Should Your Child See a Doctor?

Blisters

Definition

  • This topic mainly addresses blisters from friction or blood blisters from a pinching injury.
  • Friction Blister: Raised pocket of clear fluid, covered by skin. Friction blisters usually occur on the palms, fingers, heels or toes.
  • Blood Blister: Raised pocket of bloody fluid, covered by skin. Dark red or purple in color. A blood blister can occur when the skin gets pinched (in a hinge or a closing door). Blisters when the cause is unknown are also covered.

Friction blisters

  • Friction causes most blisters on the hands and feet.
  • Definition: A raised pocket of clear fluid covered by skin.
  • Cause: A friction blister is the result of friction and shear forces separating off the top layer of the skin. This creates a cushion (blister) of fluid over the area of friction or pressure.
  • Common Locations: Gripping surface of fingers, palm, back of heel, top of toes, side of foot.
  • Hand Friction Blisters: Hand blisters are usually due to friction from prolonged use of a tool (e.g., a shovel, pick, rake), sports equipment (e.g., tennis racquet), rowing (i.e., oars), canoeing (paddle), kayak (paddle), and gymnastics equipment (e.g., high bars, parallel bars).
  • Foot Friction Blisters: Foot blisters are usually due to friction from an activity like hiking and running. Usually the individual has new shoes, ill-footing shoes, just recently started the activity, or recently increased the amount of the activity.
  • Prevention: There are two general approaches to prevent friction blisters: toughening the skin and reducing friction force.
  • Complications: Local pain or secondary infection
  • Treatment: Painless or minimally painful small blisters can be treated with a piece of moleskin or tape that has a hole cut in the center. Larger or severely painful blisters generally need to be punctured with a sterile needle or pin to let all the blister fluid out. Then the blister can be covered with antibiotic ointment and a dressing.

Other causes of blisters on feet and hands

  • Burns - chemical
  • Burns - thermal
  • Frostbite (second degree)
  • Hand, foot and mouth disease (viral rash from Coxsackie virus)
  • Impetigo: Staph bacteria can cause impetigo with blisters
  • Insect bites: In young children, insect bites (e.g., fleas) can cause small blisters
  • Poison ivy, poison oak, poison sumac
  • Sunburn (second degree)

See more appropriate topic (instead of this one) if

When to Call Your Doctor

Call your doctor now (night or day) if

  • Your child looks or acts very sick
  • Looks infected (spreading redness, red streak)
  • You think your child needs to be seen urgently

Call your doctor within 24 hours (between 9 a.m. and 4 p.m.) if

  • You think your child needs to be seen, but not urgently
  • Looks infected (pus but no spreading redness)
  • Severe pain or large blister and you want your doctor to drain the blister
  • Cause unknown and blister on one or more finger pads
  • Cause unknown and new blisters are developing

Call your doctor during weekday office hours if

  • You have other questions or concerns
  • Cause unknown and no new blisters

Parent care at home if

  • Normal blister from friction and you don't think your child needs to be seen
  • Normal blood blister from pinching injury to skin and you don't think your child needs to be seen
  • Prevention of foot blisters from hiking or running, questions about
  • Prevention of hand blisters from sports or tools, questions about

Home Care Advice for Blisters

Treatment of Normal Friction Blister

Reassurance

  •  A friction blister is a raised pocket of clear fluid, covered by skin.
  • Most blisters should not be opened. The reason is that it increases the possibility of infection.
  • However, large or severely painful blisters generally should be drained. This is done by puncturing the blister with a sterile needle or pin and pushing the fluid out. (See #4 below)

Protect the blister

  • Goal: Protect the blister from additional pressure and rubbing.
  • Surround it with a "donut" made from moleskin (available at your local pharmacy)
  • Using a scissors, cut a piece of moleskin to a shape slightly larger than the blister.
  • Next cut a hole the size of the blister in the center. Do this by folding the moleskin in half and cut along the fold.
  • Remove the covering from the adhesive side, and then apply the moleskin with the blister in the center.
  • If the blister is taller than the moleskin, add another layer of moleskin.
  • Hold the "donut" in place with a large strip of duct tape.
  • Another option: If moleskin is not available, use a Bandaid, fold it and cut the center out to the size of the blister.
  • For foot blisters, also switch to shoes that don't rub the blister.

Pain medicine

  • Give acetaminophen every 4 hours or ibuprofen every 6 hours as needed (See Dosage table).

Severe pain: drain the blister

  • Draining a large blister can relieve the pain.
  • Wash the skin with warm water and an antibacterial soap.
  • Sterilize a needle or straight pin with rubbing alcohol or a flame.
  • Gently press the fluid to one side of the blister to create a bulge.
  • Pass the needle horizontally through the fluid creating 2 puncture holes. Gently wiggle the needle to make the holes larger.
  • Remove the needle.
  • Press the fluid out through the holes.
  • Leave the roof of the blister in place to protect the raw skin underneath.
  • Apply an antibiotic ointment (no prescription needed). Reapply it 2 times per day after cleansing.
  • Cover the drained blister with a Bandaid.

