bulla

Blisters are fluid-filled sacs on the outer layer of your skin. They form because of rubbing, heat, or diseases of the skin. They are most common on your hands and feet.

Other names for blisters are vesicles (usually for smaller blisters) and bulla (for larger blisters).

Blisters often happen when there is friction - rubbing or pressure - on one spot. For example, if your shoes don't fit quite right and they keep rubbing part of your foot. Or if you don't wear gloves when you rake leaves and the handle keeps rubbing against your hand. Other causes of blisters include:

• Burns
• Sunburn
• Frostbite
• Eczema
• Allergic reactions
• Poison ivy, oak, and sumac
• Autoimmune diseases such as pemphigus
• Epidermolysis bullosa, an illness that causes the skin to be fragile
• Viral infections such as varicella zoster (which causes chickenpox and shingles) and herpes simplex (which causes cold sores)
• Skin infections including impetigo

Blisters will usually heal on their own. The skin over the blister helps keep out infections. You can put a bandage on the blister to keep it clean. Make sure that there is no more rubbing or friction on the blister.

You should contact your health care provider if:

• The blister looks infected - if it is draining pus, or the area around the blister is red, swollen, warm, or very painful
• You have a fever
• You have several blisters, especially if you cannot figure out what is causing them
• You have health problems such as circulation problems or diabetes

Normally you don't want to drain a blister, because of the risk of infection. But if a blister is large, painful, or looks like it will pop on its own, you can drain the fluid.

There are some things you can do to prevent friction blisters:

• Make sure that your shoes fit properly
• Always wear socks with your shoes, and make sure that the socks fit well. You may want to wear socks that are acrylic or nylon, so they keep moisture away from your feet.
• Wear gloves or protective gear on your hands when you use any tools or sports equipment that cause friction.

Cold sores are caused by a contagious virus called herpes simplex virus (HSV). There are two types of HSV. Type 1 usually causes oral herpes, or cold sores. Type 1 herpes virus infects more than half of the U.S. population by the time they reach their 20s. Type 2 usually affects the genital area.

Some people have no symptoms from the infection. But others develop painful and unsightly cold sores. Cold sores usually occur outside the mouth, on or around the lips. When they are inside the mouth, they are usually on the gums or the roof of the mouth. They are not the same as canker sores, which are not contagious.

There is no cure for cold sores. They normally go away on their own in a few weeks. Antiviral medicines can help them heal faster. They can also help to prevent cold sores in people who often get them. Other medicines can help with the pain and discomfort of the sores. These include ointments that numb the blisters, soften the crusts of the sores, or dry them out. Protecting your lips from the sun with sunblock lip balm can also help.

Shingles (herpes zoster) is an infection that causes a painful rash. It is caused by the varicella-zoster virus (VZV). This is the same virus that causes chickenpox. After you have chickenpox, the virus stays in your body. It may not cause problems for many years. But as you get older, the virus may become active again and cause shingles.

Shingles is not contagious. You cannot get shingles from someone else. But you can catch chickenpox from someone with shingles if you have direct contact with fluid from their shingles rash.

The risk of spreading the virus is low if the shingles rash is kept covered. People with shingles cannot spread the virus before their rash blisters appear or after the rash crusts.

Anyone who has had chickenpox can get shingles. But the risk of shingles goes up as you get older. Shingles is most common in people over age 50.

People with weakened immune systems are at higher risk of getting shingles. This includes those who:

• Have immune system diseases such as HIV
• Have certain cancers
• Take medicines that weaken their immune system, such as steroids and medicines you take after organ transplant

Your immune system may be weaker when you have an infection or are stressed. This can raise your risk of shingles.

It is rare, but possible, to get shingles more than once.

Early signs of shingles include burning or shooting pain and tingling or itching. It is usually on one side of the body or face. The pain can be mild to severe.

Up to several days later, you will get a rash. It consists of blisters that typically scab over in 7 to 10 days. The rash is usually a single stripe around either the left or the right side of the body. In other cases, the rash is only on one side of the face. In rare cases (usually among people with weakened immune systems), the rash may be more widespread. It might look similar to a chickenpox rash.

