UMEM Educational Pearls

Category: Pediatrics

Title: Blistering Distal Dactylics (submitted by Nicole Cimino-Fiallos, MD)

Keywords: rash, fingertip, bulla, nail disorder (PubMed Search)

Posted: 3/24/2017 by Mimi Lu, MD
Click here to contact Mimi Lu, MD

Who- Mostly seen in children, but sometimes in immunocompromised adults

What- Peri-ungal infection of the fingerpad with pus-filled blister with erythematous base

Cause- May result from thumb or finger sucking. Staph and strep are the most common bugs, but it can be caused by MRSA.

DDx- herpetic whitlow, paronychia/felon, friction blister, insect bite

Treatment-

1. De-roof the blister

2. Send drainage for culture

3. Treat for staph and strep- no indication to treat for MRSA initially unless strong suspicion

4. 10 day course of antibiotics recommended

For additional information and image: http://www.medscape.com/viewarticle/718695_3

References

1) Fretzayas A1, Moustaki M, Tsagris V, Brozou T, Nicolaidou P. MRSA blistering distal dactylitis and review of reported cases. Pediatr Dermatol. 2011 Jul-Aug;28(4):433-5. PMID: 21438916.

2) Cohen R, Levy C, Cohen J, Corrard F, Deberdt P, Béchet S, Bonacorsi S, Bidet P. Diagnostic of group A streptococcal blistering distal dactylitis. Arch Pediatr. 2014 Nov;21