Friction Blisters Clinical Presentation

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD   more...
 
Updated: May 22, 2012
 

History

Friction blisters tend to occur in areas of thick adherent stratum corneum (eg, palms, soles, heels, dorsa of fingers). In regions of the body where the stratum corneum is thinner, a repeated friction force causes the stratum corneum to erode, and instead of a blister, an erosion or abrasion occurs. Children often present with poorly fitting shoes and reporting a blister on the heel.

The likelihood of forming a friction blister at susceptible sites is based on the magnitude of the frictional force and the number of times an object moves across the skin (ie, shear cycles). Moisture and lubricating substances present on the skin surface are additional factors. With a greater frictional force, fewer cycles of rubbing against the skin are needed to produce a blister.

Moisture on the skin surface may either increase the friction force or, in the case of very moist skin, decrease it temporarily by providing lubrication. Lubricating agents also tend to reduce the friction force temporarily at the onset; however, friction tends to increase with prolonged application of the external force.

Pyogenic granuloma on the hand has been described subsequent to a friction blister in a hand surgeon.[6]

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Physical

Discrete bullae formation at sites of trauma is evident.

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Causes

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.[7]

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Contributor Information and Disclosures
Author

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

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  Professor and Head, Dermatopathology, Departments of Pathology and Dermatology, UMDNJ-New Jersey Medical School

W Clark Lambert, MD, PhD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Dermatological Association, American Society of Dermatopathology, International Academy of Pathology, Medical Society of New Jersey, Sigma Xi, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

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, Medical Dermatology Society, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD  Assistant Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Hoeffler DF. Friction blisters and cellulitis in a navy recruit population. Mil Med. May 1975;140(5):333-7. [Medline].

  2. 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. Mar 10 2008;[Medline].

  3. Dai XQ, Li Y, Zhang M, Cheung JT. Effect of sock on biomechanical responses of foot during walking. Clin Biomech (Bristol, Avon). Mar 2006;21(3):314-21. [Medline].

  4. 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. Nov 6 2008;5(28):1317-28. [Medline].

  5. 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. Feb 2012;177(2):157-62. [Medline].

  6. 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].

  7. Yavuz M, Davis BL. Plantar shear stress distribution in athletic individuals with frictional foot blisters. J Am Podiatr Med Assoc. Mar-Apr 2010;100(2):116-20. [Medline].

  8. 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. Apr 2009;35(4):601-6. [Medline].

  9. Garg K, Singh D, Mishra D. Peeling skin syndrome: Current status. Dermatol Online J. Mar 15 2010;16(3):10. [Medline].

  10. Harth W, Taube KM, Gieler U. Facticious disorders in dermatology. J Dtsch Dermatol Ges. Feb 12 2010;[Medline].

  11. Sevilla JA, Rodriguez FM, Dallasta RM. [The treatment of blisters caused by friction while hiking the Road to Santiago]. Rev Enferm. Jan 2007;30(1):32-6. [Medline].

  12. Knapik JJ, Reynolds K, Barson J. Influence of an antiperspirant on foot blister incidence during cross-country hiking. J Am Acad Dermatol. Aug 1998;39(2 Pt 1):202-6. [Medline].

  13. 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. Oct 1995;33(4):626-30. [Medline].

  14. Jagoda A, Madden H, Hinson C. A friction blister prevention study in a population of marines. Mil Med. Jan 1981;146(1):42-4. [Medline].

  15. Knapik JJ, Hamlet MP, Thompson KJ, Jones BH. Influence of boot-sock systems on frequency and severity of foot blisters. Mil Med. Oct 1996;161(10):594-8. [Medline].

  16. Smith W, Walter J Jr, Bailey M. Effects of insoles in Coast Guard basic training footwear. J Am Podiatr Med Assoc. Dec 1985;75(12):644-7. [Medline].

  17. Spence WR, Shields MN. Insole to reduce shearing forces on the soles of the feet. Arch Phys Med Rehabil. Aug 1968;49(8):476-9. [Medline].

  18. Spence WR, Shields MN. New insole for prevention of athletic blisters. J Sports Med Phys Fitness. Sep 1968;8(3):177-80. [Medline].

  19. Guerra C, Schwartz CJ. Investigation of the influence of textiles and surface treatments on blistering using a novel simulant. Skin Res Technol. Apr 21 2011;[Medline].

  20. 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. May 2012;56(4):481-8. [Medline].

 
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