Documentation of a Blister in a Progress Note

Essential Physical Examination Elements

A blister should be documented as a fluid-filled elevation of the skin, specifying its size in centimeters, location, appearance, whether it arises on erythematous or normal-appearing skin, the condition of the blister roof, and any associated symptoms such as pain or pruritus, as recommended by the American Academy of Dermatology and the American College of Physicians 1, 2
Calculate body surface area (BSA) involvement if multiple blisters are present, using standardized grading: <10% BSA (Grade 1), 10-30% BSA (Grade 2), or >30% BSA (Grade 3-4), according to the American Burn Association 1
Document the number and location of all blisters using anatomic landmarks, as suggested by the British Association of Dermatologists 4

Describe the blister as tense or flaccid based on the degree of fluid distension, as described by the British Journal of Dermatology 2
Note whether blisters arise on erythematous, urticarial, eczematous, or normal-appearing skin, as recommended by the American Academy of Dermatology 2
Assess for dusky erythema or areas that feel painful to palpation, which may indicate more serious conditions, according to the American College of Physicians 1

Document presence or absence of surrounding erythema, edema, or warmth, as suggested by the American Academy of Dermatology 3
Note any pustules, erosions, or areas of skin sloughing, as recommended by the American College of Physicians 1
Record whether mucous membranes are involved (oral, ocular, genital, or perianal areas), according to the American Academy of Dermatology 1

Quantify pruritus intensity (none, mild, moderate, severe/intense), as described by the British Association of Dermatologists 2
Document pain level and whether it feels like a sunburn, as recommended by the American College of Physicians 1
Note any functional impairment or limitation of activities of daily living, according to the American Academy of Dermatology 1

Consider serial photography for monitoring progression, particularly when multiple blisters are present, as suggested by the American College of Physicians and the American Academy of Dermatology 1, 4
Document any predisposing factors such as recent trauma, friction, new medications, or immunosuppression, as recommended by the American Academy of Dermatology and the American College of Physicians 1