Some people may also have other symptoms:

• Fever
• Headache
• Chills
• Upset stomach

Shingles can cause other problems (complications):

• Postherpetic neuralgia (PHN) is most common complication of shingles. It causes severe pain in the areas where you had the shingles rash. It usually gets better in a few weeks or months. But some people can have pain from PHN for many years, and it can interfere with daily life.
• Vision loss can happen if shingles affects your eye. It may be temporary or permanent.
• Hearing or balance problems are possible if you have shingles within or near your ear. You may also have weakness of the muscles on that side of your face. These problems can be temporary or permanent.

Very rarely, shingles can also lead to pneumonia, brain inflammation (encephalitis), or death.

Usually your health care provider can diagnose shingles by taking your medical history and looking at your rash. In some cases, your provider may scrap off tissue from the rash or swab some fluid from the blisters and send the sample to a lab for testing.

There is no cure for shingles. Antiviral medicines may help to make the attack shorter and less severe. They may also help prevent PHN. The medicines are most effective if you can take them within 3 days after the rash appears. So if you think you might have shingles, contact your provider as soon as possible.

Pain relievers may also help with the pain. A cool washcloth, calamine lotion, and oatmeal baths may help relieve some of the itching.

There is a vaccine, called Shingrix, to help prevent shingles and its complications. The Centers for Disease Control and Prevention recommends that healthy adults 50 years and older get the vaccine. Your provider might also recommend the vaccine if you are over 19 and have a weakened immune system. The vaccine is given in two doses.

If you have shingles, you can help prevent spreading the virus to others by:

• Staying away from:
  • People with weakened immune systems
  • People who have not had chickenpox or the chickenpox vaccine, especially if they are pregnant
  • Premature or low birth weight babies
• Keeping the rash covered
• Not touching or scratching the rash
• Washing your hands often

Centers for Disease Control and Prevention

Diabetes is a disease in which your blood glucose, or blood sugar, levels are too high. Glucose comes from foods you eat. The cells of your body need glucose for energy. A hormone called insulin helps the glucose get into your cells.

With type 1 diabetes, your body doesn't make insulin. With type 2 diabetes, your body doesn't make or use insulin well. Without enough insulin, glucose can't get into your cells as quickly as usual. The glucose builds up in your blood and causes high blood sugar levels.

Foot problems are common in people with diabetes. They can happen over time when high blood sugar damages the nerves and blood vessels in the feet. The nerve damage, called diabetic neuropathy, can cause numbness, tingling, pain, or a loss of feeling in your feet.

If you can't feel pain, you may not know when you have a cut, blister, or ulcer (open sore) on your foot. A wound like that could get infected. The infection may not heal well because the damaged blood vessels can cause poor blood flow in your feet.

Having an infection and poor blood flow can lead to gangrene. That means the muscle, skin, and other tissues start to die. If you have gangrene or a foot ulcer that does not get better with treatment, you may need an amputation. This is a surgery to cut off your damaged toe, foot, or part of your leg. It may prevent a bad infection from spreading and could save your life.

But there's a lot you can do to prevent a foot wound from becoming a major health problem.

The best way to protect your feet is by controlling your blood sugar levels every day. This will help keep nerve and blood vessel damage from getting worse. The next step is to keep the skin of your feet healthy.

Good foot care for people with diabetes includes:

• Checking your feet every day. Look for cuts, redness, and other changes in the skin and toenails, including warts or other spots that your shoes could rub. Make sure to check the bottoms of your feet too.
• Washing your feet every day. Use warm water and soap. Don't soak your feet because that can dry out your skin. After you dry your feet, you can use talcum powder or cornstarch between your toes. They soak up moisture that can cause infection. If you use lotion, don't apply it between your toes.
• Asking your doctor how to remove corns and calluses safely. Thick skin on your feet can rub and lead to sores. But removing it the wrong way could damage your skin. So you don't want to cut the skin or use medicated pads or liquid removers.
• Trimming your toenails straight across with a clipper. If it's hard for you to trim your own toenails, or if they're thick or curve into the skin, have a podiatrist (foot doctor) do it for you.
• Always wearing well-fitting shoes and socks or slippers to protect your feet when walking. You don't want to walk barefoot, even indoors. And be sure your shoes are smooth inside. A seam or pebble could rub your skin raw.
• Protecting your feet from heat and cold. Use sunscreen on exposed skin and don't walk barefoot at the beach. In cold weather, wear warm socks instead of warming your feet near a heater or fireplace.
• Keeping the blood flowing in your feet. Put your feet up when you're sitting. Wiggle your toes and circle your feet throughout the day. Don't wear tight socks. And get plenty of activity that's not too hard on the feet, such as walking.
• Getting your feet checked at your health care visits. Even if you haven't noticed a problem, it's good to have your health care provider look at your feet.

