Blister

[NJPAIN]

Patient with bilateral lower extremity venous stasis with moderate stasis dermatitis (eczema). About 10 days ago she developed a non-friction blister believed secondary to the LE edema on the medial side of the right leg 3-4 cm above the medial malleolus. Had a similar blister of left leg several weeks ago initially managed with a bordered gauze bandage which excoriated the surrounding skin and snow-balled into several ulcerations requiring a week of Coban Lite compression dressing. I have spoken with podiatrist and wound care center who recommended aspirating blister (to prevent skin from tearing and ulcerating) and then covering with gauze wrapped with Coban. A second podiatrist recommended NOT aspirating blister. I did not aspirate the blister but did wrap with gauze and Coban providing some mild compression. Blister remained intact over 4 days of that treatment. Now, I have coated with Medline Marathon skin protectant to prevent tearing and using moderate compression stockings. Two more days and I see no end to this blister. I thought that the fluid would have resorbed and blister dried up by now but guess I was wrong. What next? Is the only way to eradicate this to aspirate it? I am not a nurse but rather a physician who is not a wound care specialist. The patient is virtually homebound and getting her to the wound center for a small lesion like this would be a monumental task. I am looking for advice based upon how you have seen this type of lesion managed in your clinical setting. THANKS.

[Davidaugustyn]

I have seen and know what you're talking about. They often don't go away and often deteriorate further. I wouldn't aspirate only because it's not ever a recommended treatment. On the other hand, talking common sense, I would if it was dad at home because they only ever end up rupturing anyway and being treated then....

In the clinical setting, we do what you're doing.