Archives of Medicine and Health Sciences 2019 7(2):309-310
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.
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 Click here to view |
 | Figure 2: Blood agar showing golden-yellow colonies with beta-hemolysis Click here to view |
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 |  |
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.
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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
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Conflicts of interest
There are no conflicts of interest.
| References | |
| 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.  |
| 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. |
| 3. | Kowtoniuk R, Bednarek R, Maroon M. Blistering distal dactylitis. JAMA Dermatol 2018;154:1480. |
| Figures |
[Figure 1], [Figure 2]
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