Friction blisters are intraepidermal blisters caused by the skin repeatedly rubbing on another object. This type of blister most commonly occurs on the hands, fingers, feet, and toes.
Friction blisters are a common occurrence in both children and adults. Populations most at risk include individuals whose recreational or occupational
activities require prolonged walking or running, such as endurance athletes, hikers, and soldiers.
activities require prolonged walking or running, such as endurance athletes, hikers, and soldiers.
PATHOPHYSIOLOGY
Friction blisters result from shearing forces within the epidermis. The shearing forces produce necrosis and dissociation of keratinocytes, leading to an intraepidermal split in the stratum spinosum. Hydrostatic pressure causes the area of separation to fill with fluid similar in composition to plasma but with lower protein levels.
The magnitude of the frictional force and the number of passes of an object on the skin determine the likelihood for blister formation.
Blisters are most likely to occur in skin areas that have a thick stratum corneum held tightly to underlying structures, such as the palms of the hands or soles of the feet. On the feet, friction blisters can occur in the setting of poorly fitting shoes. Vigorous activity and bearing heavy loads both appear to increase risk for foot blisters.
Friction injury in sites of very thin skin (eg, atrophic or sun-damaged skin) is less likely to result in blistering. Rather, the overlying epithelium may be sloughed, and an erosion may result immediately.
PREDISPOSING DISORDERS
Underlying conditions can increase risk for friction-induced blistering. Epidermolysis bullosa, a group of inherited disorders characterized by mechanical fragility of epithelial and basement membrane zone tissues, presents with blister, erosion, or ulcer formation in sites of minor skin trauma. Acquired diseases that cause skin fragility, such as epidermolysis bullosa acquisita, porphyria cutanea tarda, and pseudoporphyria, also can predispose to friction-induced blisters.
CLINICAL MANIFESTATIONS
Friction blisters are usually preceded by erythema and a sense of pain or burning at the site of skin trauma.Progression to vesicles or bullae generally occurs within hours. The vesicles and bullae are often tense and filled
with clear fluid. However, excessive trauma may damage the underlying vasculature resulting in a hemorrhagic vesicle or bulla. Pressure associated with the accumulation of fluid within blisters can cause discomfort.
Friction blisters generally occur in linear or oval configurations. Underlying disorders can influence sites of predilection. As an example, patients with localized epidermolysis bullosa simplex, the most common variant of epidermolysis bullosa, primarily develop blisters on the feet or hands.
with clear fluid. However, excessive trauma may damage the underlying vasculature resulting in a hemorrhagic vesicle or bulla. Pressure associated with the accumulation of fluid within blisters can cause discomfort.
Friction blisters generally occur in linear or oval configurations. Underlying disorders can influence sites of predilection. As an example, patients with localized epidermolysis bullosa simplex, the most common variant of epidermolysis bullosa, primarily develop blisters on the feet or hands.
More extensive friction or trauma-induced blistering may occur in other epidermolysis bullosa variants.
Friction blisters may rupture soon after formation or persist for hours to several days depending on the thickness of the overlying stratum corneum. Compared with blisters on skin sites with a thinner stratum corneum, blisters in sites with a thick stratum corneum, such as the palms or soles, tend to persist for longer periods. The re-epithelialization occurs in 7 to 1 0 days, if there is no further trauma to the area. In the absence of an underlying blistering disorder, blisters generally resolve without scarring.
Friction blisters may rupture soon after formation or persist for hours to several days depending on the thickness of the overlying stratum corneum. Compared with blisters on skin sites with a thinner stratum corneum, blisters in sites with a thick stratum corneum, such as the palms or soles, tend to persist for longer periods. The re-epithelialization occurs in 7 to 1 0 days, if there is no further trauma to the area. In the absence of an underlying blistering disorder, blisters generally resolve without scarring.
COMPLICATIONS
Blisters may become secondarily infected, manifesting as increasing redness, worsening pain, and purulent drainage. Progression to cellulitis can occur. Staphylococcus aureus infection of friction blisters resulting in toxic shock syndrome has been reported.
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