My Skin, My Health

Your skin consists of three layers: the epidermis, the dermis, and subcutaneous (below the skin) fat. A blister forms under the epidermis as a fluid-filled sac. Typically, it may be filled with clear liquid or blood, depending on the injury that damaged your skin.

A blister, which is also called a vesicle by medical professionals, they're bubbles that pop up when fluid collects in pockets under the top layer of your skin. They can be filled with pus, blood, or the clear, watery part of your blood called serum. Most are shaped like circles, you’re probably familiar with blisters if you’ve ever worn ill-fitting shoes for too long. Although they are often caused by irritation or friction (such as with a poorly fitting shoe).

Blisters can also represent disease processes. It can accompany some types of skin rashes and inflammatory conditions, including certain autoimmune diseases. Depending upon the cause of the blisters, blisters may occur singly or in groups. In contrast to abscesses and boils, which are collections of inflammatory fluid found deep in the tissues, blisters are also a symptom of some diseases. Blisters may be painful or itchy. If a blister gets infected, it will fill with milky-white pus. Blisters most often show up on the feet or hands, but they can appear anywhere on the body.

This common cause of blistering produces vesicles when friction between your skin and the shoe results in layers of skin separating and filling with fluid. Blisters are often annoying, painful, or uncomfortable. But in most cases, they aren’t a symptom of anything serious and will heal without any medical intervention. If you ever have unexplained blistering on your skin, you should see your healthcare provider for a diagnosis.

TYPES

The main types of blisters are:

Friction Blisters: Friction blisters result from repeated rubbing.
Blood Blisters: These blisters usually develop when something pinches part of your skin. They typically happen on the hands.
Heat Blisters: Heat blisters can result from a burn or when your skin gets too hot as you recover from frostbite.

Other types of blisters are named after the condition they are linked to, such as chickenpox and shingles blisters, and atopic eczema blisters.

SYMPTOMS/SIGNS OF A BLISTER?

The symptoms of a blister may look like other skin conditions. Always see your health care provider for a diagnosis, some of the signs include;

· Bruise

· Rash

· Bumps On Skin

· Blisters caused by injury or friction will appear as a localized bubble filled with either clear or bloody liquid.

· Blisters that are the result of another condition may appear in one area of your body or maybe all over your body.

· Blisters may be painful or itchy.

· If there is a systemic cause, like an infection, you may also have whole-body symptoms such as fever, pain, or fatigue.

CONDITIONS THAT CAUSE BLISTERS

Many activities and ailments can induce blistering. Blisters can be caused by friction, injury, allergic reactions, infection, or, in rare cases, a skin condition. Here are the possible causes of blisters.

1. Friction

Friction blisters, named for what causes them, are one of the most common kinds. Have you ever worn a new pair of hiking boots before you broke them in? Or raked the yard without a pair of garden gloves on your hands? Or performed repetitive actions such as playing a musical instrument? You can also get them on your hands by holding things like shovels or other tools.

Those are the kinds of things that could cause a friction blister on your heel, toe, thumb, or palm it may be filled with pus, blood, or the clear, watery part of your blood called serum. Depending on the cause, your blister could itch or hurt a lot or a little. They can appear as a single bubble or in clusters.

These blisters will usually appear in the areas that most often encounter repetitive abrasion, whether walking, running, or playing the drums. Areas of skin with a thick horny layer, attached tightly to underlying structures (such as palms of hands and soles of feet) are more likely to generate blisters. Blisters occur more readily if the conditions are warm, for example, inside a shoe. They also form more easily in damp conditions, compared with wet or dry environments.

Blisters can lead to more serious medical issues such as ulceration and infection, although, under normal conditions, this is rare.

2. Temperature extremes

The timing of blister formation helps categorize burns. Second-degree burns will blister immediately, but first-degree burns blister a couple of days after the incident. At the opposite end of the spectrum, frostbite also produces blisters. In both cases, the blister is a defense mechanism deployed to protect lower levels of skin from temperature-related damage.

3. Chemical exposure

Skin can occasionally blister because of certain chemicals. This is known as contact dermatitis. It can affect some individuals in contact with the following;

cosmetics
detergents
solvents
nickel sulfate, used in electroplating
balsam of Peru, a flavoring
insect bites and stings
chemical warfare agents, including mustard gas

4. Crushing and pinching

If a small blood vessel near the surface of the skin is ruptured, blood can leak into the gap between the layers of skin causing a blood blister to form. This is a blister filled with blood, instead of clear liquid, blood floods the area from broken blood vessels and damages the lower layers of the skin. The blood pools and forms a blister.

5. Heat

You can get these blisters from burns or sunburns. They may also form after you warm up from frostbite. Blistering skin is part of a second-degree burn.

Other conditions that may cause blisters.

