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Blisters on the skin - causes, online diagnosis & therapy

Image: Blisters on the skin have many causes. In this case: shingles.

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↓ symptoms
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Definition - skin vesicles and blisters on the skin

Skin vesicles or blisters are fluid-filled changes in the skin. These differ significantly from other forms of skin rashes (exanthema) such as pustules, nodules and wheals. While pustules are filled with pus, skin blisters by definition contain other, mostly clear liquids or blood or blood components.

The elevations filled with liquids can in principle arise in any skin layer. Where they arise depends, for example, on the cause. The local appearance of skin vesicles on the surface of the skin also depends on the underlying cause. In addition to the locally limited occurrence in certain places, it is also possible to appear over a large area so that the whole body is covered with small or large vesicles.

The skin changes can be differentiated according to their size and thus assigned to different spectrum of causes. Doctors refer to smaller fluid-filled skin changes with a size of less than 5 mm as skin vesicles or vesicles. Larger changes of 5 mm or more are called skin blisters or bullae.

Causes of skin blisters and skin vesicles

Since skin blisters are a very unspecific phenomenon, they cannot be assigned to a single cause. On the contrary, there are a number of possible triggers. We would like to take a closer look at the most important triggers for skin changes below.

Blisters on the skin from infection

Blistering of the skin is often one of the symptoms of an infection with a pathogen. These can be bacterial infections as well as infections with viruses. One of the most well-known viral infections that lead to blistering rashes is infection with herpes viruses.

While the skin vesicles occur in the classic cold sore (herpes simplex type 1) in the lip area, the blisters in the colloquial genital herpes (herpes simplex type 2) appear in the genital area. Chickenpox (varicella), shingles (herpes zoster) and, in individual cases, cancers of the mouth are also known for their vesicular rash. On the other hand, bacteria such as staphylococci and streptococci can also cause skin changes with blistering.

These include, for example, the infectious bark lichen (impetigo contagiosa) that occurs in children or the sore rose (bullous erysipelas). The infectious trigger spectrum is rounded off by fungal infections. A prime example is athlete's foot, which, depending on the type of fungus, leads to the formation of small blisters under the soles of the feet. There are also other skin fungi.

Blistering of the skin due to allergic reactions

In many cases, an allergic reaction is accompanied by the formation of blisters on the skin. So-called allergic contact eczema makes up the majority of all cases. The affected area of ​​the skin comes into direct contact with an allergenic substance. Possible triggers here are the whole range of allergens, from drugs (especially ointments) to fragrances and nickel to cleaning agents. The organism can also have an allergic reaction to medicinal products when used internally.

In some cases, skin rashes with blistering also occur here. Doctors then speak of a drug eruption. Insect bites can have similar effects if you are allergic to the venom of honey bees or certain wasp species (especially sawfly wasps). Itchy hives (urticaria) and the rare mastocytosis are also possible allergic triggers for skin rashes with blistering.

Blistering from friction, burns, etc.

The most well-known causes of skin blisters and blisters on the skin include external influences (external triggers). Most common is blistering from friction. Whether it is due to tight or unsuitable footwear or extreme stress as a result of a long hike: chafing leads to the well-known blistering of the feet and toes. When it comes to mechanically caused bubbles, doctors differentiate between classic marching bubbles, pressure bubbles and coma bubbles.

Blistering is also a highly visible symptom of second-degree burns. The latter can also occur as a result of increased UV radiation as part of a severe sunburn. The formation of blisters from UV light is typical, however, especially in the case of a sun allergy (polymorphic light dermatosis). Frostbite, cold damage or contact with caustic or extremely basic substances can also cause symptoms of vesicles.

Other blistering skin conditions

Aside from infections, external causes and allergic reactions, there are a number of other diseases of the skin and mucous membranes that can lead to the formation of blisters and vesicles. The most common representatives include the metabolic diseases perphyria, the genetic skin disease epidermolysis bullosa, the bullous pemphigoid (autoimmune disease of the skin), diabetes mellitus and herpes gestationis as an autoimmune disease that occurs very rarely during pregnancy.

