Friction Blisters Clinical Presentation

Updated: Apr 06, 2021
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
  • Print


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. Hand blisters are an occupational hazard in major league baseball pitchers. [7]

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. [10]

Erythema and superficial blisters, a friction-induced injury referred to as pool toes, may be evident on the plantar surface of the toes or on the heels in contact with a rough pool surface. [11]


Physical Examination

Discrete bullae formation at sites of trauma is evident, as seen in the image below.

Friction blisters on human foot. Courtesy of Andry Friction blisters on human foot. Courtesy of Andry French (own work), via Wikimedia Commons.


Impetigo may become a serious complication, with resulting cellulitis and sepsis.