A 4-year-old girl presented to our dermatology clinic with erythema and bullae on the right foot for 4 days. She did not complain of pain or pruritis. She had no history of recent upper respiratory tract infection, trauma or medication use. Physical examination showed that the patient was afebrile and appeared well; she did not have any superficial lymphadenopathy. We observed multiple tense fluid-filled bullae with edematous erythema over the right first metatarsophalangeal joint and sole of the foot (Figure 1). Her white blood cell count and neutrophil percentage were normal. We diagnosed blistering distal dactylitis and treated the patient with puncture of the bullae, topical 5% povidone-iodine solution and oral amoxicillin. Bacterial culture from the bullous fluid later grew group A [beta]-hemolytic Streptococcus. The lesions resolved completely in 10 days.
Blistering distal dactylitis is a superficial bacterial infection, typically caused by group A [beta]-hemolytic...