Serious foot problems can develop quickly. See your health care provider right away if you notice:

• A cut, blister, or bruise on your feet that doesn't start to heal in a few days
• Red, warm, or painful skin on your feet
• A callus with dried blood inside
• A foot infection that becomes black and smells bad that could be gangrene

Remember, controlling your blood sugar and caring for your feet every day are the best steps you can take to prevent serious diabetic foot problems.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Pemphigus is an autoimmune disorder. If you have it, your immune system attacks healthy cells in your skin and mouth, causing blisters and sores. No one knows the cause. Pemphigus does not spread from person to person. It does not appear to be inherited. But some people's genes put them more at risk for pemphigus.

Pemphigoid is also an autoimmune skin disease. It leads to deep blisters that do not break easily. Pemphigoid is most common in older adults and may be fatal for older, sick patients.

Doctors diagnose pemphigus with a physical exam, a biopsy, and blood tests. The treatment of pemphigus and pemphigoid is the same: one or more medicines to control symptoms. These may include:

• Steroids, which reduce inflammation
• Drugs that suppress the immune system response
• Antibiotics to treat associated infections

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases

A burn is damage to your body's tissues caused by heat, chemicals, electricity, sunlight, or radiation. Scalds from hot liquids and steam, building fires and flammable liquids and gases are the most common causes of burns. Another kind is an inhalation injury, caused by breathing smoke.

There are three types of burns:

• First-degree burns damage only the outer layer of skin
• Second-degree burns damage the outer layer and the layer underneath
• Third-degree burns damage or destroy the deepest layer of skin and tissues underneath

Burns can cause swelling, blistering, scarring and, in serious cases, shock, and even death. They also can lead to infections because they damage your skin's protective barrier. Treatment for burns depends on the cause of the burn, how deep it is, and how much of the body it covers. Antibiotic creams can prevent or treat infections. For more serious burns, treatment may be needed to clean the wound, replace the skin, and make sure the patient has enough fluids and nutrition.

NIH: National Institute of General Medical Sciences

Celiac disease is a chronic (long-term) digestive and immune disorder that damages your small intestine. The damage may prevent your body from absorbing vitamins, minerals, and other nutrients from the food you eat. This can lead to malnutrition and other serious health problems

Celiac disease is triggered by eating foods that contain gluten. Gluten is a protein found in wheat, barley, rye, and other grains. It may also be in other products like vitamins and supplements, hair and skin products, toothpastes, and lip balm.

Celiac disease is different from gluten sensitivity. Both involve problems with gluten and can cause some of the same symptoms, such as abdominal (belly) pain and fatigue. But gluten sensitivity does not damage the small intestine like celiac disease does.

Wheat allergy, a type of food allergy, is also different. With both celiac disease and wheat allergy, your immune system is reacting to wheat. But with wheat allergy, you can have some different symptoms, such as itchy eyes or trouble breathing. And a wheat allergy will not cause long-term damage to the small intestine.

The exact cause of celiac disease is not known. Research suggests that celiac disease only happens in people who have certain genes and eat food that contains gluten. Researchers are studying other factors that may play a role in causing the disease.

Celiac disease is more common if you:

• Have a family member who has the disease
• Have Down syndrome, Turner syndrome, or Williams syndrome
• Are White
• Are female

The symptoms of celiac disease can be different from person to person. Sometimes the symptoms may come and go. Some people may not notice any symptoms.

