Recurrent vesicular eruption on the right hand
The 8-year-old boy was otherwise healthy. So what was causing these painful lesions to erupt on his hand?
Differential includes dactylitis
Painful fingers may also be suggestive of dactylitis.
Blistering distal dactylitis, mostly caused by group A β-hemolytic streptococci, is a bacterial infection that manifests as a tense bullae over the anterior fat pad of the volar aspect of the distal part of a single finger (or rarely a toe); diagnosis is usually confirmed by culture.5
Sickle cell dactylitis, or hand-foot syndrome, is caused by localized bone marrow infarction of the carpal and tarsal bones and phalanges. Patients will complain of a sudden onset of warm, tender global swelling of the hands and/or feet that is occasionally accompanied by fever and leucocytosis.5
Spondyloarthritis dactylitis, or a “sausage-like” digit, is usually caused by flexor tenosynovitis and presents as diffuse painful swelling of the fingers and toes, mainly over the flexor tendons.5
