Blisters: Everything you need to know

Here is what you need to know on these common skin injuries.

Simply put, a blister is a pocket of fluid between the upper layers of skin. The common causes of blister formation are friction, freezing, burning, infection, or chemical burns. The blister bubble raises from the uppermost layer of skin with the aim of protecting and providing cushioning to the layers below, buying time for the tissue to heal. Depending on what causes them, blisters are filled with serum plasma, blood or pus.

The most common types of blisters are friction, heat, frost and blood blisters.

• Friction blisters: This is the most common and basic form of blisters. They are typically caused by irritation from continuous rubbing or pressure. Friction blisters usually occur on the feet, for example if your footwear doesn’t fit quite right and irritates the delicate skin of toes and heels for prolonged periods of time. Likewise, if you are using tools such as a rake or a shovel with no gloves on, the handle that keeps rubbing against your hand might cause a blister.
• Heat blisters: The timing of blister formation is helpful to categorize blisters. If the blister forms immediately then it is caused by a second degree burn, if blistering occurs only a couple of days after the incident then it is a first degree burn.
• Cold blisters: These are caused by frostbite, and as for heat blisters, they are a defense mechanism deployed to protect lower levels of skin from temperature-related damage.
• Other types of blisters: Numerous medical conditions can cause other types of blisters. These conditions include but are not limited to: allergic reactions, chickenpox (small blisters), herpes (clusters of blisters), bullous impetigo, eczema, dyshidrosis (many small, clear blisters) etc.

They are mechanical injuries, i.e. they occur due to excessive shear force between the surface of the skin and the rest of the body. The layer of the skin most susceptible to shear forces is a layer called stratum spinosum. As this layer tears away from the tissues below, a plasma-like fluid leaks from the cells and begins to fill the gap that is created between those two layers (stage 3). This fluid encourages new growth and regeneration. If you are not careful, the roof will tear and plasma will leak out of the blister (stage 4). Eventually, the blister will be completely deroofed (stage 5). In the last 2 stages, you’ll be more at risk of infection.

After 24 hours, new skin layers under the surface are in a steady formation process. After 2 days, a new layer of skin is already visible, and after 5 days, a new upper layer of skin is clearly seen.

During this healing process, the fluid present in the blister is reabsorbed by the underlying tissue and swelling subsides.

Painful blisters on the palm of the hands or soles of the feet are often caused by tissue shearing in deeper layers of the skin. These layers lie next to nerve endings, thereby producing more pain.

You can identify a blister by simply examining it. If you see a raised bubble that feels spongy and generally painful to the touch, and if it is in a place that could have been recently irritated by pressure or rubbing, it is most likely a blister.

As described above, in most cases your blister will heal on its own in a matter of a few days. A new layer of skin will form beneath the blister and the top skin layer will peel away. You shouldn’t drain or pop a blister because of the risk of infection, and because it disrupts the body’s optimal way to heal a blister. If you want to learn more about friction blister treatment, click here.

In some cases you may need to contact a primary doctor. To learn more on when to contact a physician, click here.

If you don’t protect the blister from continued pressure or friction, it will delay the healing by several weeks. Continued friction may rub away the delicate skin and the blister may break open, ooze fluid and run the risk of becoming infected or developing into a deeper wound. If the irritation is mild, the blister may heal despite continued irritation, and eventually a callus will form.

Although blisters can be a painful annoyance and make your life miserable, in most cases they won’t lead to medical issues. However, here are reasons why you should seek medical advice:

• The blister looks infected, it is draining pus, or the area around the blister is red, swollen, warm, or very painful
• You have a fever
• You have several blisters, or you cannot figure out what is causing them
• You have health problems such as circulation problems or diabetes.

The key is to eliminate the source of the friction. You can achieve this in several ways:

On the feet: wear well-fitted (not too tight or too loose), comfortable footwear and clean, dry socks. If your shoes fit badly or are too stiff (high heels for example), your feet are more at risk of blistering. Moist skin tends to blister more easily, so socks that manage moisture or frequent sock changes can be helpful. If you are prone to excessive sweating, the use of talcum powder might also help. If you are exercising or practicing sport, wear specially designed sports socks that will help reduce foot sweat or friction. In addition, hiking or walking boots need to be adequately broken in before embarking on a long trek.

Applying preventive solutions such as tape, padding or moleskin to trouble spots (based on personal experience) can help prevent blisters from appearing. You can also use friction-management patches which are applied to the inside of shoes. These will remain in place longer, throughout many changes of socks or insoles.

On the hands: Depending on what is your favorite activity, you are more or less at risk of developing hand blisters. If you are using tools or carrying out manual work, wearing gloves should help prevent blisters. The same goes if you are playing a sport where you are holding a bat, racket, club etc. For some other sports such as gymnastics, weightlifting or rowing, applying tape on the hand is an effective way to prevent blister occurrence. Additionally, the use of talcum powder in order to reduce friction could prove beneficiary in combination with gloves or as a stand-alone option. Keep in mind, however, that talcum powder also absorbs moisture and as such is not a good option for prolonged activities.

The range of COMPEED^® Advanced Blister Care active gel cushions offers a wide variety of expert solutions to help prevent blister development and speed up the healing process of a range of sizes and shapes of blisters. They contain an active hydrocolloid gel technology that, in addition to providing deep cushioning, will give you an instant pain relief and create a safe and protective environment for the blister to heal. In a recent clinical study, COMPEED^® active gel cushions were better than ordinary bandages at providing instant pain relief, extra cushioning, and reduced healing time. The active gel cushions also generated higher user satisfaction.