Some of the possible symptoms affect your digestive system. Digestive symptoms are more common in children than in adults. The digestive symptoms include:

• Bloating (feeling fullness or swelling in your belly)
• Chronic (long-term) diarrhea or greasy, bulky, unusually bad-smelling stool (poop)
• Constipation
• Gas
• Lactose intolerance because of damage to the small intestine
• Nausea and vomiting
• Pain in the abdomen (belly)
• Weight loss in adults, or not enough weight gain in children

Some people with celiac disease have symptoms that affect other parts of the body, such as:

• Fatigue
• Depression and anxiety
• Irritability (in children)
• Dermatitis herpetiformis, an itchy rash with blisters (mainly in adults)
• Bone or joint pain
• Symptoms involving the mouth, such as canker sores or dry mouth

Over time, celiac disease can cause other health problems, especially if it is not treated. These problems can include:

• Malnutrition
• Anemia, especially iron-deficiency anemia
• Bone loss
• Nervous system problems such as headaches, balance problems, or peripheral neuropathy
• Reproductive problems, such as missed menstrual periods and miscarriages in women and infertility in men and women

If you have symptoms of celiac disease, your health care provider will look for signs that you might have celiac disease. To do this, your provider will get your medical and family history and do a physical exam.

If your provider thinks that you could have celiac disease, you will have some tests. Providers most often use blood tests and biopsies of the small intestine to diagnose celiac disease. The biopsy would be done during an upper gastrointestinal (GI) endoscopy. For this procedure, your provider uses an endoscope (a flexible tube with a camera) to see the lining of your esophagus, stomach, and small intestine. It also allows your provider to take a sample of tissue for a biopsy.

The treatment for celiac disease is following a gluten-free diet for the rest of your life. Sticking with a gluten-free diet will treat or prevent many of the symptoms and other health problems caused by celiac disease. In most cases, it can also heal damage in the small intestine and prevent more damage.

Your provider may refer you to a registered dietician (a nutrition expert) who can help you learn how to eat a healthy diet without gluten. You will also need to avoid all hidden sources of gluten, such as certain supplements, cosmetics, toothpaste, etc. Reading product labels can sometimes help you avoid gluten. If a label doesn't tell you what is in a product, check with the company that makes the product for an ingredients list. Don't just assume that a product is gluten-free if it doesn't mention it.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Cellulitis is an infection of the skin and deep underlying tissues. Group A strep (streptococcal) bacteria are the most common cause. The bacteria enter your body when you get an injury such as a bruise, burn, surgical cut, or wound.

Symptoms include:

• Fever and chills
• Swollen glands or lymph nodes
• A rash with painful, red, tender skin. The skin may blister and scab over.

Your health care provider may take a sample or culture from your skin or do a blood test to identify the bacteria causing infection. Treatment is with antibiotics. They may be oral in mild cases, or intravenous (by IV) for more severe cases.

Chickenpox is an infection caused by the varicella-zoster virus. Most cases are in children under age 15, but older children and adults can get it. It spreads very easily from one person to another.

The classic symptom of chickenpox is an uncomfortable, itchy rash. The rash turns into fluid-filled blisters and eventually into scabs. It usually shows up on the face, chest, and back and then spreads to the rest of the body. Other symptoms include:

• Fever
• Headache
• Tiredness
• Loss of appetite

Chickenpox is usually mild and lasts 5 to 10 days. Calamine lotions and oatmeal baths can help with itching. Acetaminophen can treat the fever. Do not use aspirin for chickenpox; that combination can cause Reye syndrome.

Chickenpox can sometimes cause serious problems. Adults, babies, teenagers, pregnant women, and those with weak immune systems tend to get sicker from it. They may need to take antiviral medicines.

Once you catch chickenpox, the virus usually stays in your body. You probably will not get chickenpox again, but the virus can cause shingles in adults. A chickenpox vaccine can help prevent most cases of chickenpox, or make it less severe if you do get it.

Centers for Disease Control and Prevention

Corns and calluses are caused by pressure or friction on your skin. They often appear on feet where the bony parts of your feet rub against your shoes. Corns usually appear on the tops or sides of toes while calluses form on the soles of feet. Calluses also can appear on hands or other areas that are rubbed or pressed.

Wearing shoes that fit better or using non-medicated pads may help. While bathing, gently rub the corn or callus with a washcloth or pumice stone to help reduce the size. To avoid infection, do not try to shave off the corn or callus. See your doctor, especially if you have diabetes or circulation problems.

NIH: National Institute on Aging