Broken blister treatment

  • If the blister breaks open, let it drain.
  • Leave the roof of the blister in place to protect the raw skin underneath.
  • If there are any loose flaps of skin, trim them with a fine scissors.
  • Wash it with warm water and an antibacterial soap.
  • Apply an antibiotic ointment (no prescription needed) twice a day.
  • Cover it with a Band-Aid.

Expected course

  • They usually dry up and peel off in 1 to 2 weeks without any treatment.

Call your doctor if

  • Blister looks infected
  • Severe pain and you want your child's doctor to drain blister
  • Your child becomes worse

Treatment of Normal Blood Blister

Reassurance

  • A blood blister can occur when the skin gets pinched (for example, in a hinge or a closing door).
  • It creates a tiny pocket of bloody fluid covered by skin. It is dark red or purple in color.
  • A blood blister is not serious.
  • No specific treatment is needed. It is not necessary to drain it.
  • It will slowly dry up and peel off over 1-2 weeks.

Pain medicine

  • Give acetaminophen every 4 hours or ibuprofen every 6 hours as needed (See Dosage table).

Call your doctor if

  • Your child becomes worse

Prevention of Foot Blisters

Prevention - general

  • Shoes: Buy shoes that fit. Avoid shoes that are too tight or too loose. New hiking boots are often somewhat stiff. It is wise to first wear them around the house and on short walks before wearing them on a long hike.
  • Socks: Avoid cotton socks; they tend to retain moisture and stay damp. Instead use synthetic (acrylic) or wool socks. Some people prefer specially designed and padded "sports" or "hiking" socks. Other people prefer to wear two socks at a time, a thin inner liner ("wicking") sock and a thicker outer sock.
  • Lubricants: If your child frequently gets blisters at certain pressure points, you may want to try using a lubricant, such as petroleum jelly. Cover the pressure point with a small amount of the lubricant before athletic activities to decrease the friction on the spot.
  • Callus: If blisters usually occur under a callus, file the callus down and lubricate it so it won't contribute to the friction.
  • Taping Pressure Points: If a lubricant doesn't prevent blisters, taping is the next step. Taping is a very effective way to treat hot spots or friction blisters. Many hikers and runners use taping. Follow the instructions listed down below.

Prevention - taping

  • OPTION 1 - MOLESKIN
    • Moleskin is available at your local pharmacy. It is an effective way to prevent friction blisters. Here are some instructions on how to use moleskin.
    • Using scissors, cut the moleskin to a shape slightly larger than the pressure point.
    • Remove the backing from the moleskin. Apply it to the pressure point. Smooth it from the center outward so that there are no wrinkles.
    • Put on a clean and dry sock. 
     
  • OPTION 2 - TAPING WITH DUCT TAPE
    • Duct tape is available at your local hardware store. It is an effective way to prevent friction blisters. Many hikers and runners use it. Here are some instructions on how to use duct tape.
    • Using scissors, cut out a piece of duct tape into a shape slightly larger than the pressure point.
    • Apply the piece of duct tape to the pressure point. Smooth it from the center outward so that there are no wrinkles.
    • Put on a clean and dry sock.
     

Prevention - toughening the skin

  • This mainly applies to walkers, hikers, and runners.
  • Slowly increasing the distance that you hike or run over days to weeks will increase the toughness of the skin. This will reduce the likelihood of blisters occurring. 

Call your doctor if

  • You have other questions or concerns

Prevention of Hand Blisters

Prevention

  • Gloves: Wear heavy-duty work gloves when working with the hands and using such tools as shovels, picks, and rakes. Sports gloves can be used for rowing, paddling, weight lifting or cycling.
  • Lubricants: Reduce friction at pressure points by covering them with a lubricant such as petroleum jelly.

Call your doctor if

  • You have other questions or concerns

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.

References

  1. Cordoro KM, Ganz JE. Training room management of medical conditions: sports dermatology. Clin Sports Med - 01-JUL-2005; 24(3): 565-98, viii-ix
  2. Knapik JJ, Reynolds KL, Duplantis KL, Jones BH. Friction blisters. Pathophysiology, prevention and treatment. Sports Med. 1995 Sep;20(3):136-47.
  3. Pratt MK, Mustafa, Stufberg D, Common skin conditions in athletes. Clin Fam Pract - 2003 Sep; 5(3); 653
  4. Slavin KA and Frieden IJ. Picture of the month: Hand-foot-and-mouth disease. Arch Pediatr Adolesc Med. 1998;152:505-506.
  5. Veien NK. Acute and recurrent vesicular hand dermatitis. Dermatol Clin. 2009 Jul;27(3):337-53, vii.

Disclaimer

This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: Barton D. Schmitt, M.D. Clinical content review provided by Senior Reviewer and Healthpoint Medical Network.

Last Review Date: 7/5/2011

Last Revised: 8/1/2011 3:43:02 PM

Content Set: Pediatric HouseCalls Symptom Checker

Version Year: 2012

Copyright 1994-2012 Barton D. Schmitt, M.D.