Toe Blisters

[diane9]

For 10 months I have had recurring blisters on 2 toes, the great toe and the second toe of my left foot.  At the onset I had severe itching of my second toe and the top of the foot.  This was followed by tiny blisters, burning, and throbbing.  One blister grew to the size of a half garbanzo bean, remained about 10 days, drained, and healed. After the blister was full grown the itching subsided. This process has repeated itself 12 times to date. Blisters sometimes engulf the whole toe. The last one on my big toe was the size of a large, fat lima bean. The blisters are usually on the inside, near the end of the toe rather than in the crease, and sometimes grow around to the bottom.

Also at the onset, I had stayed overnight 10 times in a hospital with a friend recovering from surgery.  I noticed that I was having the random hive(s) here and there anyplace on my body.  I also was experiencing swollen lumps on my lips.  I am prone to cold sores, and thought these were cold sores, but they would disappear and not be as tender as herpes. These other skin problems have not been constant, though I still have 4 or 5 hives on my body occasionally. I was wearing sandals the entire time I was "staying" in the hospital. Stressed.

I have been to podiatrists, a dermatologist, infectious disease specialists, a rheumatologist, and my family doctor. I have followed the instructions anyone has given me. The dermatologist said it was herpes and I took the meds.  I became ill shortly afterwards while in Thailand, erupted a new blister, and had BP 220/140.  A Thai doc suggested I be tested for SLE.  I was.  Very low positive, which the rheumatologist said was not positive, and that I don't have lupus.  The IDS did cultures (fluid and tissue) and all results were negative, including herpes. I now have an appointment with another dermatologist in 5 months.  Will I have a blister to show him?

In the meantime, these lesions erupt about every 2 - 6 weeks.  When they are erupting they are very distracting.  It takes 3 - 4 days for the itching, burning, throbbing, and occasional sharp pain to subside. The only relief I have found is applying ice directly to the inflammed, swollen area. When the blister has erupted and the pain has subsided, there is sometimes another area that stays inflammed, though it doesn't become a problem unless it is rubbed, or certainly, if it is scratched. There are also times when one or both of the toes become "ready" to blister, but don't.  They just give me fits with the itching, which I try to ignore.

The blisters and swelling sometimes prevent me from putting on a shoe.  By the way, I wear very sensible, though not athletic, shoes with lots of toe room.

Which type of specialist should I be sticking with?  (Everyone tells me to go to someone else and now I have come full circle)
Does this sound like anything you've heard of?  If so, what?
How treat it?  68 yrs. 113 lbs, 5'2" Excellent health. Good circulation. Active. No diabeties.

[Alan Rockoff, MD]

I think you should stick with a dermatologist, at least to the point of getting a biopsy of a fresh blister.  This should processed both routinely and for immunofluorescence.  The purpose would be to rule in or out the condition called bullous pemphigoid.  This can produce both tense blisters as well as itchy, hivelike bumps which may or may not turn into blisters.

I suggest you use whatever influence you or your primary doctor can wield to get seen sooner than 5 months.  A good photo may help convince the skin doctor to see you sooner.

Pemphigoid is not serious and is treatable.  But whether it's that or not, I think a biopsy is indicated to make the diagnosis.

Best.

Dr. Rockoff

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[Jamie13]

I would be interested to know what Diane found out about her blisters, if possible.  I am having the exact same problem of toe blisters (without the hives).  It started about four months ago after walking barefoot in the grass at a park.  I assumed that it was an allergic reaction to a bug bite or a plant I might have stepped on but it seems to be in my system as I am suffering from my fourth round of blisters.  It is localized to the middle toe of my right foot.  It has not spread to other toes and I see no reaction on my hands from touching the blisters.  They are very itching and sometimes have a burning pain.  The blisters last less than a week but there are usually tiny brown dots left over after they are gone...I thought this might be from scratching (?)  They turn up on the bottom, top, and sides of my toe and symptoms seem to intensify with scratching.  They are not very large...never any bigger than a pencil eraser, but are not always perfectly round.  I have not shown them to a doctor but I am now convinced that they are not just going to go away on their own.  Any insight would be much appreciated.  I am a 25 year old female.  Thank you!

[Alan Rockoff, MD]

Excellent.  I would be interested in hearing what you learn.  You can let me know through my website hyperlink.  

Dr. Rockoff

Please note: this is not an open invitation to everyone--I can't and don't respond to unsolicited messages sent to my website--sorry.

[diane9]

I am very grateful for the answers to my questions.  I do believe that none of the 6 docs I've seen in 14 visits have listened to a complete description of my symptoms.

I have seen my primary care doc, and shown him the MedHelp answer, and we have a plan for a biopsy when the next flare-up occurs. I have an appointment with a local dermatologist in one month.