My name is Agnes and I’m 29 years old. My problem is quite embarrassing and that is why I haven’t been to a doctor yet. For about 4 months now, I have been getting strange blisters on my body. They look like a rash gone bad. If it’s not around my elbow, it is at the back of my neck and sometimes at the back of my knees.

I don’t understand it. When I shower, my body itches like crazy and that never used to happen. A brutal friend once told me it is a sign of Aids but I tested myself once perhaps 3 months ago and all was good. What is wrong with me? Please help.

Agnes

Dear Agnes,

You have not specified whether the blisters are painful or whether they are preceded by itching? Are they small to begin with and then enlarge in size?

Blisters are usually small pockets of fluid formed in the superficial layers of skin, commonly due to rubbing. If they get infected, they can fill with pus. These kinds of blisters commonly form on hands and feet. Doing a lot of manual wok, walking much or using ill fitting shoes can precipitate them.

Rubbing or constant irritation of any part of the skin can result in blisters. Superficial burns due to exposure to excess heat or some chemicals usually result in blisters over the affected part. Insect like bites by spiders or mosquitoes can also lead to this condition. 

Blisters can also develop in any part due to crushing.  But blisters due to these reasons will subside spontaneously after the cause is removed.

Sometimes local skin infections can lead to blisters. Small eruptions appear in viral infections, which can change to pus filled pockets as in chicken pox or other infections with eruptions.

Bacterial infections can sometimes lead to small blisters but they are painful. Worm infestations like ascaris can at times cause eruptions which may convert into blisters due to scratching or secondary infections. Regarding the intense itching, it can be due to an allergy to some substance and even a fungal infection.

Skin diseases like pemphigus,  epidermolysis bullosa and others manifest as blisters. 

Allergy to any substance used locally like creams or lotions can also cause blisters, which seems more likely in your case.  Drug allergies, like that due to doxycycline or nalidixic acid are also responsible for blister formation. The risk with persistent blisters is that of developing secondary bacterial infections like boils. If they persist, there is a risk of spread of infection in blood stream, i.e. sepsis.

One can puncture them or they can rupture spontaneously, but unless the cause is treated, there can be recurrence.  After the puncture of a blister, there is the risk of a scar remaining, particularly if it is done in the early stages.   This risk is more in adults. 

You should get tests done for diabetes, because diabetes increases susceptibility to skin infections. Exclude worm infestations by stool examination. Keep your home insect free, use mosquito nets for sleeping. Cut out any lotion or creams that you are using presently for two or three days and see the change in the blisters.

As such no active treatment is needed for blisters. If the cause is treated, they will subside. But in persistent problems as in contact dermatitis, local corticosteroid ointment can be applied.

If the blisters are multiple and they increase in size or become painful, if there is an accompanying fever, it is better to consult a doctor.

Dr. Rachna Pande is a Specialist in Internal Medicine at Ruhengeri Hospital