blister

水疱

　 　 　 　 　 　 　

WordNet

1. get blistered; "Her feet blistered during the long hike" (同)vesicate
2. (botany) a swelling on a plant similar to that on the skin
3. a flaw on a surface resulting when an applied substance does not adhere (as an air bubble in a coat of paint)
4. cause blisters to form on; "the tight shoes and perspiration blistered her feet"
5. subject to harsh criticism; "The Senator blistered the administration in his speech on Friday"; "the professor scaled the students"; "your invectives scorched the community" (同)scald, whip
6. (pathology) an elevation of the skin filled with serous fluid (同)bulla, bleb
7. fungus causing white pine blister rust and having a complex life cycle requiring a plant of genus Ribes as alternate host (同)Cronartium ribicola
8. an impure form of copper having a black blistered surface
9. blister containing a nonpurulent clear watery content
10. a disease of Scotch pines
11. very fast; capable of quick response and great speed; "a hot sports car"; "a blistering pace"; "got off to a hot start"; "in hot pursuit"; "a red-hot line drive" (同)hot, red-hot
12. hot enough to raise (or as if to raise) blisters; "blistering sun" (同)blistery

PrepTutorEJDIC

1. (皮膚の)水ぶくれ,火ぶくれ / (植物・ペンキ・ニス・プラスチックの表面にできる)気泡 / …‘に'火(水)ぶくれをつくる / 火(水)ぶくれができる
2. きらきら(ぴかぴか)光る;(…で)光る《+『with』+『名』》 / きらめき,輝き
3. =cold sore
4. とても暑い / 強烈な / しんらつな,毒舌の

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/10/28 01:58:44」(JST)

wiki en

[Wiki en表示]

For other uses, see Blister (disambiguation).

"Vesiculation" redirects here. For vesiculation in geology, see vesicular texture.

Blister
Blister on foot caused by friction.
Classification and external resources
Specialty	Dermatology
ICD-10	T14.0
ICD-9-CM	919.2
DiseasesDB	1777
MedlinePlus	003239
Patient UK	Blister
MeSH	D001768

A blister is a small pocket of lymph within the upper layers of the skin, typically caused by forceful rubbing (friction), burning, freezing, chemical exposure or infection. Most blisters are filled with a clear fluid, either serum or plasma. However, blisters can be filled with blood (known as blood blisters) or with pus (if they become infected).

The word "blister" entered English in the 14th century. It came from the Middle Dutch "bluyster" and was a modification of the Old French "blostre", which meant a leprous nodule—a rise in the skin due to leprosy. In dermatology today, the words vesicle and bulla refer to blisters of smaller or greater size, respectively.

Causes

A blister may form when the skin has been damaged by friction or rubbing, heat, cold or chemical exposure. Fluid collects between the epidermis—the upper layer of the skin—and the layers below. This fluid cushions the tissue underneath, protecting it from further damage and allowing it to heal.

Friction or rubbing

Picture of various size blisters on the sole of a foot due to friction.

Intense rubbing can cause a blister, as can any friction on the skin if continued long enough. This kind of blister is most common after walking long distances or by wearing old or poorly fitting shoes. Blisters are most common on the hands and feet, as these extremities are susceptible while walking, running, or performing repetitive motions, such as joystick manipulation whilst playing certain video games, digging with a shovel, playing guitar, etc. Blisters form more easily on moist skin than on dry or soaked skin, and are more common in warm conditions. Less-aggressive rubbing over long periods of time may cause calluses to form rather than a blister. Both blisters and calluses can lead to more serious complications, such as foot ulceration and infection, particularly when sensation or circulation is impaired, as in the case of diabetes, neuropathy or peripheral artery disease (PAD).

Extreme temperature

A blister caused by burning.

The time of blistering is one of the tools used to determine the degree of burns sustained. First and second degree burns may result in blistered skin; however, it is characteristic of second degree burns to blister immediately, whereas first degree burns can have blisters after a couple of days. Blisters can also form on the hands and feet as a result of tissue damage incurred by frostbite.

Chemical exposure

Blisters caused by chemical exposure.

Sometimes, the skin will blister when it comes into contact with a cosmetic, detergent, solvent, or other chemical such as nickel sulfate, Balsam of Peru, or urushiol (poison ivy, poison oak, poison sumac). This is known as contact dermatitis. Blisters can also develop as a result of an allergic reaction to an insect bite or sting. Some chemical warfare agents, known as blister agents or vesicants, cause large, painful blisters wherever they contact skin; an example is mustard gas.

