Proper Care for Burn Blisters: Essential Tips for Skin Injury Management

Burn with large blisters?

Hello, doctor.
Last year, while traveling abroad with friends, I accidentally spilled boiling water (from a hotel-sized water heater) on my bare calf.
The immediate treatment involved rinsing with a large amount of cold water and applying ice packs (for about half an hour each).
The next day, a large blister formed, approximately 10×5 cm in size.
Due to language barriers and lack of knowledge, I was unable to seek medical attention at that time.
The patient experienced pain but was still able to walk, and with four days left in the trip, I performed the following actions: I used a needle sterilized with iodine and heated it to puncture the blister, draining the fluid.
Then, I followed standard wound care procedures (1.
cleaning with saline solution → 2.
disinfecting with iodine → 3.
covering with sterile gauze and securing it with breathable tape around the edges).
At that time, I left it alone, but the patient reported feeling the fluid moving inside while walking.
Eventually, at the airport, the blister was accidentally punctured by a suitcase, exposing the new skin underneath (at that time, I only performed step 3).
I keep thinking that if I had handled it better, the patient wouldn't have a scar, so I would like to ask you, doctor, how should it have been managed properly? Thank you, doctor, and I apologize for bothering you during your busy schedule.
I truly appreciate your help.

Huang Yu, 20~29 year old female. Ask Date: 2017/06/04

Dr. Wu Yuxin reply Dermatology

Is it meaningful to bring up something from last year now? If it's causing significant distress, it's advisable to seek medical attention as soon as possible.

Reply Date: 2017/06/04

More Info

When dealing with burn blisters, especially those resulting from second-degree burns, proper care is crucial to promote healing and minimize the risk of complications such as infection and scarring. Your experience with a burn from boiling water, leading to a significant blister, raises several important points regarding immediate and ongoing care.

Immediate Care for Burn Blisters
1. Cooling the Burn: The first step you took—cooling the burn with cold water or ice packs for about 30 minutes—is appropriate. This helps to reduce the temperature of the skin and can alleviate pain. However, it’s important to avoid ice directly on the skin, as it can cause further damage.

2. Do Not Pop Blisters: While it may be tempting to drain a blister, it is generally advised against unless the blister is very large or painful. Blisters serve as a natural barrier to protect the underlying skin from infection. By popping the blister, you risk exposing the wound to bacteria, which can lead to infection.

3. If Popped, Clean Carefully: If a blister does break, it’s essential to clean the area gently with saline solution or mild soap and water. Avoid using alcohol or iodine directly on the open wound, as these can be irritating.

Ongoing Care
1. Covering the Wound: After cleaning, covering the area with a sterile, non-stick dressing is important. This protects the wound from further injury and contamination. It’s good that you used breathable tape to secure the dressing, as this allows for some air circulation while keeping the area protected.

2. Monitoring for Infection: Keep an eye on the blister and surrounding skin for signs of infection, such as increased redness, swelling, warmth, or pus. If any of these symptoms occur, it’s important to seek medical attention promptly.

3. Pain Management: Over-the-counter pain relievers like ibuprofen or acetaminophen can help manage pain and inflammation. Always follow the recommended dosages.

4. Avoiding Irritation: Since you mentioned that the blister was affected by movement and pressure (like from luggage), it’s crucial to avoid any friction or pressure on the area. If possible, wear loose-fitting clothing and avoid activities that might aggravate the burn.

When to Seek Medical Attention
If the burn area shows no signs of improvement after a few days, or if you notice any signs of infection, it’s advisable to consult a healthcare professional. In some cases, a healthcare provider may need to drain a blister safely or prescribe antibiotics if an infection is present.

Scarring and Long-Term Care
Scarring is a common concern after burns. To minimize scarring, once the blister has healed, you can consider using silicone gel sheets or ointments that promote healing and reduce scar formation. Additionally, protecting the area from sun exposure is crucial, as UV rays can darken scars.

Conclusion
In summary, while your initial response to the burn was appropriate, the management of the blister could have been improved by avoiding popping it and ensuring it remained protected. For future reference, always prioritize keeping blisters intact, clean, and covered. If complications arise, do not hesitate to seek medical advice. Proper care can significantly impact healing and the cosmetic outcome of burn injuries.

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