Management of New Blisters in Hospice Patients

Initial Assessment and Wound Care

The British Journal of Dermatology recommends assessing symptom burden, including pain, pruritus, and functional impairment from blisters, to determine the impact on comfort 2
The British Journal of Dermatology suggests evaluating signs of infection, such as surrounding erythema, purulent drainage, fever, or increased pain, to guide antimicrobial use 3, 2
Leaving blisters intact whenever possible serves as a natural biological dressing and reduces infection risk, as recommended by the British Journal of Dermatology 4, 1
Gently cleansing with warmed sterile water, saline, or dilute chlorhexidine (1:5000) is a recommended universal wound care measure by the British Journal of Dermatology 6, 1
Applying bland emollient, such as 50% white soft paraffin with 50% liquid paraffin, over all affected areas is recommended by the British Journal of Dermatology 6, 1, 5

The British Journal of Dermatology recommends applying topical antimicrobials (silver-containing products) only to sloughy or clinically infected areas, not prophylactically 6, 5
Short-term use of topical antimicrobials is appropriate when signs of local infection are present, as suggested by the British Journal of Dermatology 5
The British Journal of Dermatology advises taking bacterial cultures from three lesional areas on alternate days if extensive erosions develop 6

For localized bullous pemphigoid, applying clobetasol propionate 0.05% cream 10-20 g daily to lesional skin only provides symptom control without systemic side effects, as recommended by the British Journal of Dermatology 7, 1
For extensive disease, topical clobetasol 30-40 g daily over the entire body is preferred over systemic steroids due to lower mortality risk, as suggested by the British Journal of Dermatology 3, 2

Documenting the number and location of new blisters daily to track progression is recommended by the British Journal of Dermatology and Praxis Medical Insights 1, 5
Changing dressings using aseptic technique is a recommended practice by the British Journal of Dermatology and Praxis Medical Insights 6, 5
Avoiding aggressive diagnostic workup and routine removal of blister roofs, as well as avoiding high-dose systemic steroids in elderly hospice patients, are recommended by the British Journal of Dermatology and Praxis Medical Insights 4, 1, 7, 2