Crushing/pinching

A blood blister usually forms when a minute blood vessel close to the surface of the skin ruptures (breaks), and blood leaks into a tear between the layers of skin. This can happen if the skin is crushed, pinched or aggressively squeezed.

Medical conditions

There are also a number of medical conditions that cause blisters. The most common are chickenpox, herpes, impetigo, and a form of eczema called dyshidrosis. Other, much rarer conditions that cause blisters include:

• Bullous pemphigoid: a skin disease that causes large, tightly filled blisters to develop, usually affecting people over the age of 60.
• Pemphigus: a serious skin disease in which blisters develop if pressure is applied to the skin; the blisters burst easily, leaving raw areas that can become infected.
• Dermatitis herpetiformis: a skin disease that causes intensely itchy blisters, usually on the elbows, knees, back and buttocks. The blisters usually develop in patches of the same shape and size on both sides of the body.
• Chronic bullous dermatosis: a disease that causes clusters of blisters on the face, mouth or genitals.
• Cutaneous radiation syndrome
• Epidermolysis bullosa

Pathophysiology

Friction blisters

Friction blisters are caused by excess shear stress between the surface of the skin and the body. The strata of skin around the Stratum spinosum are most susceptible to shear. As the Stratum spinosum tears away from the connecting tissues below, plasma from the cells diffuses out. This plasma solution helps new cells divide and grow into new connective tissues and epidermal layers.

The clear fluid will be reabsorbed as new cells develop and the swollen appearance will subside. Painful blisters located on hands (palmar surface) and feet (plantar surface) are due to tissue shearing deeper in the epidermis, near nerve endings. Lower tissues are more susceptible to infection.

Prevention

Friction blisters

Friction blisters, caused by rubbing against the skin, can be prevented by reducing the friction to a level where blisters will not form. This can be accomplished in a variety of ways.

Blisters on the feet can be prevented by wearing comfortable, well-fitting shoes and clean socks. Inherently ill-fitting or stiffer shoes, such as high heels and dress shoes, present a larger risk of blistering. Blisters are more likely to develop on skin that is moist, so socks that manage moisture or frequent sock changes will aid those with particularly sweaty feet. While exercising or playing sports, special sports socks can help keep feet drier and reduce the chance of blisters. Before going for a long walk, it is also important to ensure that shoes or hiking boots have been properly broken in.

Even before a "hot" or irritated area on the foot is felt, taping a protective layer of padding or a friction-reducing interface between the affected area and the footwear can prevent the formation of a blister. Bandages, moleskin and tapes generally must be applied to the foot daily, and most have a very high coefficient of friction (COF), but a friction-management patch applied to the shoe will remain in place much longer, throughout many changes of socks and insoles. This type of intervention may be used with footwear that is worn daily, with specialty shoes and boots like hockey skates, ice skates, inline skates, ski boots and cleats, or even with orthotic braces and splints. For periods of sustained use such as hiking and trail running, especially where water ingress or moisture build up in the shoe or boot can occur, moisture wicking liner socks can provide the required friction protection.

To avoid friction blisters on the hands, gloves should be worn when using tools such as a shovel or pickaxe, doing manual work such as gardening, or using sports equipment like golf clubs or baseball bats. Oars used for competitive rowing are known for causing frequent blisters on the hands of oarsmen. Weightlifters are also prone to blisters as are gymnasts from the friction developed by the rubbing against the bars. To further reduce the occurrence one can tape the hands, and there are also a number of products on the market that claim to reduce the occurrence of blisters. These are all intended to be worn as a liner underneath a glove. The majority of these offerings simply add padding and create a layer that reduces the coefficient of friction between the skin and the glove.

A lubricant, typically talcum powder, can be used to reduce friction between skin and apparel in the short term. People put talcum powder inside gloves or shoes for this purpose, although this type of lubricant will increase the friction in the long term, as it absorbs moisture. Increased friction makes blisters more likely.

Other

Sunscreen and protective clothing should also be used during the hottest part of the day to avoid blisters from sunburn. Avoiding sunlight during midday is the best way to avoid blisters from sunburn. Protective gloves should be worn when handling detergents, cleaning products, solvents and other chemicals.

References

External links

UpToDate Contents

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• 1. 皮膚の水疱を有する患者に対するアプローチ approach to the patient with cutaneous blisters
• 2. 水疱性類天疱瘡および粘膜類天疱瘡の臨床的特徴および診断 clinical features and diagnosis of bullous pemphigoid and mucous membrane pemphigoid
• 3. 後天性表皮水疱症 epidermolysis bullosa acquisita
• 4. 表皮水疱症の疫学、病因、分類、および臨床的特徴 epidemiology pathogenesis classification and clinical features of epidermolysis bullosa
• 5. 活動的な小児または骨格発達の未成熟な思春期における踵痛：原因の概要 heel pain in the active child or skeletally immature adolescent overview of causes

English Journal

• Hierarchical models for epidermal nerve fiber data.

