While playing indoor soccer a couple days ago, I was fouled and fell forwards so that my hand skidded across the court a bit. It left the blister as you see in the image here:
What should I consider when deciding to remove this blister? I could open and drain this blister, removing the excess skin afterwards, or leave it as is.
I figure since it's in a place that is likely to be touched/disrupted I should remove it since it's likely to open anyways.
In the blister shown, the likelihood of rupture is decreased because of the thickness of the epidermis on the palm of the hand, so you can leave it alone until the underlying area re-epithelializes. You'll know this is happening because of the decreased pain and the slow reabsorption of the fluid. Eventually you will just peal it off what's left of the blister, finding clean new skin underneath.
But this is a great starting point for an answer about the treatment of blisters in general: is it better to leave them alone, drain the fluid, or de-roof them (take the top of the blister off)?
There is a lot of disagreement about what constitutes the optimal treatment of blisters. Some background might be in order.
Blisters form when the upper layers of the epidermis separate from the lower layers, usually at the level of the stratum spinosum. At that level, the cells (because of proximity to the dermis, which contains the capillaries) have moisture in and between them. When the separation occurs, sterile fluid from the stratum spinosum oozes unopposed into the space between the layers, and a blister forms.
The fluid, similar to plasma, contains molecules which may promote the rapid division which takes place in the stratum basale. This then differentiates into the upper layers of the epidermis and healing by new skin formation.
Hydrostatic pressure causes the area of the separation to fill with a fluid that is similar in composition to plasma but has a lower protein level. About 6 hours after formation of the blister, cells in the blister base begin to take amino acids and nucleosides; at 24 hours, there is high mitotic activity in the basal cells; at 48 and 120 hours, new stratum granulosum and stratum corneum, respectively, can be seen.
The sterile fluid is a very rich and inviting growth medium for bacteria. For this reason, some people think it should be removed. The denuded skin underneath has lost some of it's protection against infection. For this reason, some think the blister should be left intact. Between these two extremes are those who favor drainage of the fluid leaving the cover intact.
To my thinking (and training), this is the worst option. Poking a hole in the blister, no matter how cleanly it's done, will leave a point of entry for bacteria (it doesn't take much). The bacteria will flourish in the moisture (which will still seep into the space) under the roof of the blister, protected from being washed away. This may (and often does) lead to an infection of the wound.
It's much better to prevent infection than to treat it.
The reasoning of either of the other camps is more supportable. I favor leaving the blister intact as long as possible, giving the underlying wound time to form new stratified protective epidermalis.
Treatment by people in this camp consists of carefully cleaning and disinfecting the surface of the blister and the surrounding skin, and covering it loosely with protective padding, usually gauze, then wrapping the entire thing with gauze wrap. The patient is instructed to check the blister daily; if it "pops" or becomes cloudy, the roof must be removed (most people prefer to have this done by a doctor or nurse), the area cleaned to remove any bacteria which might have entered, and a sterile dressing (over a light application of an antibacterial cream) reapplied, and changes daily until healed.
The opposite camp reasons that the blister will break anyway, so get it over with and get the sterile dressing on, then clean and redress (with a light application of an antibacterial cream) daily. Also, if the blister is tense, it may be impeding healing of the base by decreasing blood flow. The problem with this approach is that it hurts more than leaving it alone, and the risk of infection is still greater than if the blister is intact.
Many studies have been done to try to determine the best approach. Common sense plays a role. If the blister is very delicate (as in a large, tense and fragile blister of a burn), or if it looks unstable, I'll remove the roof of the blister. If I think it can be preserved for even one or two days, I'll leave it on. Every day it's left on without infection is a day of healing and decreased pain as new skin is made.
From one paper:
There seems to be a paucity of good clinical evidence related to this subject, despite several review articles. The sole paper found involved a small sample, but showed infection rates to be higher if blisters are aspirated or deroofed, and that pain scores were higher in the group that underwent deroofing.
From a pain point of view:
aspiration appears to result in less pain than deroofing. (See above: also more infection.)
