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Help with blisters

Discussion in 'General Issues and Discussion Forum' started by posalafin, Aug 3, 2010.

  1. posalafin

    posalafin Active Member

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    Hi I am asking for advice on a patient I saw today with blisters on his left foot. Case details are:

    42yo caucasian male owns his own panel beating business, works aprox 14hrs/day, 6 days/week.

    PHx: CVA; hypertension; diagnosed T2DM 3 weeks ago.

    Meds: coversyl; aspirin; insulin

    Allergies: Nil

    Footwear: at work rotates between 3 pair of slip on work boots, wears cotton socks; outside work usually sports shoe & thongs

    Hx: 6 month Hx of sudden onset of blisters on plantar, medial & lateral aspect of L) midfoot. Multiple blisters at any one time in varoius stages of development & resolution. Often has to break blisters due to large size causing pain when working. Denies havig blisters anywhere else on body. Denies itching; redness and states that whenever he breaks the blisters the fluid is always clear and has no unusual odour

    Has seen his GP multiple times over 6 months where he has been prescribed topical & oral antifungals; oral AB's and topical corticosteroids at different times none of which has made any difference. GP has taken samples of blister fluid & skin for pathology testing which was apparently NAD. Three weeks ago GP decided to test for diabetes and fasting glucose was 30; admitted to hospital commenced on IV insulin now on daily insulin. Reports that over past 2 weeks average BGL reading have been between 9 - 11mmol/L. GP has referred to me for opinion.

    Pt denies any change in footwear (socks or shoes) preceeding onset of blisters.

    O/E: No neuropathy on monofilament testing; vibration 8octales bi-laterally. Pedal pulses strong & regular bi-laterally; CR 2 secs; colour & temp normal. No bony deformity; no nail dystrophy. R) foot skin in good condition with no xerosis or HK.
    L) foot has multiple blisters on plantar, medial & lateral aspect in various stages of development and resolution. Some mild redness around some of the larger blisters but skin otherwise normal. Skin on non affected areas of L) foot is normal.

    Pt & his wife claim that he doesn't sweat excessively and as indicated above he is very rigorous with his foot hygiene. Denies palmar or armpit sweating (wife says he hardly ever seems to sweat under armpits).

    Any suggestions as to a diagnosis would be welcomed. I would especially like to know if anybody has seen this presentation associated with hyperglycaemia (and would that be likely to only affect one foot). I personally don't think this is a fungal infection.


    David Kelly
  2. Admin2

    Admin2 Administrator Staff Member

    Related threads:
    Other threads tagged with blisters
  3. Boots n all

    Boots n all Well-Known Member

    David l would advise that your client gets rid of his 3 pair of slip on boots and replaces them with lace up boots or shoes, this will reduce the opportuntiy for him to be moving in the boot, a possible cause of the blisters
  4. Have you seen this....

    So appart from the change in boots maybe consider the Armstrong device which is designed to reduce shear and friction.


    Hope that helps
  5. cornmerchant

    cornmerchant Well-Known Member


    Just a quick thought as havent got time to look it up but have a feeling this blistering is related to the diabetes- had a patient who developed huge bullae on both lower legs and feet, Referred her down to the GP - its a condition which diabetics are predisposed to.
    Sorry to be vague but will look it up when I get back from work.

  6. posalafin

    posalafin Active Member

    Thanks for your replies. I have heard of Bullosis Diabeticorum, a spontaneous blistering condition however this usually occurs in several places on the legs and feet and is also usually associated with neuropathy. This patient doesn't have neuropathy and I would have thought the blisters would have resolved or at least improved with his blood glucose being bought under (or close to) control.

    I don't think the blisters are from friction as he has been wearing this type of footwear for years and the location of all the blisters just doesn't fit with the presentation.

    I have referred him back to the GP and suggested to the GP that he be referred to a dermatologist.

    Thanks for your feedback

  7. Boots n all

    Boots n all Well-Known Member

    Possibly your are right the boots are not causing the problem, but l would consider it a simple part of ilimination of possible causes.
    Nice call on the Armstrong device Mr Weber
  8. Sian M

    Sian M Member

    Even though footwear may or may not be the initial causative factor I would certainly address that issue... How old are his shoes? Is there obvious signs of more wear on his L shoe? Has he had any changes in odema? Whats going on biomechanically and which side and how affected was he by the CVA???

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