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Words on Wounds
A forum to discuss the latest news and ideas in skin and wound care.
Wednesday, January 22, 2014
Blisters: To Pop or Not to Pop?
Blisters are common across all ages. In general, blisters are formed in areas where friction is a problem, such as tight footwear rubbing against the feet. A Stage II pressure ulcer can present itself as a blister. Blistering is also a predominant clinical sign for certain autoimmune skin diseases, such as pemphigoid and pemphigus. There is no consensus for the management of blisters. We conducted a recent quick poll on our website asking you whether blisters should be deroofed or removed. The majority of respondents voted in favor of leaving the blisters intact. I think the answer to whether to pop the blister or not will depend on a few factors: 1. Location: For areas such as the ankle, wrist, and elbow, where the blister may impair mobility or range of motion, it may be wise to drain the blister and use an atraumatic dressing to cover the area. 2. Stability of the blister: If the blister is large and protected by very fragile skin, it may be beneficial to manually drain the blister in a clean and controlled environment to minimize contamination of underlying tissue if the blister were deroofed accidentally. 3. Content of the blister: We usually recommend not to remove blisters that are clear and filled with serous fluid. However, pus and blood can be irritating to underlying tissue and may warrant prompt evacuation. 4. Pain: Blisters that are painful may also benefit from manual evacuation. To evacuate a blister, you can use a sterile needle or lancet to puncture the epidermis without damaging the dermal layer. Manual expression may be required to drain the fluid. Keep the skin flap to cover the dermis and consider an atraumatic dressing for protection.
1/30/2014
Dr. Kevin Woo said:
Once the blister is evacuated (if appropriate), the dermis is now exposed, similar to a skin tear. It is best practice to preserve the skin flap and roll the skin flap over to cover the dermis where the skin tear has taken place. All the dressings and skin substitutes are designed to emulate natural skin that provides a permeable barrier to promote moist wound healing. This is the reason why we would like to keep the intact skin for as long as possible.
1/26/2014
Dr. Edwin P. Monroy said:
Can anyone give me an answer why you would want to leave the "blister roof" on if it broke intentionally or not? Is it best to remove it or to allow it to reattach to the wound base?
About the Author

Kevin Y. Woo, PhD, RN, ACNP, GNC(C), FAPWCA
Kevin Y. Woo, PhD, RN, ACNP, GNC(C), FAPWCA, is Director of Nursing/Wound Care Specialist, Villa Colombo, Homes for the Aged, Inc, Toronto, Ontario, Canada; Wound Care Consultant, West Park Healthcare Centre, Toronto; Assistant Professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto; and Associate Director, Interprofessional International Wound Care Course, MScCH program, University of Toronto.