· Burns or scalds

· Impetigo (a contagious infection of the skin)

· Pemphigus (a rare, blistering skin disease that often occurs in middle-aged and older adults)

· Pemphigoid (a blistering autoimmune disorder, more common in older adults)

· Dermatitis herpetiformis (a blistering autoimmune disorder that usually affects adults between 20 and 60 years old)

· Viral infections (including chickenpox and herpes zoster)

Medical conditions

Several medical conditions can cause blisters, these include;

Chickenpox: The rash forms small blisters that eventually scab over.
Herpes: The cold sores produced by the herpes simplex virus are clusters of blisters.
Bullous impetigo: Mostly seen in children under two years, blisters can form on the arms, legs, or trunk.
Eczema: Blistering can occur alongside several other skin symptoms such as cracking, crusting, and flaking.
Dyshidrosis: A skin condition characterized by a rapid occurrence of many small, clear blisters.
Bullous pemphigoid: An autoimmune disease that affects the skin and causes blisters, this is most common in older patients.
Pemphigus: A rare group of autoimmune diseases, this affects the skin and mucous membranes. The immune system attacks an important adhesive molecule in the skin, detaching the epidermis from the rest of the layers of skin
Dermatitis herpetiformis: This chronic blistering skin condition is unrelated to herpes but similar in appearance.
Cutaneous radiation syndrome: These are the effects of radiation exposure.
Epidermolysis bullosa: This is a genetic disease of the connective tissue that causes blistering of the skin and mucous membranes.
Genital herpes: a sexually transmitted infection (STI) that most commonly affects the groin
Pompholyx: a type of eczema
Scabies: a skin condition caused by tiny mites
Hand, foot, and mouth disease: a viral infection that usually affects young children

BLISTERS FORMATION

The most common type of blister for most individuals is the friction blister. In their most basic form, they occur due to increased shear stress between the surface of the skin and the rest of the body.

The layer of the skin most susceptible to shear forces is the stratum spinosum. As this layer tears away from the tissues below, a plasma-like fluid leaks from the cells and begins to fill the gap that is created. This fluid encourages new growth and regeneration.

Roughly 6 hours after the blister appears, cells at the base of the blister start to take up amino acids and nucleosides. These are the building blocks of protein and DNA. At 24 hours, cell division is markedly increased. New skin layers above the stratum spinosum are steadily formed. At 48 hours, a new layer of skin can be seen, and at 120 hours, a new upper layer of skin is visible. As these new cells develop, the fluid is reabsorbed and the swelling subsides.

Painful blisters on the palm of the hands or soles of the feet are often caused by tissue shearing in deeper layers of the skin. These layers lie next to nerve endings, thereby producing more pain.

MANAGEMENT AND TREATMENT

Blisters generally heal on their own within a few days without medical intervention. As the new skin grows beneath the blister, the fluid will slowly disappear and the skin will naturally dry and peel off. Here are a few things you can do at home to make them more comfortable

· Blisters are best left intact to prevent infection of the affected area. Popping blisters is not recommended, because the bubble is a protective layer that fends off infection. Once the barrier is removed, the wound is open to potential invasion by bacteria and can become infected.

· Covering the blister with a bandage or gauze can help protect it from additional trauma while it heals.

· If the blister bursts, resist the urge to peel off any dead skin on the top.

· Allow the fluid to drain away naturally and carefully wash it with mild soapy water.

· Cover the blister and the surrounding area with a sterile, dry dressing.

· Some medications, such as hydrocolloid dressings, can help prevent further discomfort and encourage the healing process. Hydrocolloid dressings are available for purchase online.

· Similarly, with blood blisters, allow them to heal in their own time. They can be more painful than standard blisters and an ice pack can offer some relief and reduce swelling. Place a towel over the affected area, ensuring that the ice pack does not come into contact with the skin directly.

· Apply antibacterial cream or ointment.

· Wash the area with soap and water.

· Keep the area clean and dry. Do not burst or puncture the blister.

· If the blister bursts, place a bandage or dressing on the area to keep it clean.

· Watch the area for signs of infection such as increased warmth, swelling, redness, drainage, pus formation, or pain. If you notice any signs of infection, call your doctor. You may need antibiotics.

DO’s and DON’Ts

DO’s

· wash your hands before touching a burst blister

· allow the fluid in a burst blister to drain before covering it with a soft plaster or padded dressing

DON’Ts

· do not pick at the edges of the remaining skin

· do not wear the shoes or use the equipment that caused your blister until it heals

Treatment from a GP

A GP is regarded as a family doctor, he or she might burst a large or painful blister using a sterilized needle. If your blister is infected, they may prescribe antibiotics. They can also offer treatment and advice if blisters are caused by a medical condition.

