Blisters

Overview

Different types of skin diseases are observed in children, teen, and adults due to viral and bacterial infections or adverse environmental conditions. Blisters are one of the common types of skin ailments that occur due to numerous environmental (weather or climatic changes) or pathogenic factors (virus, bacteria or fungi). It mainly arises due to moist skin conditions and is usually self-limiting in nature. But in few extreme cases, blisters may spread from the site of origin to the other parts of the body and may damage the skin severely. Hence consultation with a dermatologist is mandatory in order to completely cure blisters and associated skin problems.

What are blisters?

Blisters are fluid-filled elevated skin eruptions, having a distinct boundary that may be observed in different parts of the body such as heels, elbows, and knees which are usually exposed. Blisters may form singly or in groups and are usually not persistent in nature. The fluid within the blisters may be transparent, translucent, purulent, or hemoserous in nature and are exuded on pricking. On complete healing, blisters dry up and form scabs which can be peeled off leaving scars on the skin. These scars take time to heal and may require skin ointment or other medications fora speedy recovery. Blisters may be contagious or non-contagious depending on the causative agent or degree of spread of the infection.

What causes blisters?

Blisters may be caused by numerous physiological, environmental or pathogenic factors, depending on the environment and lifestyle a patient is subjected to. The commonly observed causes of blisters are described below-

• Infections caused by viral pathogens like Herpes simplex, Varicella Zoster
• Infections caused by bacterial pathogens like Staphylococcus, which may lead to Staphylococcal Scalded Skin Syndrome
• Living in unhealthy and unhygienic conditions
• Presence of dirt on the skin (increases surface friction)
• Wearing socks or stockings regularly without washing and proper cleaning
• Lack of bathing and cleansing of the skin
• Wearing shoes without laces (causes dirt to settle in the foot)
• Wearing moist gloves or socks repeatedly
• Moist and saturated skin (may cause damage to the epidermis, making it break due to shear forces)
• Damage to connective tissue due to shear forces
• Delayed or incomplete recovery of connective tissues due to loss of capability to adapt to environmental changes
• Increasing load or weight abruptly (allows the skin very less time to adapt to forces of high intensity)
• Leisure or sports activities like trekking, hiking, surfing, gliding, swimming and a few more which either exert a lot of force (shear force) on the foot-skin or expose the skin to moist and humid conditions for a long time.
• Defective, poor-fitting or very tight footwear which may create pressure spots on the skin that may gradually lead to blisters
• Lack of ventilation due to poorly aerated clothing or footwear
• Deficiency of vitamins or essential micronutrients in the regular diet (reduces immune capacity and adaptability of the skin)
• Few over-the-counter drugs such as Ibuprofen, Naproxen or Piroxicam
• Reduced use of moisturizers or skin ointments (leaves the skin exposed to infections)
• Existing skin diseases such as Eczema or Dermatitis
• Autoimmune disorders like bullous pemphigoid or dermatitis herpetiformis
• Environmental factors like burns (thermal or chemical) or repeated friction
• Immune response to few allergens such as pollen grains, animal dander or few foods (Eg: sea-foods)
• Allergic response due to insect bites
• Prolonged exposure to harmful radiations used for treating few existing diseases like cancer

Symptoms of blisters

Blisters are easily identified because of their shapes, sizes, and appearances. In the initial stage, blisters are localized to one particular portion of the body. The very common symptoms of blisters are described below-

• Irregular reddish, fluid-filled lumps appearing singly or in groups
• Presence of well-defined borders
• Fluid within the blister may be transparent or cloudy and gets discharged as a sticky secretion on being pricked
• Reddish patch on the skin where eruptions appear
• Formation of crusty scales (which can be peeled off) once the blisters heal
• Scars on the skin after the scales are peeled off
• Irritation, pain, and inflammation of the affected skin
• Constant itching
• Burning sensation and extreme tenderness of the skin

Types of blisters

Blisters are closely associated with a particular form of the autoimmune disease called Pemphigus. It occurs primarily due to the separation of skin cells and accumulation of fluids in between skin layers that lead to the formation of blisters. The different types of Pemphigus are described below-

• Pemphigus Vulgaris: They are mainly manifested as painful mouth blisters. They do not leave scars after healing.
• Pemphigus Foliaceus: They are manifested as blisters on the face and scalp. As the diseases gradually progress, blisters appear on the trunk as well (chest and back). Loosened moist scales may be formed on the affected skin which may cause irritation and itching.
• Pemphigus Vegetans: In this case, thick sores and blisters are formed in the underarms (axilla) and groin.
• IgA Pemphigus: It is triggered by the IgA antibody and is relatively benign in nature. Fluid-filled lumps are formed in this case.
• Paraneoplastic Pemphigus: It is a rare variety of blister and is usually observed in cancer patients. It is characterized by blisters and sores on the mouth and lip. Scars are found on the linings of eye-lids.

Another classification of blisters is provided below-

• Friction blisters: They are formed due to shear forces that severely damage the connective tissues present between epidermis and dermis. “Hot spots” or “pressure spots” are created. Blister formation occurs in the later stage due to leakage of plasma between the damaged skin layers.
• Blood blisters: Blood blisters may form underneath the skin or below the nail-bed. These are formed due to damage of blood vessels and subdermal tissues, which cause blood and lymph to get trapped beneath the skin.

Diagnosis

The following diagnostic tests are usually carried out-

• Blood and swab tests
• RAST (Radio Allergosorbent Test)

Treatment

If your blister has not popped yet

• Do not try to burst or pop your blister.
• Make sure that it is left open to breathe or covered loosely.
• Wear protective shoes or socks to make sure that your blister does not pop – if is it on your foot.
• If your blister is on any other part of your body; take caution so that it does not burst.

If your blister has popped

• Make sure to wash your hands and the blister with warm water.
• Dab it dry and do not rub it.
• Use an iodine or hydrogen peroxide solution to clean the blister.
• Leave the blister open to heal naturally or cover it with a loose bandage, till it heals.
• If the blister still continues to drain pus, visit your doctor to get an antibiotics course prescribed.

Prevention

• Apply powder in your socks to make sure that the sweats absorbed by the socks do not give you blisters.
• Do not wear new shoes for a long time.
• Keep yourself clean and dry.
• Wear comfortable shoes, which are not too tight.

References