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How To Use A Hydrocolloid Dressing… Properly!

duoderm hydrocolloid ulcer dressing

How To Use A Hydrocolloid Dressing… Properly!

Do not use hydrocolloid blister dressings on blisters with an intact or torn roof! If you put a hydrocolloid dressing on a blister with an intact or torn roof, it may rip the skin of the blister roof off upon removal. As a result, you’ll have made your blister worse, instead of better.

Hydrocolloid dressings should only be used on deroofed blisters. That is, blisters where the roof has been removed, leaving a red raw sore. Something like these (below).

hydrocolloid dressings are for deroofed blisters
These are deroofed blisters. This is the type of blister that you can use a hydrocolloid dressing on.

Deroofed heel blisters, like these for instance (above), are the kind of wounds that needs a sterile hydrocolloid dressing to heal quickly. Firstly, as the raw blister base heals, it weeps. This weepiness is called exudate and it combines with the dressing to provide the best environment for healing. In other words, hydrocolloids accelerate healing. Secondly, this prevents the dressing from sticking to the raw wound. Therefore, it won’t disrupt valuable healing tissue as it is removed.

Want to learn more about where hydrocolloids fit into the recommended blister treatment sequence? Read our how to get rid of foot blisters article.

[Video] Common hydrocolloid dressing mistakes

Four popular hydrocolloid blister dressing brands

Compeed is a hydrocolloid blister dressing
Band-Aid Advanced Healing is a hydrocolloid blister dressing
Band-Aid Advanced Healing
Duoderm is a hydrocolloid dressing often used for ulcers
Duoderm ulcer dressing

How to use hydrocolloid dressings successfully on blisters

Hydrocolloid dressings suffer a poor reputation in blister management in the running and hiking communities, as highlighted below for instance:

My team have dealt with hundreds of cases of Compeed that has almost morphed into “one” with the skin. It’s really difficult to see where the Compeed finishes and where the skin begins. We actually recommend against it for long events for that reason. And if we see it in use, we speak up and discourage it.

Personally, my worst blister treatment experiences of all time have been removing this partially metamorphosed Compeed from badly blistered feet.

The open skin under the dressing stinks and the skin goes all wrinkly.

Some perspective

I completely understand these concerns. I’ve witnessed them myself, many times. Here’s an example (below).

How to use a hydrocolloid (in this case, Compeed) the wrong way in an ultramarathon

This was from the 2015 ANZAC Ultramarathon in Canberra. This runner had applied Compeed when he saw a blister forming. The skin of the blister roof was intact at the time. Later, as he removed his sock, he realised the Compeed had melded with the sock and he couldn’t get the two apart. He also couldn’t peel the Compeed from his blister. So as he took his sock off, the Compeed ripped the blister roof off. It was nasty!

If you’ve had a bad outcome when you’ve treated your blister with Compeed or any other hydrocolloid, there are three potential reasons why. It’s easy to avoid each of them.

Avoid these 3 mistakes using hydrocolloid blister dressings

1) Hydrocolloid blister dressings are not for blister prevention

There is an expectation that the hydrocolloid dressing alone will prevent a blister from developing and/or prevent it from getting worse. In fact, this expectation is wrong. Don’t use hydrocolloids for blister prevention – they are blister treatments. 

2) Only use hydrocolloids for healing deroofed blisters

Hydrocolloid dressings have an adhesive which makes them stick. For this reason, do not put them on a blister with its roof intact, or with its roof torn. This wound care strategy will only tear the skin of the roof off when you come to remove the dressing. Hydrocolloids need a weepy wound base to work their magic – they absorb the exudate and this does two good things:

  • Firstly, it prevents the dressing from sticking to that part of the skin
  • Secondly, it partially dissolves to provide a gel that promotes healing

In my university days (some 25 years ago now) I was on the grinder doing some heavy orthotic modifications when my hand slipped and the grinder took a nasty gouge from my knuckle. I grabbed some Duoderm from the student clinic and used it as directed until it was healed. We used Duoderm at uni for acute and chronic ulcer management). Within a week or so, the deep gouge had filled in and there was a nice pink area of healed skin in it’s place.

Not only that, the skin remained flexible enough so as not to limit flexion of my finger during and after healing – something that wouldn’t have happened if I’d allowed the wound to dry out and scab over. It was remarkable. I still have a scar but it is quite underwhelming considering the size of the initial injury. If you don’t believe me, the next time you have a weepy wound, get a hydrocolloid dressings and try it.

3) Don’t expect hydrocolloid dressings to stay on, on their own

Although hydrocolloids have an adhesive to make them stick to the skin, I don’t expect it to work on feet – not well enough. On your arm, fine. On my finger, fine. But on your feet, not fine. Think about the in-shoe environment – it’s sweaty in there. In other words, that’s a constant threat to good adhesion. Because all it takes is for one edge of the dressing to roll-back a little and be exposed to the sock (annoyingly, it will stick like glue to the sock – see photo above).

I recommend Fixomull or a similar fixation tape around the circumference of a hydrocolloid dressing. Leave the majority of the dressing area visible – we need to visualise the degree of weepiness to determine when to change the dressing. This is good wound care practice. Plus, hydrocolloids allow wound gasses to evaporate through the dressing (whilst being waterproof from the outside).

Secure all hydrocolloid dressing edges with a fixation tape like Fixomull to prevent roll-back. Resist the temptation to put Fixomull all over it – you need to see how the wound is interacting with the dressing to know when to change it.

How long to leave a hydrocolloid blister dressing on for?