• Andersson C1,2, Rajala T3, Särkkä A1,2.
• Statistics in medicine.Stat Med.2018 Feb 10;37(3):357-374. doi: 10.1002/sim.7516. Epub 2017 Nov 7.
• PMID 29114916

• Human suction blister fluid composition determined using high-resolution metabolomics.

• Niedzwiecki M, Samant P, Walker DI, Tran V, Jones DP, Prausnitz MR, Miller GW.
• Analytical chemistry.Anal Chem.2018 Feb 9. doi: 10.1021/acs.analchem.7b04073. [Epub ahead of print]
• Interstitial fluid (ISF) surrounds the cells and tissues of the body. Since ISF has molecular components similar to plasma, as well as compounds produced locally in tissues, it may be a valuable source of biomarkers for diagnostics and monitoring. However, there has not been a comprehensive study to
• PMID 29425024

• BPDAI and ABSIS correlate with serum anti-BP180 NC16A IgG but not with anti-BP230 IgG in patients with bullous pemphigoid.

• Daneshpazhooh M1, Ghiasi M2, Lajevardi V2, Nasiri N2, Balighi K2, Teimourpour A3, Khosravi H4, Saeidi V2, Mahmoudi H2, Chams-Davatchi C2.
• Archives of dermatological research.Arch Dermatol Res.2018 Feb 8. doi: 10.1007/s00403-018-1817-9. [Epub ahead of print]
• PMID 29423547

• Randomized, controlled trial of TNF-α antagonist in CTL-mediated severe cutaneous adverse reactions.

• Wang CW1,2, Yang LY3, Chen CB1, Ho HC1,4, Hung SI5, Yang CH1,4, Chang CJ6,7, Su SC1,8, Hui RC1,4, Chin SW1, Huang LF3, Lin YY1, Chang WY3, Fan WL8, Yang CY1, Ho JC4,9, Chang YC1, Lu CW4, Chung WH4; Taiwan Severe Cutaneous Adverse Reaction (TSCAR) Consortium.
• The Journal of clinical investigation.J Clin Invest.2018 Feb 5. pii: 93349. doi: 10.1172/JCI93349. [Epub ahead of print]
• PMID 29400697

Japanese Journal

• X線CT画像を用いたアルミニウム合金ダイカストの鋳巣欠陥判別システムの開発

• 鋳造工学 = Journal of Japan Foundry Engineering Society 88(2), 85-91, 2016-02
• NAID 40020738157

• Overlapping stentとコイル塞栓により治療した破裂内頚動脈血豆状動脈瘤の2例

• 脳神経外科ジャーナル 25(2), 157-163, 2016
• NAID 130005127606

• 石油タンク底板内面用重防食塗膜の劣化プロセス追跡:-温度勾配下におけるふくれ成長の定量的評価-

• 圧力技術 54(1), 25-34, 2016
• NAID 130005126556

• FOOMA JAPAN 2015 Report : Blister Packs and New Tray-type Packaging Applied to Pre-made Foods : Wide-mouth Plastic Bottles for Fruit Juices and Milk Expand the Range of High-value Beverage Possibilities

• Convertech & e-print 5(6), 32-34, 2015-11
• NAID 40020659845

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• blisterの意味・用例｜英辞郎 on the WEB：アルク

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Related Pictures

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★リンクテーブル★

リンク元	「100Cases 39」「水疱」「glisten」「vesication」「水疱性病変」
関連記事	「blistering」

「100Cases 39」

　　[★]

erratic adj. adj. 軌道の定まらない。一貫性のない、不安定な、不規則な

bowel motion 腸運動、排便

fit adj. adj. 体調がよい、健康で

emaciated adj.

glisten vi. ぴかぴか光る

dislodge

palliative

erythema multiforme 多形紅斑

dermatitis herpetiformis 疱疹状皮膚炎

itch 痒み

itching

celiac disease セリアック病

herpes gestationis 妊娠性疱疹

皮膚の水疱

83歳　男性

主訴：皮膚と口内における多数の水疱

現病歴：水疱は2日前より出現。水疱は破れやすく、赤色の有痛性病変が残る。3ヶ月前から5kg体重が減少しており、食欲が減退している。患者は体調の不調を自覚してた。排便習慣が不規則になり、排便にいくらか血液を認めた。

