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Blisters and Skin Atrophy

Blisters

In day to day practice, it is not overly common for patients to seek treatments for blisters. As a result, it was interesting to note the variety of approaches different podiatrists had for dealing with them.blisters and skin athropy Alderley

For an event like the Oxfam 100km trailwalk, the main goal is to keep the lesion site as pain free and clean from possible infection as possible. The first consideration required is the location of the blister. If it is at all possible, it is best to keep the blister intact. This gives the best chance to fight against infection as there is not true rupture to the skin. This is often not possible, however as blisters form at locations of high friction. As a result, those friction forces will usually eventually cause the blister to rupture.

In this case, first clean the area with an alcohol swab or saline wash to make the area as clean as possible. Very carefully pierce the blister with a sterile needle head or scalpel at its lowest point to allow it to drain. Always keep the roof of the blister intact as this will provide a barrier from any irritation to the sensitive dermis beneath, as well as provide a physical barrier against infection. After the blister is drained, swab the area with an antiseptic like betadine. Dress the area with padding and tape, to provide both cushioning for the area as well as a barrier to prevent further friction.

If the roof of the blister has been lifted off, try to carefully replace it. If this isn’t possible, a ‘second skin’ dressing is ideal before dressing. If unavailable, dress it as you would a normal wound with antiseptic and a dressing that completely covers the blister to ensure best protection from contamination and infection.

What about prevention techniques?

There are mountains of ideas that people have to prevent blisters, all, it seems, with varied levels of success. In theory, the main strategy is to minimise the friction between the feet, the toes, and the shoes. It is important to keep the feet as dry and clean as possible, as any excess moisture will add to friction. Wearing two pairs of socks, changing socks regularly with an alcohol wipe in between changing, or strapping the feet are some strategies that may be used. Injinji socks have special hiking socks with designated toe pockets that may help minimise rubbing between the toes. A number of studies have found that 100% cotton socks are worse for holding in excess moisture than polyester or polyester blend socks. Finally, some patients will also rub a layer of petroleum jelly over their feet to produce less friction.

If you are prone to callus build up, it is recommended that you have the callus paired back by a podiatrist prior to undertaking any significant walk, as it can contribute to pressure in an already over used area.

Skin Atrophy

What is Skin atrophy?

Skin atrophy is a reduction of skin volume in the upper layers of skin, there are many reasons why this may happen. Prolonged use of steroid medication, endocrine changes and age. This causes the skin to become fragile and prone to injuries that may lead to ulcerations. The skin will starts to look fragile with a shiny appearance.

In advance stages of skin atrophy the blood vessels in the body can become pronounced and visible to the eye. From a podiatric prospective nails cutting without the correct technique can be extremely dangerous and has be the cause of many wounds to the lower limb, due to sharp edges being left and people accidentally cutting their skin whilst scratching with the feet. With the elderly population it is imperative that the skin is kept hydrated and thereof supple with the use of a good emollient. If the skin is dry it is unable to absorb little knocks and scapes, however when the skin is hydrated and supple it makes the skin harder to damage.

Unfortunately getting older is a part of life but with some small changes to our skincare regimen will help protect out skin for the years to come. For example using milder soaps and adding daily moisturising to our bathing regime. Patients with skin atrophy should be mindful of the condition as even prolonged use of a plaster over the same area could cause a skin tear and thus a portal of infection which could lead to larger complications during healing.

What can cause skin atrophy?

There are a range of comorbidities that can contribute to thinning of the skin:

  • Ageing of the skin
  • Dermatomyositis
  • Lupus
  • Scleroderma
  • Lipoid necrobiosis diabetic
  • Reaction to the use of medications including topical steriods