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 Table of Contents  
TEACHING IMAGES
Year : 2019  |  Volume : 7  |  Issue : 2  |  Page : 309-310

Childhood blistering distal dactylitis: An uncommon cutaneous manifestation of Staphylococcus aureus


1 Department of Dermatology, Yenepoya Medical College, Mangalore, Karnataka, India
2 Department of Microbiology, Yenepoya Medical College, Mangalore, Karnataka, India

Date of Submission24-Oct-2019
Date of Decision06-Nov-2019
Date of Acceptance08-Nov-2019
Date of Web Publication16-Dec-2019

Correspondence Address:
Dr. Malcolm Pinto
Department of Dermatology, Yenepoya Medical College, Derlakatte, Mangalore - 575 018, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/amhs.amhs_147_19

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  Abstract 


Blistering distal dactylitis (BDD) is a rare, bacterial skin infection presenting as bullous lesions over the fingers, especially in the age group of <16 years. We present a case of a child presenting with BDD secondary to Staphylococcus aureus infection.

Keywords: Blistering distal dactylitis, Staphylococcus aureus, child


How to cite this article:
Saep M, Pinto M, Malkappa SK. Childhood blistering distal dactylitis: An uncommon cutaneous manifestation of Staphylococcus aureus. Arch Med Health Sci 2019;7:309-10

How to cite this URL:
Saep M, Pinto M, Malkappa SK. Childhood blistering distal dactylitis: An uncommon cutaneous manifestation of Staphylococcus aureus. Arch Med Health Sci [serial online] 2019 [cited 2020 Jul 6];7:309-10. Available from: http://www.amhsjournal.org/text.asp?2019/7/2/309/273059



A 6-year-old girl was brought to the skin outpatient department with a fluid-filled lesion over the right middle finger for 4 days. There was no history of prior trauma. Examination revealed solitary bulla over the volar aspect of the distal phalanx of the right middle finger [Figure 1]. Fluid from the lesions was drained and the samples were sent for Gram staining and pus culture and sensitivity. Gram staining showed plenty of polymorphs with uniformly stained Gram-positive cocci arranged singly and in clusters. Culture on blood agar showed golden-yellow colonies with beta-hemolysis [Figure 2]. The isolate tested positive for catalase test and slide and tube coagulase test and showed yellow colonies on Mannitol Salt Agar.
Figure 1: Solitary bulla over the volar aspect of the distal phalanx of the right middle finger

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Figure 2: Blood agar showing golden-yellow colonies with beta-hemolysis

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The patient was treated by drainage of the bulla with oral cefixime and dicloxacillin combination twice daily for 5 days orally and the lesion resolved within a span of 2 weeks.


  Discussion Top


Hays and Mullard, in 1972, first used the term “Blistering Distal Dactylitis” (BDD). It is a bacterial skin infection manifesting as a localized vesiculobullous lesion over the volar fat pad of the distal phalanx of the fingers. It is commonly observed in children. The usual causative organism is Group A beta-hemolytic Streptococcus, but less commonly Staphylococcus aureus and Staphylococcus epidermidis are seen.[1] The route of entry of the organism is usually exogenous through arthropod bites, traumatic erosions, and burns.

The lesions of BDD can be confused with herpetic whitlow, friction blisters, thermal and chemical burns, and bullous impetigo. Herpetic whitlow is diagnosed by a Tzanck smear from the vesicle which shows multinucleated giant cells. Clinical response to antibiotics makes herpetic whitlow unlikely and can be used to differentiate from BDD. A detailed history of thumb-sucking, insect bites, or contact with chemicals or heat gives clues to differentiate these conditions from BDD. Bullous impetigo is characterized by smaller and more superficial bullae than BDD. The diagnosis of BDD is mainly with the help of Gram staining and bacterial culture and sensitivity of the fluid.[2] Treatment is by deflating the bullae with a sterile needle without deroofing it. Wet compresses and topical antibiotics can lead to brisk resolution of the lesion. Systemic antibiotics are recommended to prevent the development of new lesions and spread of infection to other sites.[3]

BDD is an important differential diagnosis for a vesiculobullous lesion over the fingers in a child. This case is reported for its classical clinical image involving the volar surface of the distal digit and due to S. aureus being the underlying etiological agent.

Declaration of patient consent

The authors certify that they have obtained all the appropriate patient consent forms. In the form, the patient(s) has/have given her consent for her images and other clinical information to be reported in the journal. The patient understands that every effort will be taken to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hinkamp CA, Shah NH, Holland N, Wright A. Recurrent blistering distal dactylitis due to Staphylococcus aureus in an immunocompetent elderly woman. BMJ Case Rep 2018;2018. pii: bcr-2017-222772.  Back to cited text no. 1
    
2.
Fretzayas A, Moustaki M, Tsagris V, Brozou T, Nicolaidou P. MRSA blistering distal dactylitis and review of reported cases. Pediatr Dermatol 2011;28:433-5.  Back to cited text no. 2
    
3.
Kowtoniuk R, Bednarek R, Maroon M. Blistering distal dactylitis. JAMA Dermatol 2018;154:1480.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2]



 

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