既往歴：生来、健康であり、既往なし。

生活歴：一人住まい

嗜好歴：喫煙・飲酒無し

服薬歴：処方薬なし。マルチビタミンタブレットは体調の不調を感じてから薬局で購入している。これ以外て薬を購入していない。

身体所見　examination

全身：emaciateで調子悪そうである

皮膚：全身の皮膚に水疱

口内：びらん(sore)あり　sore→有痛性のびらん・潰瘍

脈拍：102/min、irregularly irregular →　不規則な不整脈　→ ( )

血圧：160/78 mmHg

上記以外、心臓、呼吸器系に異常を認めない。

腹部触診：6cmの硬い結節を肝の辺縁に触知。可動性のある硬性の腫瘤を左腸骨窩に触知。

直腸診：鮮血色の血液と糞便の混合物が認められる

検査　examination

低値：Hb, MCV,Alb

高値：AlP

Q1. まず皮膚病変の診断をつけろ。

Q2. 次に皮膚病変と患者の病態を関連づけてみろ。

A. 尋常性天疱瘡

特徴：表皮内水疱、弛緩性水疱、ニコルスキー現象、口内びらん、

・病因：癌腫、リンパ腫、胸腺腫、全身性エリテマトーデス、特定の薬物(ペニシラミン、カプトプリル)などによる

治療：ステロイド、免疫抑制薬

鑑別疾患

・水疱性類天疱瘡：緊満性水疱、水疱は尋常性天疱瘡に比べて破れにくく大型になりやすい。

・多形性紅斑：中心に水疱を伴った的形病変(target-shaped lesion with central blisters)。よく全身紅皮症と粘膜潰瘍と伴う(スティーブン・ジョンソン症候群)。病因は単純ヘルペスウイルス、薬剤(スルフォナミド)、悪性腫瘍。

・疱疹状皮膚炎：肘、膝、顔面に小水疱病変(vesicular lesion)が形成される。vesicleはblister(<0.5cm)より小さく、ひっかくことで破裂する。非常にかゆい。セリアック病に合併することがある

・その他の疾患

　・糖尿病

　・妊娠性疱疹

　・家族性水疱疾患

まとめ

・悪性腫瘍に合併しうる(→腫瘍の存在下で皮膚病変が出現したのであれば腫瘍随伴性天疱瘡と診断されるべき)、

・天疱瘡は気づかないうちに体液を喪失し、あるいは水疱からの感染の結果としての敗血症が生命を脅かす。

「水疱」

　　[★]

英

blister, bulla

関

小水疱、弛緩性水疱、緊満性水疱、水疱症、発疹

• 表皮内・表皮下に滲出液を入れた空隙を生じた状態
• 直径5mm以上

水疱を生じる疾患

• 1. 物理化学的障害による水疱性皮膚疾患

• 熱傷・化学熱傷、凍瘡・凍傷、褥瘡、外傷性水疱]]など

• 2. 日光など光線による水疱性皮膚疾患

• ポルフィリン症、種痘様水疱症、多形日光疹、色素性乾皮症など

• 3. 細菌感染による水疱性皮膚疾患

• ブドウ球菌性膿痂疹、ブドウ球菌性熱傷様皮膚症候群など

• 4. ウイルス感染による水疱性皮膚疾患

• 単純ヘルペス感染症(口唇ヘルペス、陰部ヘルペス)、水痘・帯状疱疹など

• 5. 炎症性水疱性皮膚疾患

• 接触皮膚炎、多形滲出性紅斑、血管炎、皮膚筋炎など

• 6. 薬剤性水疱性皮膚疾患

• 固定薬疹、スティーブンス・ジョンソン症候群、中毒性表皮壊死症など

• 7. 自己免疫性水疱症

• 尋常性天疱瘡、落葉状天疱瘡、水疱性類天疱瘡など

• 8. 先天性水病症

• ダリエ病、へイリー・へイリー病、先天性表皮水疱症など

「glisten」

　　[★]

• n.

• 閃光、きらめき

• vi.

• (ぬれたりして)キラキラ輝く、きらめく、ヒカピカ光る

the superficial nature of the blister means that the blisters are prone to burst leaving a glistening red base which breeds easily.

　

「vesication」

　　[★]

• n.

• 水疱形成、発疹

関

bleb、blister、blistering、bulla、bullae、bullous lesion、eruption、exanthem、exanthema、exanthemata、rash、skin rash

「水疱性病変」

　　[★]

英

bullous lesion

関

小疱、水疱、水疱形成

bleb、blister、bulla、bullae、vesication

「blistering」

　　[★]

• adj.

• 水ぶくれを起こさせる。痛烈な、猛烈な

• adv.
• n.

関

blister = bulla 水疱