I take care of three patients with this disorder, about which too little is known. Clobetasol is used to relieve itching and pain caused by the immune factors that inundate the area of the blisters. I went through weeks and weeks of bandaging and dressing the blisters, spending over an hour a day on these patients. We finally realized that many of them are better left open to air in order to dry up and heal faster. The bacteria love those immune factors that seep out from the blisters, which are surely rich in proteins and aminos. It can be a catch-22: Adherent dressings cause trauma when removed, while nonadherent dressings trap moisture and occlude oxygen from the wound, leading to infection and cellulitis, etc.
Cleaning every shift with NS and then drying with sterile guaze is very important if you are going to leave these blisters open to air. Keeping the patient off of the wounds is also important, it presents a skin risk that can open them to further complications. Airstream chucks pads work really well, we kept running out of both TIME and DRESSINGS keeping up with severe outbreaks. Better to let them lay on a clean breathable pad in comfort than to torture them with tape. One of these three had a tape allergy to top it off! So that's how we figured out these best practices... we had few other choices. The tape was causing it's own outlined blisters that peeled right off in the shape of where the tape was! Ouch... Open to air with close monitoring and infection control practices is the best way...
Another exacerbating factor: daipers. Nix on the daipers. You will have to go head-to-head with managers since some will see it as a dignity issue so get the doctor on your side. You're already in for a fight once you tell your boss that you are going to leave open wounds undressed.
One thing I'm curious about is whether Revina (trypsin/balsam peru/castor oil) is useful for treating the opened blisters. You would think it might be useful here but it is never prescribed from what I can tell. Is it due to the skin layer where these bullae occur not being the right locus?