Blisters are small pockets of fluid that form in the upper layers of the skin in response to friction, burning, freezing, chemical exposure or infection. While blisters are quite common and generally harmless, recurrent painful blisters or those that don't seem to heal can indicate an underlying medical condition that requires treatment. This article provides an overview of the common causes of recurring blisters on the feet, hands and other areas, along with diagnosis and treatment recommendations from a podiatrist's perspective.
What Causes Painful Recurring Blisters?
There are several potential causes of chronic, recurring blisters:
Friction
Friction is the most common cause of blisters on the feet. Tight-fitting or poor quality shoes, socks and hosiery can rub against the skin and cause blisters. Athletes and runners are especially prone to blisters from friction due to long periods of activity. Blisters most often develop on the heels, toes, balls of the feet and sides of the feet in areas exposed to friction.
To prevent friction blisters, wear properly fitted, high quality athletic shoes and moisture wicking socks. Apply petroleum jelly or anti-friction balms to hotspots proactively.
Infection
Certain viral, bacterial and fungal infections can cause fluid-filled blisters on the skin. Examples include:
Chickenpox - caused by the varicella-zoster virus, chickenpox often starts with a blister-like rash.
Impetigo - a highly contagious bacterial skin infection characterized by oozing blisters.
Athlete's foot - a fungal infection that can lead to blisters on the feet.
Infectious blisters are often preceded by other symptoms like fever, malaise and muscle aches. Seeking prompt medical treatment is important to prevent the infection from spreading.
Autoimmune disorders
Some autoimmune diseases like dermatitis herpetiformis, bullous pemphigoid and linear IgA can cause recurring blisters and skin lesions. These blisters are often itchy and burn. Autoimmune blistering conditions require diagnosis and management by a dermatologist.
Inherited conditions
There are also some rare inherited conditions that predispose people to chronic blistering of the skin, including epidermolysis bullosa. Genetic testing can help diagnose blistering disorders. Wound care and pain management are important to prevent infection and improve quality of life.
Medication side effects
Certain medications like chemotherapy drugs, anti-inflammatories and antibiotics can sometimes cause blistering reactions. Switching medications often helps resolve this side effect.
Sunburn
Severe sunburn can result in large, painful blisters - especially in children. Blistering sunburns need to be monitored for signs of infection. They can be treated with aloe, compresses and OTC pain relievers.
Thermal burns
Thermal burns from contact with heat, fire or chemicals damage the skin and underlying tissue, resulting in pain and fluid-filled blisters. Second and third degree burns require urgent medical care to prevent scarring and infection.
Pemphigus
Pemphigus is a group of rare autoimmune disorders that cause blisters on the skin and mucous membranes. Pemphigus vulgaris is the most common type and primarily affects middle aged and older adults.
Porphyria
Porphyria cutanea tarda is a disorder that can cause blistering lesions on sun-exposed areas like the face and hands. It is triggered by sun exposure in susceptible individuals with high levels of porphyrins.
Diagnosing Recurring Blisters
To properly diagnose the underlying cause of recurring blisters, the podiatrist will:
Take a full medical history, asking about risk factors, family history, timing of blisters etc.
Examine the location, size, shape and type of blisters - are they clear fluid-filled, blood-filled, pus-filled etc?
Evaluate for signs of infection - redness, warmth, swelling, oozing, fever?
Order blood tests if autoimmune disorders are suspected.
Take a skin sample for biopsy to look for viral, fungal or bacterial organisms.
Consider allergy testing for potential irritants or allergens.
Check footwear and socks for sources of friction.
Refer patient to a dermatologist for assessment of inherited conditions.
Determining the root cause is key for effective treatment and prevention.
Treatments for Recurring Blisters
Treatment will depend on the underlying cause but may include:
Preventing friction
Wear properly fitted shoes and socks without seams over sore spots.
Use moisture wicking socks and change them frequently if feet sweat.
Apply petroleum jelly or anti-friction balms to hot spots before activity.
Pad blister-prone areas with molefoam or lambswool.
Take breaks during long periods of activity to air out feet.
Treating infection
Oral antibiotics or antifungal medications.
Antiviral medications for viral infections.
Draining large, painful blisters with a sterile needle.
Keeping blisters clean and covered with dressings.
Epsom salt soaks may help soothe blisters on feet.
Managing autoimmune disorders
Corticosteroids, immunosuppressants or biologics to reduce inflammation and blistering.
Antibiotics for secondary infections.
Wound care to prevent scarring.
Pain medication as needed.
Protecting from sun exposure
Sunscreen, sun protective clothing/hats, avoiding peak sun hours.
Phototherapy under medical supervision can help manage some light-sensitive conditions.
Adjusting medications
Switching to alternative medications that don't cause blistering reactions.
Altering dosage or frequency if blistering is mild.
Treating burns
Aggressively cooling burns right after injury.
Cleaning wounds, draining blisters and bandaging properly.
Oral pain medication, topical burn creams or gels.
Surgical debridement for severe, deep burns.
Skin grafting in case of extensive loss of skin layers.
Tips for Blister Self-Care
Avoid bursting blisters unless they are painful - the skin covering helps prevent infection.
If blisters do pop or are drained, wash thoroughly with soap and apply antibiotic ointment and dressings.
Elevate limbs with blisters to reduce swelling.
Take over-the-counter pain relievers as needed for pain.
Apply cool compresses to soothe discomfort from blisters.
Keep blistered areas clean and dry to prevent secondary infections.
See a doctor for signs of worsening infection like fever, red streaks, fouls smells.
Contact the doctor immediately if you develop blisters while on a new medication.
When to See a Doctor
Consult a podiatrist or dermatologist if you experience any of the following:
Frequent or worsening blisters without obvious cause
Blisters accompanied by rash, itching or peeling skin
Blisters that easily rupture and are slow to heal
Signs of infection - pus, redness, swelling, heat
Blisters after starting a new medication
Painful blisters on the palms, soles or mouth
Family history of inherited blistering disorders
Timely diagnosis and treatment can help manage chronic blistering conditions and improve quality of life.
Key Takeaways
Friction and burns are common causes of one-time blisters, while infections, autoimmune disorders and medications often underlie recurrent blisters.
Diagnosis involves a medical history, physical exam, testing blister fluid, blood tests and potential skin biopsies.
Preventing friction, treating infections, managing autoimmune diseases, avoiding triggers and proper wound care promote blister healing.
See a podiatrist promptly for painful, chronic blisters to determine the underlying cause.
Prompt treatment can help manage inherited and autoimmune blistering disorders.
Follow self-care tips like keeping blisters clean and covered to prevent infection.
FAQs
Should I pop a blister?
It's best to keep blisters intact if possible to prevent infection. See a doctor if a blister is very painful and needs draining.
How can I tell if a blister is infected?
Signs of infection include pus, worsening redness, swelling, heat and streaking. Fever can also indicate an infection needing antibiotic treatment.
Is blistering a sign of cancer?
Blistering is not a direct symptom of cancer, but some cancers and cancer treatments can indirectly cause blistering. See your doctor about recurring blisters.
Can stress or anxiety cause blisters?
Stress and anxiety themselves don't directly cause blisters, but they can lead to behaviors that provoke blisters like lip/cheek biting or rubbing hands excessively. Managing stress is helpful.
When should I seek urgent care for a blister?
Seek urgent medical care if you have a high fever, shaking chills, dizziness or rapid heart rate along with spreading blisters, which may indicate a serious infection.
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