Symptoms - skin vesicles and blisters on the skin

Blisters on the skin are not in themselves a disease, but a symptom of a disease or an allergy or mechanical damage to the tissue. Consequently, the formation of fluid-filled bubbles of different sizes and intensities and in different parts of the body is an indicator of the underlying cause.

Symptomatic of the classic vesicle formation in contrast to other skin changes is the content of the bladder, which consists neither of firm tissue nor of pus, but of blood or clear liquids. However, the blistering itself is often accompanied by other symptoms such as itching.

Any symptoms of illness such as fever, nausea or cough give the doctor an indication of the underlying disease. It is interesting, however, that the bubbles appear in different forms depending on the cause.

Get a knowledgeable opinion on skin vesicles and blistering

Due to the variety of possible triggers and the diversity of the skin blisters, in many cases the look of an experienced dermatologist is necessary. You should definitely see a doctor if you have long-lasting symptoms that do not improve, or if you have particularly large skin rashes with blistering or if you have other symptoms. In many cases, however, the first glance of an experienced dermatologist is sufficient for an initial diagnosis.

With us you have the opportunity to conveniently send pictures and a description of your skin blisters to our experienced dermatologist team from Heidelberg. You will then receive a competent initial diagnosis including a possible therapeutic approach. Alternatively, use our offer to get a second opinion on your skin changes. This step is often enough to save you a lengthy visit to the doctor.

Blisters on the skin - diagnosis

Often the cause of the blistering is obvious. For example, if you ran a blister while hiking, had skin contact with a potential allergen, or suffered severe sunburn. In these cases, you can often take action yourself. However, if the cause is not known, we recommend going to a doctor or having a look through our dermatologist service.

Timely diagnosis is important, for example, for the rapid treatment of infectious diseases such as chickenpox or shingles. This is the only way to minimize the risk of infection. At the beginning of the medical examination, there is therefore an anamnesis interview. The doctor asks various key points:

  • How long have the complaints existed?
  • Are the blisters on the skin itchy or painful?
  • Where are the skin vesicles?
  • Where did the skin blisters first appear?
  • Are there any other complaints besides the skin blisters?
  • Have you recently been in contact with people suffering from infectious diseases?
  • Are you known to have allergies to certain substances?
  • Do I have to take medication regularly?
  • Has a new drug been recently prepared?
  • Do you have any previous illnesses?

With the help of these questions, the doctor can narrow down the range of causes and initiate further appropriate examinations. The second step is the physical examination. If a simple visual diagnosis is not enough, the doctor uses a magnifying glass or a reflected light microscope to look at the skin vesicles.

Usually some secretion is taken from the blisters during the examination. The doctor sends this to the laboratory for identification of the possible pathogen. Depending on the doctor's suspicion, additional skin tests, allergy tests, or blood tests may be necessary to determine the cause and the best possible therapy.

Therapy for skin vesicles and blisters on the skin

Treatment for skin blisters and blisters largely depends on the cause. This is especially true for more serious autoimmune and metabolic diseases. Special therapies are also required for frostbite and burns. Only when the underlying disease, infection, allergy, etc. are treated comprehensively, the blisters also disappear. As an example, we would like to present some examples of the treatment of common causes of skin rash with blistering.

  • Shingles: During the healing phase, which lasts several weeks, antiviral agents (antivirals) are usually administered. Painkillers are also used against the often severe nerve pain. The blisters themselves are treated with special lotions that dry them out.
  • Chickenpox: Since chickenpox regresses on its own and does not cause pain, only medication (antihistamines) and lotions are used to relieve the itching.
  • Bacterial infections: Antipruritic drugs are also used for itchy bacterial infections. Depending on the causative bacterium and the intensity of the infection, the doctor will prescribe antibiotics.

You can do this yourself against skin blisters

You can also help yourself if you have sunburn, minor burns, blisters on your feet or insect bites. A combination of gentle and cool is usually the most effective option here. The latter works with both ice packs and home remedies such as curd compresses. It is only important that you do not open the skin vesicles without consulting your doctor.

Germs could enter the wound through the open wound and cause inflammation there, for example. After briefly describing your case, our experts can often tell you at a glance whether it is a matter of blistering that can easily be treated at home.