Blisters: General Principles on Care

• Always drain blisters as soon as possible and use a sterile pin or needle.

• Sterilize the needle or pin with rubbing alcohol or passing it through a flame, when letting it cool for 30 seconds.

• Before performing the procedure, and try to make Marcus Welby MD proud, make sure you have topical antibiotic, band aids big enough to cover completely, gauze to collect the fluid, and moleskin or athletic tape to cover the band aid.

• Push the fluid towards one side of the blister and puncture the dead top layer of skin keeping the needle/pin parallel with the skin, sort of above the fluid.

• Do not push the needle/pin into the live, deep layers of skin below the fluid.

• You must puncture the skin 3 to 5 times in different places to ensure that the top will not just reseal over and allow a new blister to form.

• Even with the best intentions, 30% of all blisters have to be popped again.

• After popping the blister, soak in warm water in a basin with two tablespoons of any type of salt for 30 to 60 minutes (the longer the better) to pull out the fluid. I do like the sound of the SALTS from the DEAD SEA.

• After soaking, dry off the blister well, apply topical antibiotic over the holes made by the needle/pin, or any other exposed, open skin, and cover with a band aid(s) bigger than the size of the blister.

• Place with firm pressure tape or moleskin over the band aid(s) to give an added push on the roof of the blister to re-seal with the underlying skin.

• Take off the dressing twice daily to soak for 30 minutes until all the soreness is gone. It is so important to continue soaking until the soreness is gone to pull out extra fluid and inflammation. This can take 1 to 7 days based on the size and depth of the blister.

• Once the soreness is gone, the dressing can be removed except when you are in a situation that a re-blister may occur (perhaps that next hike!).

• Keep moleskin or tape over the old blister area for 2 weeks more to protect against re-blister. It is extremely important to massage softening creams or moisturizers into the area for these 2 weeks to re-soften the skin. Massage twice daily for 2 minutes. All the soaking you do in the first week dries the skin and deep tissues.

• The goal is to get the skin soft again and the deep tissue not inflammed.

• When the blistering process is severe with skin breakdown and exposed deep tissue (loss of the roof), use one of the over the counter medicines in the water while you soak. See if your pharmacy has any one of these powders or liquids: Domboros, Pediboros, Bluboros, and Burrows Solution. Follow the directions for concentrations.

• The medicated powders or solutions listed above are so powerful drying agents that you immediately have to twice daily use the softening/moisturizing creams on the skin.

• With the severe blistering, more skin protection is also needed like big squares of moleskin attached only to good skin, Silvadene-like silver tainted ointments, and perhaps some padding. The silver ointments are anti-bacterial as well as great for the skin. Ask the pharmacy.

• What if the blister is possibly infected? So you pop the blister and pus comes out, immediately see a doctor.

• What if the blister has blood? Blood is the food of infection. Blood blisters must be taken a lot more seriously, and drained as quickly as possible. If you think it is getting or is infected, see above and see a doctor.

• Every year I have to have an infected blister hospitalized or, at least, see an infectious disease specialist. I hate infections!!