The common sense comes in with type, size, and location of blister, reliability of care by the patient or their family, location or level of activity likely to cause rupture, or in the case of hikers' blisters (and others away from medical care), what the best model is to prevent infection while still using the involved area if necessary.
Also changing the scene are the new available protective dressings of deroofed blisters that allow moist healing, non-occlusive protection and visibility of the underlying skin.
Management of burns blisters
Friction blisters. Pathophysiology, prevention and treatment.
Generally speaking, it's best to leave blisters undisturbed. Unroofing the blister completely is definitely ill-advised, as it exposes the entire dermis underneath, removing a primary barrier to infection. Cover it loosely with rolled gauze and leave it alone; it will either drain on its own, or reabsorb the fluid over time.
In first aid, we normally leave blisters alone. But there is one exception. In multi day walking events, there is a protocol to treat blisters.
If the blister is open or it contains blood, consult a medical professional.
A blister is a small pocket of fluid in the upper skin layers and is one of the body’s responses to injury or pressure.
Depending on the cause, the treatment could include:
Source: Better Health at Australian State Government of Victoria
In general, you shouldn't break small blisters (no bigger than your little fingernail) and leave blisters intact (do not attempt to pop them). However if blisters break, clean the area with mild soap and water, apply an antibiotic ointment if you see signs of infection (apply "patch test" to make sure you don't have a bad reaction), and cover/protect it with a nonstick gauze bandage (a clean dressing). Do not tear off the flaps of skin left over from broken blisters. You'll shed them soon enough; don't risk irritating your skin even more now.
For soothing, you may take a cool bath or shower and apply a a clean towel dampened with cool tap watermayo.
If you develop larger blisters, contact a doctor (podiatrist, pharmacist, dermatologist), because large blisters are best removed, as they rarely will remain intact on their own. Also seek medical help if you experience immediate complications, such as extreme pain, headache, confusion, nausea or chills.
These herbs may be applied topically to minor burns:
Apply moisturizer such as Aloe vera lotion, cream or gel, or low-dose hydrocortisone cream, which may provide relief in some cases.
Apply externally to the burned area, 3 - 4 times daily as needed, for soothing and healing.
Calendula (Calendula officinalis), or pot marigold, as an ointment or a tea applied topically.
To make tea from tincture, use 1/2 to 1 tsp. diluted in 1/4 cup water. You can also steep 1 tsp. of flowers in one cup of boiling water for 15 minutes, then strain and cool.
Gotu kola (Centella asiatica)
A cream containing 1% of the herb, may help repair skin tissue.
Propolis
A resin created by bees to build their hives, has been used historically to treat skin wounds.
One study found that people given propolis to apply to minor burns healed as well as those treated with silver sulfadiazine, a prescription ointment. More research is needed, however.
Source: Burns at UMMC
Following tips may improve your healing and general health:
If the burn is very recent, eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes) and vegetables (such as squash and bell peppers).
One study found that high doses of vitamin C post burn reduced fluid requirements by 40%, reduced burn tissue water content 50%, and reduced ventilator days.
Eat fewer red meats and more lean meats, cold water fish, tofu (soy) or beans for protein.
Avoid refined foods, such as white breads, pastas, and sugar.
Use healthy cooking oils, such as olive oil or vegetable oil.
Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
Avoid caffeine and other stimulants, alcohol, and tobacco.
Drink 6 - 8 glasses of filtered water daily.
Source: Burns at UMMC
Other natural home remedies include:
Brew three or four teabags in a pitcher of warm waterUMMC.
When the tea is almost black, remove the teabags and let the liquid cool to room temp. Gently dab at the sunburn with a cloth soaked in the tea, the more the better. Do not wash it off. If the cloth causes pain, dab at the burn with the teabags instead.
Apply witch hazel lotion which may soothe your skinWebMD.
Use Egg Oil (Oleova).
Egg oil is rich in omega-3 fatty acids like Docosahexanoic Acid.
The omega-3 fatty acids in egg oil are bound to phospholipids which have the ability to form liposomes (nanoparticles), which may be able to penetrate deep and heal the dermis.
Avoid egg whites, peanut butter, petroleum jelly, and vinegar in particularmayo.
See: How to Treat a Sunburn at wikiHow
See also:
