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Blisters are a common feature in most forms of Epidermolysis Bullosa (EB), and managing them often becomes a part of daily care.
The following recommendations outline commonly used methods for caring for EB blisters. These guidelines are drawn from multiple clinical and community sources and are intended to support care across all forms of EB. Because needs vary, families and clinicians should use discretion and adapt these methods based on the individual’s symptoms and response.
Step-by-Step Procedure to Lancing Blisters:
1. Wash hands, assemble supplies. Sterile needles or lancets should be used to lance blisters that are tense or over a dime size.
2. Gently push the fluid to one corner of the blister.
3. Prick 1 or 2 holes on the side of the blister (not the top). The hole should be big enough to drain the fluid.
4. Gently drain the fluid using gauze or a Q-tip to push the fluid toward the slit in the blister, with the help of gravity. Another piece of gauze can be used to soak up the liquid from the blister. Liquid may be clear, cloudy, or blood.
5. Keep roof of blister intact (do not remove).
6. May use lancet on more than one blister, if there are no signs of infection indicated by white or cloudy drainage.
7. Apply designated ointment → non-adherent clean bandage(s) → rolled gauze and retainer net dressing to secure bandage as needed.
🚫 NO ADHESIVE TAPE OR REGULAR BANDAIDS.
Hand washing is the most effective measure to control infection.
Materials that are stuck to the skin should be soaked until they can be removed easily. This can be done in the bath tub, or by applying room temperature water or a soaked compress directly to the bandage/clothing.
Skin may be cleaned with a variety of gentle cleansers such as Dove soap, Hibiclens, or Saline-based solutions.
Blisters tend to increase in size when allowed to remain intact. For this reason, most blisters should be drained. Sterile needles or lancets may be used to puncture the side of the blister roof. A tiny pinhole may re-seal and allow the blister to refill, so take care to open the blister roof adequately by lancing in more than one location. The blister roof should remain intact to facilitate healing and comfort.
Mild, over-the-counter antibiotics (Polysporin, Bacitracin) are effective in preventing infection and may be rotated every month or two to discourage bacterial resistance. Bactroban (Mupirocin) is a prescribed antibiotic, and should be used only when infection is present (signs of infection include increased redness, swelling, pain, presence of pus, and warmth).
After the application of a topical antibiotic, a non-stick dressing such as Mepitel, Impregnated Gauze, or Telfa pad should be applied to denuded or unprotected areas, such as the blister roof. Next, rolled gauze should be wrapped around the non-adherent dressing, and then secured with a tubular dressing retainer such as Spandage or Surgilast. The dressing retainer is an important alternative to tape, which will cause damage to the skin.
Daily dressing changes are recommended and can be coordinated with a bath or cleansing of the skin. Some contact layer dressings, such as Mepitel may be left in place for several days, although the outer dressings should be changed, and the wound should be assessed daily.
More Guides
Guidance for Adults with EB and their Carers
Healthy Body and Skin BookletA quick-reference guide on the key aspects of skin and wound care in EB.
Clinical Practice GuidelinesInternational consensus best practice guidelines skin and wound care in epidermolysis bullosa.
Related Resources
Clinical Best Practice Guidelines for Skin and Wound Care in EB
CPGs are recommendations intended to optimize patient care, that are informed by a systemic review of evidence and an assessment of the benefits and harms of alternative care options.
Learn More
Wound Care Distribution Program
Receive wound care supplies free of charge during times of need.
Learn More
EB Nurse Educator Program
Our EB Nurse Educator is available to provide sound advice for those with and caring for someone with EB.
Learn More*Please note that all medical information given by debra of America is for informational purposes only. Our information is not intended to substitute the care and guidance given by a qualified physician. All regimens of care should be discussed with the patient's doctor. Always check with your physician prior to starting any medications or treatment regimens.
