Patient of Dr P Barua

A 5-yrs girl presented to me with a painful blister on her right index finger. She had developed the lesion less than 24 hours ago, after coming back from her village home- where she had been visiting some paddy fields. She also stated that something made a bite on her finger. No present or past history of major illness nor any drug allergy. No blistery lesion or major skin problem before. No contributory family history was found. No treatment was taken for this problem.

O/E: Single bullae over the whole flexural aspect of distal phalanx of right finger. Tense and tender. Tinny erosion/ulcer was marked. Serous clear fluid on top and thick pus like fluid at the base of the lesion were noticed.

D/D: For blistery lesion mnemonic is CU DVA EVEI. I will go for Infective.

P/D: INSECT BITE

Rx: Pricked out the fluid to release tension.
    Oral Antibiotic: Flucloxacillin as I found
    some pus.
    Oral Antihistamine: Mebhydrolin
    Topical Antibacterial: Mupuricin 1%

There is a condition called blistering distal dactylitis which can look like this and is a Strep infection responding to Flucloxacillin orally. I would not use a topical here.The organism can be cultured from the blister fluid. (Submitted By: Dr Ian McColl)