See a GP if:

· a blister is very painful or keeps coming back

· the skin looks infected, it's hot and the blister is filled with green or yellow pus

· the skin around the blister looks red, but this can be harder to see on darker skin tones

· a blister is in an unusual place such as your eyelids, mouth, or genitals

· several blisters have appeared for no reason

· a blister was caused by a burn or scald, sunburn, or an allergic reaction

How long does it take blisters to heal?

Most blisters heal naturally on their own in a few days. Be sure to bandage the blister and wear different shoes while it heals. If you have blisters from burns or frostbite, or you think your blisters could be infected, consult your healthcare provider.

PREVENTION

Blisters develop to protect damaged skin and help them heal. You have several options for preventing blisters, most involve preparation and caution. Preventing blisters depends on the type of blister;

Friction blisters: Friction blisters are best prevented by removing the cause of the friction. This can be achieved in several ways.

Make sure your shoes fit well and do not rub.
Break in new shoes before wearing them for extended periods.

· Adequately breaking in walking or hiking boots before embarking on a long trek is also important.

Wear gloves to protect your hands if you plan on doing a lot of manual labor.
Wear properly fitting clothes to prevent chafing that can lead to blisters on other parts of your body.

Blood blisters (It’s harder to prevent them)

Stay alert when using tools or things that can pinch.
Wear gloves when working with pruners, strong pliers, or in other tight situations.

Heat blisters

· Use sunscreen if you plan to be in the sun for an extended period.

Be extra careful when handling hot items or working around a fire.
Wear weather-appropriate clothing to avoid frostbite. If your skin gets frostbitten, slowly raise your body temperature using lukewarm water.

Avoiding blisters on the feet

· During exercise and sports, specially designed sports socks can reduce the amount of available foot sweat.

· Applying tape, padding, or moleskin to trouble spots can help prevent blisters from appearing. Even better are friction-management patches which are applied to the inside of shoes. These will remain in place longer, throughout many changes of socks or insoles.

Avoiding blisters on the hands

In some sports, such as gymnastics, weightlifting, or rowing, taping up the hands is good practice. Additionally, talcum powder acts to reduce friction and can be used in combination with gloves and tape, or as a stand-alone option. But, because talcum powder absorbs moisture, it will not work well for long durations of activity.

DIAGNOSIS AND TESTS

Do I need to have a doctor look at my blister? Doctors usually diagnose blisters by looking at your skin, but blisters generally do not need a healthcare provider to look at them. There are no tests or diagnostics for blisters.

If a burn or frostbite caused your blisters, a healthcare provider may need to treat the underlying cause. You may also need to see your provider if a blister shows signs of infection, such as:

Pus (yellowish or greenish discharge).
Hot or painful area around the blister.
Red streaks around the blister.

You should see a healthcare provider if your blister does not improve after a few days. You should also see a provider if the blister appears infected. If it is infected, your skin will be red and swollen. The blister fills with a white or yellowish fluid rather than a clear fluid or blood.

BLISTERING DISORDERS

A blister (bulla, or, when small, a vesicle) is a bubble of fluid that forms beneath a thin layer of dead skin. Small fluid-filled blisters are medically known as vesicles. Bullae (singular = bulla) are blisters that are larger than 1 cm across.

The fluid is a mixture of water and proteins that oozes from injured tissue. Blisters that develop as part of a systemic (bodywide) disease may start in the deeper layers of the skin and cover widespread areas. These blisters heal more slowly and may leave scars.

Although burns and repeated friction (for example from wearing tight shoes or using a shovel for a long time) are common causes of blisters, these are not considered blistering disorders.

In an autoimmune disorder, the body’s immune system, which normally protects the body against foreign invaders, mistakenly attacks the body’s own tissues, in this case, the skin. Some autoimmune blistering disorders include;

· Mucous membrane pemphigoid

· Pemphigoid gestationis

· Epidermolysis bullosa acquisita

· Linear immunoglobulin A disease

· Pemphigus foliaceous

· Autoimmune Disorders

Other blistering disorders include staphylococcal scalded skin syndrome, toxic epidermal necrolysis, severe cellulitis, and certain drug rashes.

SOME FACTS ON BLISTERS

• Blisters are filled with serum, plasma, blood, or pus.

• Friction, burns, frostbite, and some medical conditions can produce blisters.

• Blisters help prevent further damage to deeper tissues.

• It is best to leave blisters intact to protect the underlying layers from infection.

• Wearing well-fitting shoes and avoiding exposure to certain chemicals can prevent blisters from occurring.

CONCLUSION

Blisters are pretty standard, but it doesn’t make them any less painful. For runners, hikers, and anyone always on their feet, blisters can be a major pain. If you get a blister, it should get better on its own in a few days. If your blister appears infected, see your healthcare provider.