Andrew mentioned that a likely area of increased scientific research in the near future will be in regard to symptoms and whether to treat them or not. For example, when I would get a blister, my father would always insist on puncturing the blister and cutting the dead skin. His reasoning was that it would allow new skin to regrow at a quicker rate. Seems logical, so I followed his advice, but now I am having doubts about his advice and wonder if it would be better to let my skin heal uninterrupted.
histology of a blister
The first pertaining study I found was an experiment was published in the Journal of the American Medical Association. The study was well conducted experiment. It used 83 volunteers (72 active duty servicemen and 6 male civilians and 3 female civilians) and administered about 300 friction blisters amongst the volunteers. All the blisters were administered in the same fashion. A mechanical pencil eraser was pressed down on the skin and “briskly rotated in a counter-clockwise direction.” The location of the administered blisters was also consistent. All but four blisters were “produced on the hypothenar eminences of both palms.” The other four were placed on heels of the volunteers.
To evaluate different methods of treatment, the scientist conducted the study by randomly chosing blisters of the soldiers (the civilians blisters were used for histology) to leave undrained, blisters to be drained, and blisters to be deroofed. By randomly choosing the blisters for each category, the study eliminates any externalities or confounding variables. One of my concerns was the consistency of the blister administration. It is unlikely that any human could exert the same force and movement with the eraser 300 times, but the randomization will eliminate that concern. The experiment concluded that draining the blisters either 3 times within the first 24 hours or 1 time between 24 and 72 hours allows for the quickest recovery time and least amount of pain.
Recovery time is important, (especially in the military) but I wonder about infectious risk when puncturing the blister to let it drain or deroofing it entirely. Luckily, a study in the British Medical Journal addresses my concerns. The study was observational and experimental, evaluating burn victims and their blister healing process. The study had 202 participants with similar wounds. The scientist chose individuals that “the extent of injury averaged 1% of body surface area; all burns except one were partial thickness and healed with conservative treatment. Only thermal burns of the arms and legs that could be treated with paraffin gauze dressings were included; most were of mixed depth. All residual sprays and ointments used in first aid were removed by washing with sterile saline.” Since the blisters were not administered by scientists, this part of the study is observational, but the treatment of the blisters was the experimental portion of the study. Participants’ blister(s) were randomly treated by leaving them intact, having them aspirated, or having them deroofed. The wounds were swabbed and “analyzed according to standard bacteriological methods.” The study results are in the table below.
The results of the study conclude that keeping a blister intact is the most effective method to limit infectious risk. Although the treatment method was randomized and that should eliminate any externalities, the blisters were not administered by scientists like study published in the Journal of the American Medical Association. That being said, the study is still convincing because the scientist observed and chose similar burn blisters to use in their expiriment of treatment.
Both of theses two studies used good sample sizes and randomization when experimenting with blister treatment. Neither study concluded that deroofing a blister, like my dad suggests, is a good idea. A person with a blister can make it heal faster by aspirating it of fluid, but that also increases the risk of infection. Blisters are generally not life-threatening, but these studies shed light on future physician approaches to the treatment of symptoms.
Just last week I found blisters on my heels due to my rain boots. They were very painful and walking in shoes became very difficult. I decided to pop the blister and drain it. I felt immediately relief. Now, the blister is beginning to scab over. According to webmd.com, popping blisters is not good unless the blisters are large and painful. This is because of the high risk of infection, like you discovered in the second study. Blisters are not necessarily a big deal because “new skin will form underneath the affected area and the fluid is simply absorbed.” Now, I think I will leave my blisters be and fight through the pain.
I disagree with your dispute of my classification of the second study as “an observational study.” First, I stated that the study was “observational and experimental.” In that study, scientist did not administer the burns causing the blisters; therefore, that aspect of the study was observational because there was no control of the independent variable (burns) that supposedly cause the dependent variable (blisters). (I guess one could argue that it is relatively known that burns cause blisters and there is not need for an “observational study” on the matter.) The latter half of the study was experimental because the independent variable (treatment) was randomly controlled to discover the affects on the dependent variable (bacteria count and Staph aureus count). Your second dispute in regards to the first study that was mentioned was also faulty. The group of people is not the randomization aspect of the experiment. It is the treatment that was random because it is the treatment that the scientists want to know more about. Although that study only used military personal for experimentation, I do not see how that would pose a problem due to the fact that their skin heals and re-grows like everyone else. Is it a good idea to conduct a similar test on regular people? Sure, why not, but the fact that all members participating were in the military does not denounce the conclusions deduced from the study.
I’m really surprised there are actual studies about blisters, but they seems to be scientifically designed and conducted, like what you say. One thing I disagree with you though, is that I don’t think what you refer to in the second study is “an observational study.” Observational study should be scientists don’t add influence on the objects and observe them for some time which can be short to several minutes or long to several years (depends on the study), then take measurements of the objects and collect data. Finally, compare the results before and after that period of time, then draw conclusions. What you think to be observational study is just the process of researchers observing the objects’ properties and making preparation of the experiment, but good intention of distinguishing observational and experimental studies! Plus, I doubt whether the objects in the first experiment are proper ones for a randomized study, since objects used to conduct study should be both randomly selected from the crowd and randomly allocated into different groups(control or experiment groups). Here, the 83 volunteers include 72 active duty servicemen and 6 male civilians and 3 female civilians. I think maybe active duty servicemen have some special identities different from civilians because of their training, and experiments of blisters conducted on them may have different results than normal people. Moreover, you can find more studies pertaining to the same question to further back the point. For your “infection point”, I want to share some tipstips: do not drain a blister of any size if “You have a condition such as diabetes, HIV, cancer, or heart disease, because of the risk of infection. You think your blister is from a contagious disease, such as chickenpox, because the virus can be spread to another person.”