific treatment plan?

Management of Open Blisters

For an open blister without a specific treatment order, clean the area gently with antimicrobial solution, leave the blister roof in place as a biological dressing, apply petrolatum-based ointment, and cover with a non-adherent dressing. 1

Immediate Assessment and Initial Management

Determine Blister Status

• If the blister is already ruptured/open: Leave the remnants of the blister roof in place unless there are clinical signs of infection (increased erythema, purulent discharge, fever, or worsening pain) 1, 2
• If infection is present: Remove the blister roof remnants completely 2
• If no infection: The remaining blister roof acts as a natural biological dressing that reduces infection risk and promotes re-epithelialization 1, 3

Wound Cleansing

• Clean the affected area gently with antimicrobial solution such as chlorhexidine (1:5000) or sterile saline, taking care not to cause further trauma 1, 3
• Alternatively, use warmed sterile water for gentle irrigation 3
• Perform daily washing with antibacterial products to reduce bacterial colonization 1

Topical Treatment Application

Primary Barrier Protection

• Apply petrolatum-based products (such as 50% white soft paraffin with 50% liquid paraffin) over the entire affected area to support barrier function and reduce transcutaneous water loss 1, 3
• Alternatively, apply petrolatum-based antibiotic ointment, which eliminates bacterial contamination within 16-24 hours and accelerates healing 1

Antimicrobial Considerations

• Apply topical antimicrobial agents only to sloughy or crusted areas, not to the entire wound 3
• Consider silver-containing products or dressings for areas with clinical concern 3
• Use antimicrobials for short periods only when appropriate 4

Dressing Selection and Technique

Dressing Type

• Cover with a low-adhesion, non-adherent dressing such as Mepitel™ or Atraumanò held in place with soft elasticated viscose 1, 3
• Apply a secondary foam or burn dressing to collect exudate if needed 3

Dressing Changes

• Change dressings using strict aseptic technique 1
• Maintain barrier nursing principles to reduce nosocomial infections 3

Monitoring and Infection Surveillance

Daily Assessment

• Monitor daily for signs of infection including increased erythema, purulent discharge, fever, or worsening pain 1
• Take swabs for bacterial and candidal culture from lesional skin on alternate days if there are clinical signs of infection 3
• Administer systemic antibiotics only if there are clinical signs of infection, not prophylactically 3

Documentation

• Document the number and location of any new blisters daily to monitor disease progression 4

Extent-Based Management Algorithm

Limited Involvement (<10% Body Surface Area)

• If blisters are asymptomatic: observation and local wound care only are sufficient 1, 4

Moderate Involvement (10-30% Body Surface Area)

• Consider high-potency topical corticosteroids 1, 4
• Obtain dermatology consultation 1

Extensive Involvement (>30% Body Surface Area)

• Immediate hospitalization with systemic treatment is required 1, 4
• Transfer to appropriate specialized care setting 3

Pain Management

• Administer over-the-counter analgesics such as acetaminophen or NSAIDs for pain control 1
• These are well-tolerated and effective for blister-related pain 1

Critical Pitfalls to Avoid

• Never routinely remove the blister roof from open blisters without infection: The roof serves as an optimal biological dressing 1, 3, 2
• Do not apply systemic antibiotics prophylactically: Use only when clinical signs of infection are present 3
• Avoid adhesive dressings: These can cause further trauma upon removal 1, 3
• Do not delay dermatology consultation for moderate-to-severe cases: Early specialist involvement improves outcomes 1