Diagnosis is made clinically and confirmed with gram stain and bacterial culture of the blister fluid. Request pdf blistering distal dactylitis in an adult blistering distal dactylitis is a localised infection of the anterior pad of the distal phalanx of the digits. Is blistering dactylitis a variant of bullous impetigo. Dactylitis is considered a hallmark feature of psoriatic arthritis psa, but it is found in other spondyloarthropathies, especially reactive arthritis, and other conditions eg, sarcoidosis, gout, sickle cell disease, and a variety of infections. Blistering distal dactylitis in an adult request pdf. This article is within the scope of wikiproject medicine, which recommends that medicinerelated articles follow the manual of style for medicinerelated articles and that biomedical information in any article use highquality medical sources. Dactylitis is a medical condition in which a digit finger or toe becomes inflamed, taking the shape of a sausage and causing a lot of pain. About 60% are caused by staphylococcus aureus and some are caused by group a streptococcus gas or streptococcus pyogenes.
Just as the sickle cell type, blistering dactylitis normally manifests in children, developing anywhere from the age of 6 months to up to 4 years. Dactylitis can occur in seronegative arthropathies, such as psoriatic arthritis and ankylosing spondylitis, and in sicklecell disease as result of a vasoocclusive crisis with bone infarcts, and in infectious conditions including tuberculosis, syphilis, and leprosy. Pdf blistering distal dactylitis bdd is a rare, bacterial skin infection presenting as bullous lesions over the fingers, especially in the age group of find, read. Patients with dactylitis may have nail disease which is linked to enthesitis. Because the inflammation develops in the fat pad of the finger, it can make. Sicklecell dactylitis affects young children and is selflimiting.
Bullous pemphigoid is a chronic autoimmune skin disorder resulting in generalized, pruritic, bullous lesions in elderly patients. Blistering bullous dactylitis is a localized form of bullous impetigo, usually affecting children between 2 and 16 years of age, although cases have also been reported in children aged distal dactylitis michael k. Is blistering distal dactylitis a variant of bullous. Please visit the project page for details or ask questions at wikipedia talk. Impact of antibiotic treatment of group a streptococcal. Blistering distal dactylitis can be coincident with grampositive infection or colonization of the nasopharynx or conjunctiva 10, but such infections or colonizations do not result in bdd. Bullous pemphigoid is an uncommon skin disease characterized by tense blisters on the surface of the skin. Occasionally, the inner lining tissue of the mouth, nasal passages, or conjunctivae of the eyes mucous membrane tissue can be involved. Bullous myringitis is a type of ear infection in which small, fluidfilled blisters form on the eardrum. Introduction to bullous diseases dermatologic disorders.
These proteins are within the nc16a domain of collagen xvii. There is another type referred to as blistering distal dactylitis and occurs when the fleshy pad of the distal part of the finger comes to be inflamed. While dactylitis refers to nonspecific inflammation of a finger or toe, blistering distal dactylitis specifically refers to a periungual infection, most often caused by group a hemolytic streptococci. Lawrence, amy jo nopper, in principles and practice of pediatric infectious diseases fifth edition, 2018. Blistering distal dactylitis an overview sciencedirect. Typically affects kids 2 years to 16 years, but has been shown in children distal dactylitis. Is blistering distal dactylitis a variant of bullous impetigo. The bullae of bdd should be incised and drained, the erosions of dried out and treatment with a. Also called sausage fingers, the puffy nature of the inflammation. This is an example of blistering distal dactylitisa superficial bacterial. The organism can be identified by a gramstained smear and culture of the blister fluid. Blistering distal dactylitis in an adult jama dermatology jama. Matt lyon and marla c doehring, blistering distal dactylitis. Although epidermolysis bullosa acquisita is thought to be an autoimmune disease, epidermolysis bullosa is a group of inherited diseases in which epithelial adhesion protein defects lead to.
Dactylitis is a feature of the conditions listed below. Blistering distal dactylitis in an adult ramya kollipara. Blistering distal dactylitis is an unusual superficial infection typically localized to the volar surface of the distal phalanx. Diagnosis is usually made on clinical grounds based on the presence of large, tense, superficial, and typically painful bullae, the base of which may be erythematous. Alphabetical index of skin diseases blistering distal dactylitis. Dactylitis also integrates implement ed composite indexes such as the composite psoriatic.
The causative agent is a group a betahemolytic streptococcus. Chicago, il blistering distal dactylitis is a distinctive infection localized to the volar fat pad of the distal phalanx of the finger. Bdd was first linked to infection with group a haemolytic streptococcus in children, but has more recently linked to staphylococcus aureus and noted in adults. Blistering distral happens when the pad of the finger becomes inflamed. There is also another form referred to as blistering distal dactylitis. This is still a controversial topic but there is good evidence for common mechanisms between dactylitis and enthesitis in psoriatic arthritis. This also normally happens with children from 6 months to up to 4 years of age. Blistering distal dactylitis dermatology jama dermatology jama.
