How to Treat Blisters
For most blisters, drain them while preserving the blister roof, which acts as a natural biological dressing that reduces infection risk and pain while promoting healing. 1
Initial Assessment
Before intervening, evaluate for signs of infection including:
- Surrounding erythema or warmth
- Purulent discharge
- Increasing pain
- Systemic symptoms like fever 1
High-risk patients require special attention, particularly those with diabetes mellitus, peripheral neuropathy, peripheral arterial disease, or chronic venous insufficiency, as they face higher infection and impaired healing risks. 1 In diabetic patients specifically, check for peripheral neuropathy (which may mask inflammatory signs) and assess glycemic control, as hyperglycemia predisposes to infection. 1
Treatment Algorithm Based on Blister Type
Pressure-Painful or Large Blisters
Drain the blister while keeping the roof intact:
- Clean the area with sterile water, saline, or dilute chlorhexidine 2
- Puncture at the base with a sterile needle (bevel up) at a site allowing gravity drainage 3
- Apply gentle pressure with sterile gauze to facilitate drainage 3
- Preserve the blister roof - it serves as a protective biological dressing that reduces bacterial contamination, decreases pain, and supports re-epithelialization 1, 2
- Apply bland emollient (such as 50% white soft paraffin with 50% liquid paraffin) 2, 3
- Cover with non-adherent dressing to reduce infection risk and minimize pain during changes 1
Small, Uncomplicated Blisters Without Pain
Leave intact whenever possible, as the blister serves as a natural biological dressing. 2, 4
Ruptured Blisters Without Infection
Leave remnants of the blister roof in place and apply sterile dressing. 4
Ruptured Blisters With Clinical Infection
Remove the blister roof remnants completely, clean thoroughly, and apply appropriate antimicrobial therapy. 4
Diabetic Foot Blisters
For patients with diabetes and foot blisters, professional foot care should include drainage of large blisters and protection of small blisters as part of an integrated foot care program. 5 In diabetic patients with hammertoes and recurrent distal toe ulcers from blisters that fail conservative treatment, consider digital flexor tenotomy. 5
Post-Drainage Care and Monitoring
- Change dressings using aseptic technique 2
- Document blister size, location, and appearance daily to track progression 1, 2
- Reassess within 24-48 hours to ensure appropriate healing response 1
- Watch for signs of compartment syndrome or deep tissue involvement requiring urgent surgical consultation 1
Antimicrobial Use
Do not use prophylactic antibiotics for clean blisters without infection. 1 Reserve systemic antibiotics only for wounds showing clinical signs of infection or systemic symptoms. 1
For topical antimicrobials:
- Apply silver-containing products only to sloughy or clinically infected areas, not prophylactically 2
- Use topical antimicrobials for short-term periods when local infection signs are present 2
- Take bacterial cultures from lesional areas if extensive erosions develop 2
For simple wound care after drainage, bacitracin ointment may be applied 1-3 times daily and covered with sterile bandage. 6
Common Pitfalls to Avoid
- Never routinely remove blister roofs - this increases infection risk and pain 2, 4
- Avoid aggressive debridement in high-risk patients, especially those with diabetes or peripheral vascular disease 1
- Do not use prophylactic antibiotics on clean, uninfected blisters 1
- In elderly or hospice patients, avoid high-dose systemic steroids and aggressive diagnostic workup 2