Friction Blisters
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Friction blisters of the skin commonly occur in active populations. They are the result of frictional forces between the involved skin area and the object with which the skin is in contact. Friction blisters create localized discomfort; however, they should not be taken lightly because secondary impetigo may become a serious complication with resulting cellulitis and sepsis. [1]
The bulk of research on friction blisters comes from the military because of the nature of the physical activity involved in this field. Friction blisters have also received much attention in the field of sports medicine.
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The influence of epidermal hydration on the friction of human skin against textiles was studied. Increasing cutaneous hydration may cause sex-specific changes in the mechanical properties and/or surface topography of human skin, leading to skin softening and increased real contact area and adhesion. [2]
Studies involving rubbing the skin with a constant force show an initial slight exfoliation of the skin over the involved area. Focally, mild erythema also develops. The patient may experience stinging or burning, while a zone of pallor develops around the erythematous area. The pallor eventually extends into the region of erythema and this area develops into a blister.
The effect of wearing socks with different frictional properties on plantar shear was studied because this is a possible mechanical risk factor for foot lesion development. [3] Wearing socks with low friction against the foot skin reduced the plantar shear force on the skin more than a sock with low friction against the insole.
Friction blister formation is affected by epidermal hydration. In a study of 11 men and 11 women, the friction between the inner forearm and a hospital fabric was measured in different hydration states. [4] Increasing skin hydration caused sex-specific changes in the mechanical properties and/or surface topography, as the friction of female skin demonstrated significantly higher moisture sensitivity.
Technology such as thermographic images may facilitate assessment of traumatically damaged foot skin. [5]
Poorly fitting shoes are the most common cause. Heat, sweating, and maceration of the skin may predispose to friction blister formation. A study of foot blister formation in 3 groups of 11 participants showed biomechanical interactions on the plantar surface of individuals prone to blisters to be at variance from less predisposed to this finding. [6] Baseball pitchers suffer repeated trauma between the baseball seams and the fingers of the pitching hand, most often at the tips of the index and long fingers. [7]
During the first Iraqi War, the prevalence of foot friction blisters among American troops was 33%, of which 11% required medical care. [8]
No known predilection is reported for any particular race.
No known predilection is described for either sex. Women aged 26-34 years who are unable to break in their boots and have a past history of blisters, were the most likely to develop friction blisters among American troops during the first Iraqi War. [8]
No known predilection is apparent for any age group.
Friction blisters create localized discomfort; however, they should not be taken lightly because secondary impetigo may become a serious complication with resulting cellulitis and sepsis.
Educate patients about the importance of prevention measures (see Prevention).
For patient education resources, see the Bacterial and Viral Infections Center and Skin, Hair, and Nails Center, as well as Impetigo, Skin Rashes in Children, and Antibiotics.
Hoeffler DF. Friction blisters and cellulitis in a navy recruit population. Mil Med. 1975 May. 140(5):333-7. [Medline].
Gerhardt LC, Strässle V, Lenz A, Spencer ND, Derler S. Influence of epidermal hydration on the friction of human skin against textiles. J R Soc Interface. 2008 Mar 10. [Medline]. [Full Text].
Dai XQ, Li Y, Zhang M, Cheung JT. Effect of sock on biomechanical responses of foot during walking. Clin Biomech (Bristol, Avon). 2006 Mar. 21(3):314-21. [Medline].
Gerhardt LC, Strassle V, Lenz A, Spencer ND, Derler S. Influence of epidermal hydration on the friction of human skin against textiles. J R Soc Interface. 2008 Nov 6. 5(28):1317-28. [Medline]. [Full Text].
Hashmi F, Richards BS, Forghany S, Hatton AL, Nester CJ. The formation of friction blisters on the foot: the development of a laboratory-based blister creation model. Skin Res Technol. 2013 Feb. 19(1):e479-89. [Medline].
Yavuz M, Davis BL. Plantar shear stress distribution in athletic individuals with frictional foot blisters. J Am Podiatr Med Assoc. 2010 Mar-Apr. 100(2):116-20. [Medline].
McNamara AR, Ensell S, Farley TD. Hand Blisters in Major League Baseball Pitchers: Current Concepts and Management. Am J Orthop (Belle Mead NJ). 2016 Mar-Apr. 45 (3):134-6. [Medline].
Brennan FH Jr, Jackson CR, Olsen C, Wilson C. Blisters on the battlefield: the prevalence of and factors associated with foot friction blisters during Operation Iraqi Freedom I. Mil Med. 2012 Feb. 177(2):157-62. [Medline].
Sasmaz S, Karaoguz A, Uzel M, Coban YK. Pyogenic granuloma on the hand subsequent to friction blister in a hand surgeon. Dermatol Online J. 2006. 12(3):22. [Medline].
Ashique KT, Kaliyadan F. Long-Term Follow-up and Donor Site Changes Evaluation in Suction Blister Epidermal Grafting Done for Stable Vitiligo: A Retrospective Study. Indian J Dermatol. 2015 Jul-Aug. 60 (4):369-72. [Medline].
Ko WC, Chen YF. Suction blister epidermal grafts combined with CO2 laser superficial ablation as a good method for treating small-sized vitiligo. Dermatol Surg. 2009 Apr. 35(4):601-6. [Medline].
