Blister Protection and Detection
A friction blister is a soft pocket of raised skin caused by irritation from continuous rubbing or pressure. Friction blisters usually occur on the feet, where tight or poor-fitting shoes can rub and irritate delicate toes and heels for long periods, but can also happen on the backs of your legs and hips from rubbing against braces and other surfaces you are sitting or lying on. This type of irritation causes minor damage to the skin and the tissue just beneath the skin.
If the skin looks raised and irritate, possibly with a raised pocket at the center, it is likely a blister. Friction blisters typically drain on their own within days and a fresh layer of skin forms beneath the blister so it can peel away with general skin wear and washing.
However, if pressure or friction continues in the same area over a length time, the blister may last two weeks or even longer. Continued friction may rub away the delicate top skin layer, and the blister may break open, and the risk becoming infected or developing into a deeper wound is highly possible. If the irritation is mild, the blister may heal despite continued irritation, and eventually a callus will form.
Prevention of friction blisters means wearing shoes, prosthetics and braces that fit you well. They must not be too tight anywhere and must not slide up and down your too much when you are moving around. Wear socks and protective dressing to protect delicate skin and prevent irritation. Also, try to keep your skin dry. If another activity is causing blisters -- for example, if your notice in physical therapy or rehabilitation that you are developing a sensitive sore area from a particular way you sit or stand, ask your therapist to point out other ways to perform the same activity in a way that is less irritating, and take advantage of protective devices, such as gloves, sleeves, under padding and other protective materials.
After each bath, make sure your skin is clean and dry. Examine yourself or have a caregiver help you to make sure your skin is clear of any scrapes, bumps, bruises, etc. Keep skin moisturized with a good over the counter body lotion your doctor recommends to make sure that your skin doesn’t become too dry and cracked. Consider, too, using talcum powder to keep your skin dry, particularly if you deal with incontinence or get hot and sweaty through the day. Make sure to wipe sweat from skin, keeping it clean and dry to ward off bacteria. Any bacteria, particularly if you have compromise immunity, could make your skin and you more vulnerable to infection and serious wounds. Repetitive blisters and breakdown in a particular area is especially vulnerable to infection and slower healing if not attended to properly.
If you sit a lot, wear braces and prosthetics for a long period of time in the day, or are in bed a lot, consider something called offloading. Move around in your wheelchair or chair so your skin doesn’t ‘settle’ too much in one area or another. Weight from the rest of your body can create more pressure in certain spots than others. Put your legs up to increase circulation, wiggle around and stretch as best you can or ask someone to help you. Rub the backs of your limbs gently to get the blood flow going and air circulating. Move around and raise up occasionally in your wheelchair or scooter seat, roll over in bed several times a day. Consider wearing gloves if you use crutches, a walker, or use a manual wheelchair. Also, repetitive transferring on your hands and arms can cause blisters and calluses, so gloves are a great way to protect your hands from the elements and strain.
Because blisters typically get better on their own in just a few days if you have good circulation, generally no special treatment is required other than to keep the blister clean and dry. Your skin provides a natural protection against infection, so a blister should be left intact for as long as possible. Do not pick at the blister or try to purposely drain the blister, or cut away the overlying skin. That overlying skin is your body’s protection from infection. Protect the blister with a sterile bandage if you can’t avoid constant contact with that blister, like on the backs of your legs and thighs when you’re in your wheelchair or in braces. If the blister breaks on its own, wash the area with soap and water, and gently pat the area dry. Use an antibacterial ointment and cover it with a bandage until you can get to the doctor to look at it.
People with diabetes and people who cannot reach blisters easily because of a physical disability, may need a doctor to look at their blisters sooner than other people who don’t have a disability or chronic illness. People with diabetes often have nerve or circulation problems that make it harder to feel and notice wounds. That causes wounds to heal more slowly. In people with poor circulation or spinal cord injury, a simple blister might go unrecognized and could become infected with repetitive rubbing and transfers. People with diabetes and compromised mobility need to care for the skin over their entire body daily. Examine yourself for sores or blisters, or ask the help of a caregiver.
For typical blisters, medical care is needed only if an infection develops or with compromised sensation and immunity. An infection is more likely to occur if the skin over the blister has been pierced, broken or popped. These types of blisters need to be watched for a few days to make sure they heal properly.
See your doctor immediately if you think you have a blister or pressure sore you cannot handle, or if there is an infection. If you notice significant redness, it’s very painful, notice drainage that is not clear fluid or you develop a fever, get to a doctor. Also, seek professional help if the blister is so large or painful that walking or engaging your other daily activities become too difficult for you. Most blisters heal on their own in a few days, but be vigilant and watchful. Take good care of your skin. Keep it clean and dry and moisturized daily. It’s the largest organ of your body and a sponge to bacteria, so treat with care. A little extra pampering of your skin protects you from head to toe, inside and out.
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