Good question! Hydrocolloids can be left on for a few days, or even a week. It all depends on how weepy the wound is. It can take a bit of practice to get this right.

  • If your deroofed blister is very weepy, don’t use a hydrocolloid straight away. If you do, and you leave it on for a week, the surrounding skin will become macerated (water-logged, white, rubbery). Rather than changing your hydrocolloid twice a day, instead, use an island dressing at the start. Change it frequently until the weepiness abates. Then start with your hydrocolloid.
  • Conversely, if your deroofed blister is on its way to healing already, if it’s dry or got a scab over it, a hydrocolloid is not the best choice. Use an island dressing simply for protection.
  • Just like the Goldilocks fairy tale, there’s a “just right” scenario for hydrocolloids. That is, a deroofed blister with a moderate amount of weepiness. In this situation, leave your hydrocolloid on for a day at least. You’ll know when to change it – the weepy gel-like substance under the dressing will track toward the edge of the dressing. When it gets to the edge of the dressing, change it.

Of course, if your blister base does not seem to be healing, you suspect it is infected, you’re just not sure how to care for your blister or you have a health condition, seek medical advice from your doctor.

Rebecca Rushton

Podiatrist, blister prone ex-hockey player, foot blister thought-leader, author and educator. Can’t cook. Loves test cricket.

No Comments
  • Helen s
    19 August 2016 at 11:51 am

    This is a brilliant article – I wish Compeed et al explained when and how to use these plasters properly as well as you do!

  • John Vonhof
    16 September 2016 at 5:36 am

    Great informative article that athletes and medical people need to understand. Compeed has it’s place, but it has limited uses. It’s important to remember that after applying a patch like this and taping it down as Rebecca says, bunch up your socks to roll them on and off – otherwise you can pull the dressing loose. If using this on a heel, I also suggest using a shoehorn to ease the heel into the back of the shoe. Protect the patch! That’s key.

  • Karen
    2 June 2017 at 3:27 am

    Thanks for this article! You just stopped me from applying a dressing to a new blister.
    One question that I don’t think is addressed in the article: if a blister still has an intact roof, is it best to leave it alone? If the roof is torn and the blister is still weeping, should you remove the loose skin and apply a dressing or continue to leave it alone?

  • Rebecca Rushton
    2 June 2017 at 6:49 am

    An island dressing is what you’re after Karen (like a Band-Aid or Cutiplast). If torn, leave the roof in place – it provides a little protection to the raw blister base. And if the roof is intact, that’s a good thing because it can’t possibly get infected – the skin is keeping the germs out.

  • kat
    18 January 2018 at 2:31 am

    Thank you very much for this great information !!

  • Rebecca Rushton
    18 January 2018 at 6:08 am

    It’s a pleasure Kat 🙂

  • andy gillies
    11 May 2018 at 11:27 am

    great advice

  • katie miller
    10 October 2018 at 4:01 am

    I found this video after I applied hydrocolloid bandages to both of my heels, one of them had an open roof blister and one had a closed roof one. I realize that I made a mistake by applying it to the closed roof blister, so I’m wondering if I should just wait for it to start falling off? Will that help it not to hurt so bad when taking it off?
    I am required to wear these boots to work that gave me these blisters, and I’m wondering if wearing these bandages will make me get more blisters or get worse ones? I was thinking of wearing moleskin over the bandages to prevent blisters.

  • Rebecca Rushton
    11 October 2018 at 12:01 pm

    Forget about hydrocolloids and moleskin in this instance. Put Engo Patches on your work boots instead Katie and that will stop the blisters by way of reducing friction levels far more than the other two: https://blisterprevention.com.au/engo-blister-prevention-patches/. If I were you, I’d leave the current dressing on for a while to give the blister fluid some time to absorb and the skin to gain a bit extra strength before taking your hydrocolloid bandage off. But if in doubt, see a podiatrist for their advice and assistance.

  • Bo Gunnarsson
    6 January 2019 at 5:08 am

    Hi,I totally agree with others, brilliant article! Was/been searching the web for more/better info of these compeed patches. I’m trying to find out what is the most adviseable way of removing a patch "prematurely" (i.e before it falls of by itself). I like Katie Miller below put one on when I shouldn’t and I need to take it of. I read in another thread that soaking it in hot water and soap would loosen it, is that a good way for a removalt?

  • Rebecca Rushton
    7 January 2019 at 8:25 am

    Hi Bo. The official way to remove a hydrocolloid plaster resulting in less skin trauma is to get one corner and pull parallel to the skin surface. Unfortunately, this will block your visibility of the blister roof (assuming there’s a blister under your Compeed) and you’ll be less able to gauge if your blister roof is about to tear.
    I have no idea about soaking it in hot water. It makes sense that this will liquefy the adhesive so it might help.

  • Lindsey Esb
    28 March 2019 at 3:51 am

    So what if I happened to read this article after putting it on an open burn? The skin peeled off and I put on to protect myself during sleep. I am worried of the pain of removing the bandage as it has stuck to my skin perfeclty.

  • Rebecca Rushton BSc(Pod)
    28 March 2019 at 8:01 am

    You should really seek the advice of your doctor Lindsey. I wouldn’t like to give any specific advice on this, especially considering there are different degrees of burn injuries.

  • Denis Mountain
    22 April 2019 at 12:00 pm

    Thanks for this informative post. I really appreciate your writing skills it’s really good. I really like this blog. I usually purchased all the dressings and other first aid items online from woundcare. that was an amazing experience of mine with me.

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