Bdd was first linked to infection with group a betahaemolytic streptococcus in children, but has more recently linked to staphylococcus aureus and noted in adults. Blistering bullous dactylitis is a localized form of bullous impetigo, usually affecting children between 2 and 16 years of age, although cases have also. Blistering distal dactylitis classically is caused by s. Diagnosis is by skin biopsy and immunofluorescence testing of skin and serum. Blistering distal dactylitis is a cutaneous condition characterized by tense superficial bullae occurring on a tender erythematous base over the volar fat pad of the phalanx of a finger or thumb 262. Download the pdf to view the article, as well as its associated figures and tables. Cicatricial scarring pemphigoid presents with severe, erosive lesions of the. Blistering distal dactylitis statpearls ncbi bookshelf. Most commonly caused by group a betahaemolytic streptococcus but also may be due to staphylococcus aureus. Blistering distal dactylitis clinical presentation tense vesicles filled with purulent fluid and surrounding erythema on the dorsal surface of distal fingers and. Several kinds of dactylitis may occur, ranging from the swelling, enlargement, and scratches of both the fingers and the toes seems to originate from the flesh and is usually involves only some. Moreover, this type is associated with shortening of the digits which is also observed in tuberculosis dactylitis, syphilitic dactylitis and other pathologies 7 8.
However, in the medical literature, it is known that both the finger and the toe can be affected. A mucous membrane is the moist tissue lining the mouth, nose, eyes, throat, esophagus tube that runs. Blistering distal dactylitis bdd manifests as acral oval bullae 1030 mm in diameter, and is caused by infection with gram. Herpetic whitlow is caused by herpes simplex virus hsv type 1 or 2, usually on the thumbs or fingers. Less common, but known to cause bullous disease see staph scalded skin multiple lesions may predict infection with s. Superficial infection of the anterior fat pad of the distal portion of the fingers most often occurs in children. Blistering distal dactylitis bdd manifests as acral oval bullae 1030 mm in diameter, and is caused by infection with grampositive bacteria. The condition is caused by antibodies and inflammation abnormally accumulating in a particular layer. Bullous pemphigoid is characterized by large, tense bullae, but may begin as an urticarial eruption.
Blistering distal dactylitis are very common in children. Bullous pemphigoid bp is an autoimmune subepidermal bullous dermatosis defined immunologically by the existence of autoantibodies directed against 2 structural proteins found in the hemidesmosomes of the dermalepidermal junction. Blistering distal dactylitis is a superficial infection of the anterior fat pad of the distal portion of the fingers, caused by group a. Blistering distal dactylitis is an acral infection caused by s. Blistering distal dactylitis is a superficial infection of the. Patients with dactylitis may have clinical evidence of enthesitis elsewhere. Background blistering distal dactylitis bdd is characterised by tense seropurulent fluidfilled bullae usually on the anterior fat pads of the distal phalanges, though it has been described to extend and affect the proximal and lateral nail folds, as well as to cause a periungal paronychia. Topical and systemic corticosteroids are used initially.
Dactylitis causes severe inflammation of the finger and toe joints. Bullous disease bullous buhluhs diseases are a group of rare blistering diseases. Blistering distal dactylitis an overview sciencedirect topics. The target is the protein bp180 also called type xvii collagen, or less frequently bp230 a plakin.
Blistering distal dactylitis bdd is a localized bacterial infection manifesting as fluidfilled lesions over the fingers especially in children. Blistering distal dactylitis develops when the fleshy pad of the distal portion of the finger becomes inflamed. The name of the condition comes from the greek word daktylos, meaning finger. The blisters can form on the skin and mucous membranes. Some studies have confirmed that a single antibiotic treatment against the. The causative agent is a group a f3hemolytic streptococcus. As with the sickle cell variety, blistering dactylitis usually manifests in children, occurring anywhere from the age of six months to up to four years. While blistering distal dactylitis typically affects the volar fat pads of the fingers, it may also occur more proximally on the hand or involve the thumbs or toes. Blistering distal dactylitis may rarely present in adults including those who are not immunocompromised or reporting trauma and thus should be in the differential diagnosis for an adult presenting with bullae at the fingertips. In reactive arthritis, sausage fingers occur due to synovitis. A 7yearold boy presents to the ed with 3 days of rash and itching on the side of his index finger. The most common organism responsible for this is betahemolytic streptococci.327 1093 1353 1304 493 776 288 1115 902 1446 1378 561 1085 122 575 257 1387 313 938 277 304 1420 934 1306 164 1108 576 1320 1487 997 1448 209 165 313 96 133 838 1471 670 657 1098 924 1415 239 1375 1141