Garg K, Singh D, Mishra D. Peeling skin syndrome: Current status. Dermatol Online J. 2010 Mar 15. 16(3):10. [Medline].
Harth W, Taube KM, Gieler U. Facticious disorders in dermatology. J Dtsch Dermatol Ges. 2010 Feb 12. [Medline].
Sevilla JA, Rodriguez FM, Dallasta RM. [The treatment of blisters caused by friction while hiking the Road to Santiago]. Rev Enferm. 2007 Jan. 30(1):32-6. [Medline].
Janssen L, Allard NAE, Ten Haaf DSM, van Romburgh CPP, Eijsvogels TMH, Hopman MTE. First-Aid Treatment for Friction Blisters: “Walking Into the Right Direction?”. Clin J Sport Med. 2018 Jan. 28 (1):37-42. [Medline].
Gonzalez de la Guerra JM, González Campo M. [Betadine in the care of friction blisters. Treatment protocol in primary health care]. Rev Enferm. 2013 Jun. 36(6):24-31. [Medline].
Knapik JJ. Prevention of food blisters. J Spec Oper Med. 2014 Summer. 14(2):95-7. [Medline].
Kirkham S, Lam S, Nester C, Hashmi F. The effect of hydration on the risk of friction blister formation on the heel of the foot. Skin Res Technol. 2014 May. 20(2):246-53. [Medline].
Knapik JJ, Reynolds K, Barson J. Influence of an antiperspirant on foot blister incidence during cross-country hiking. J Am Acad Dermatol. 1998 Aug. 39(2 Pt 1):202-6. [Medline].
Reynolds K, Darrigrand A, Roberts D, Knapik J, Pollard J, Duplantis K, et al. Effects of an antiperspirant with emollients on foot-sweat accumulation and blister formation while walking in the heat. J Am Acad Dermatol. 1995 Oct. 33(4):626-30. [Medline].
Hashmi F, Kirkham S, Nester C, Lam S. The effect of topical anti blister products on the risk of friction blister formation on the foot. J Tissue Viability. 2016 Apr 29. [Medline].
Jagoda A, Madden H, Hinson C. A friction blister prevention study in a population of marines. Mil Med. 1981 Jan. 146(1):42-4. [Medline].
Knapik JJ, Hamlet MP, Thompson KJ, Jones BH. Influence of boot-sock systems on frequency and severity of foot blisters. Mil Med. 1996 Oct. 161(10):594-8. [Medline].
Smith W, Walter J Jr, Bailey M. Effects of insoles in Coast Guard basic training footwear. J Am Podiatr Med Assoc. 1985 Dec. 75(12):644-7. [Medline].
Spence WR, Shields MN. Insole to reduce shearing forces on the soles of the feet. Arch Phys Med Rehabil. 1968 Aug. 49(8):476-9. [Medline].
Spence WR, Shields MN. New insole for prevention of athletic blisters. J Sports Med Phys Fitness. 1968 Sep. 8(3):177-80. [Medline].
Guerra C, Schwartz CJ. Investigation of the influence of textiles and surface treatments on blistering using a novel simulant. Skin Res Technol. 2011 Apr 21. [Medline].
Bogerd CP, Niedermann R, Brühwiler PA, Rossi RM. The effect of two sock fabrics on perception and physiological parameters associated with blister incidence: a field study. Ann Occup Hyg. 2012 May. 56(4):481-8. [Medline].
Lipman GS, Ellis MA, Lewis EJ, Waite BL, Lissoway J, Chan GK, et al. A prospective randomized blister prevention trial assessing paper tape in endurance distances (Pre-TAPED). Wilderness Environ Med. 2014 Dec. 25 (4):457-61. [Medline].
Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi
Disclosure: Nothing to disclose.
Kuljit Chima, MD Assistant Attending Physician in Clinical Dermatology, Columbia University Medical Center
Kuljit Chima, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.
W Clark Lambert, MD, PhD Clinical Professor of Pathology, Clinical Professor of Medicine (Professor of Dermatology), Rutgers New Jersey Medical School; Professor of Pathology, Rutgers Graduate School of Biomedical Sciences
W Clark Lambert, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, American Dermatological Association, American Federation for Clinical Research, American Society of Dermatopathology, College of American Pathologists, Dermatological Society of New Jersey, Institute of Electrical and Electronics Engineers, International Academy of Pathology, International Federation of Pigment Cell Societies, International Society of Dermatopathology, Medical Society of New Jersey, Sigma Xi, Society for Investigative Dermatology, Xeroderma Pigmentosum Society
Disclosure: Nothing to disclose.
Michael J Wells, MD, FAAD Dermatologic/Mohs Surgeon, The Surgery Center at Plano Dermatology
Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association
Disclosure: Nothing to disclose.
Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.
Robin Travers, MD Assistant Professor of Medicine (Dermatology), Dartmouth University School of Medicine; Staff Dermatologist, New England Baptist Hospital; Private Practice, SkinCare Physicians
Robin Travers, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Informatics Association, Massachusetts Medical Society, Women’s Dermatologic Society, Medical Dermatology Society
Disclosure: Nothing to disclose.
Friction Blisters
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