Why Do Blisters Reappear After Burn Wound Healing?

After the burn wound has healed, blisters may develop again?

Hello, doctor.
My son is currently three years old.
On June 22, he was burned on his calf by an exhaust pipe, resulting in a second-degree burn.
After treatment, during a follow-up appointment on July 12, the doctor indicated that the wound had healed (with a pink surface) and that we could start using silicone gel sheets.
That evening, we began using the sheets, but the next morning, we discovered that two new blisters had formed on the previously healed wound.
We immediately stopped using the sheets.
During the follow-up visit, the doctor explained that burn wounds can sometimes develop blisters again, and we must wait for the blisters to heal before using the sheets.
I would like to know why new blisters formed on a wound that was already healed.
Is this related to the use of the sheets? Thank you.

Ms. Huang, 30~39 year old female. Ask Date: 2017/07/13

Dr. Wu Yuxin reply Dermatology

I haven't personally seen the lesion, so I can't make a judgment.
You should consult your attending physician, as they are the most familiar with your son's condition.

Reply Date: 2017/07/13

More Info

When dealing with burn wounds, particularly second-degree burns like the one your son experienced, it's important to understand the healing process and the factors that can lead to the reformation of blisters.
Burns can damage the skin in various ways, and the healing process can be complex. In the case of second-degree burns, the injury affects both the epidermis (the outer layer of skin) and part of the dermis (the layer beneath the epidermis). This type of burn often results in blisters, which are a natural protective response of the body. They form as a result of fluid accumulation between the layers of skin, providing a cushion to protect the underlying tissue from further injury and infection.

After the initial healing phase, the skin may appear to be healing well, often turning a pinkish color as new tissue forms. However, the skin remains fragile during this phase, and various factors can lead to the reformation of blisters. Here are some reasons why blisters might reappear after a burn wound seems to have healed:
1. Fragile New Skin: The new skin that forms after a burn is often delicate and not fully matured. It can be easily damaged by friction, pressure, or even minor trauma, leading to the formation of new blisters.

2. Moisture and Occlusion: Using silicone gel sheets or other occlusive dressings can be beneficial for healing, but if the skin is not ready for such treatment, it may trap moisture and create an environment conducive to blister formation. If the skin is still healing and not fully intact, the pressure from the dressing can cause new blisters to form.

3. Infection: If the wound becomes infected, it can lead to increased fluid accumulation and the formation of blisters. Signs of infection include increased redness, swelling, warmth, and discharge from the wound.

4. Allergic Reaction: Sometimes, the materials in dressings or topical treatments can cause an allergic reaction, leading to irritation and blistering.

5. Underlying Conditions: Certain skin conditions or sensitivities can predispose individuals to blistering, even after a burn appears to be healing.

In your son's case, it is crucial to follow the advice of his healthcare provider. Since the doctor indicated that the blisters could occur and advised waiting until they heal before reapplying the silicone sheets, it’s essential to give the skin time to recover fully.
Here are some recommendations for managing the situation:
- Avoid Irritation: Ensure that the area is not subjected to friction or pressure. Avoid tight clothing or anything that might rub against the healing skin.

- Keep the Area Clean: Gently clean the area with mild soap and water, and pat it dry. Avoid scrubbing, as this can further irritate the skin.

- Monitor for Infection: Keep an eye on the wound for any signs of infection, such as increased redness, swelling, or discharge. If any of these symptoms occur, contact a healthcare provider.

- Consult with a Specialist: If the blisters continue to form or if there are concerns about the healing process, it may be beneficial to consult a dermatologist or a specialist in burn care for further evaluation and management.

In conclusion, while it can be concerning to see new blisters form after a burn wound appears to be healing, it is not uncommon. The healing process can be unpredictable, and factors such as skin fragility, moisture retention, and potential irritation can contribute to this phenomenon. Following proper care guidelines and maintaining communication with healthcare providers will help ensure the best outcome for your son's recovery.

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