blisters and boils

Bubble trouble

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Your Health - Dr. Gita Mathai

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A blister is a very superficial lesion, which occurs when the surface layer of the skin gets separated from the deeper layers. Fluid or blood can accumulate in this space. This raises the surface of the skin. A small, translucent or blood-filled bump forms, which may or may not be painful. Blisters can occur singly, in clusters or all over the body.

Single blisters occur on the feet - if shoes are tight or ill fitting - or the hands, if repetitive movements are performed with tools. Exposure to extreme temperatures (both freezing and boiling) can cause a blister.

Blisters can cause throbbing pain because of pressure. The clear liquid or blood that accumulates inside remains uninfected as long as the skin over the blister is intact. Care should be taken to make sure the skin does not break. The protective skin should not be pricked. If you don't disturb it, a blister will usually disappear on its own within a few days. Antibiotic treatment is not required.

Before wearing a new pair of shoes or using tools, take a bar of soap (traditionally, Lifebuoy is used) and rub it on the dry skin. It prevents blisters forming due to friction. Sports people or those in the NCC or military can also wear thick socks.

Bites of bed bugs, scabies mites, mosquitoes and spiders can also cause blisters. These tend to itch. Scratching can lead to the skin breaking, which in turn can cause a secondary infection. In the case of a spider bite, there is a clear blister in the centre surrounded by a red area. It tends to burn, not itch. After a few days, the area in the centre becomes black and the skin sloughs off.

A herpes virus infection also leads to blisters. Multiple blisters, usually on the face, occur and recur in clusters in the same area with the Herpes simplex infection. They are precipitated by other unrelated, incidental infections such as a flu or fever. Their appearance is preceded by a pricking sensation. They last a few days and then disappear spontaneously, only to reappear with the next infection.

Herpes genitalis, a sexually transmitted infection, produces blisters in the genital area. These are extremely painful. The first infection needs to be aggressively treated with antivirals. Despite this, the virus continues to live in the nerve roots in the pelvic area. The ulcers recur painfully every few months. Eventually, the attacks become less frequent and then cease altogether.

Herpes zoster occurs several years after a childhood attack of chicken pox. It causes painful blisters along the distribution of a single nerve. The pain and the blisters take around 10 days to disappear. Although the attacks do not recur, the pain can persist for months or years as "post herpetic neuralgia." The initial attack can be shortened with antiviral medication and the pain lessened with medication. A vaccine is in the pipeline for the prevention of Herpes zoster.

The herpes virus also causes chicken pox. A few days after fever, a rash appears and blisters begin to break out all over the body. They are painless and will subside harmlessly if left alone (not scratched). Attacks occur as epidemics particularly in schools. The disease is contagious from before the appearance of the rash till the blisters have scabbed and fallen off. The duration and severity of the attack can be reduced with antiviral medication. The Varicella vaccine can be administered after the age of one and again at the age of 10 years to prevent chicken pox.

The Coxsackie virus produces highly infectious "hand, foot and mouth'' disease, with blisters in these areas, particularly in young children. It disappears on its own in 7-10 days with no treatment.

So if you have blisters, make sure you don't scratch or burst them and visit the doctor only if they are painful.

Dr Gita Mathai is a paediatrician with a family practice at Vellore and author of Staying Healthy in Modern India. If you have any questions on health issues please write toyourhealthgm@yahoo.co.in