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November 1982

Blistering Distal Dactylitis: A Manifestation of Group A ß-Hemolytic Streptococcal Infection

Author Affiliations

USN Portsmouth, Va

Arch Dermatol. 1982;118(11):879-880. doi:10.1001/archderm.1982.01650230007013

To the Editor.—  Blistering distal dactylitis is a distinct clinical entity that has gone virtually unnoticed in the pediatric1-3 and dermatologic4,5 literature. In our busy pediatric clinic, it is not a rare problem. We see approximately 24 cases a year. However, we have not encountered any adults with blistering distal dactylitis, and, to our knowledge, no cases have been reported.Clinically, blistering distal dactylitis has a rather characteristic appearance. Overlying the distal volar fat pad, there is a medium to large nontender blister with an erythematous base (Figure). It is not uncommon for the blister to extend dorsally to the nailfolds, and more than one digit is frequently involved. There are usually no associated systemic symptoms.Aspiration of a blister yields a thin, pale, purulent exudate that routinely yields group A β-hemolytic streptococci. Staphylococcus aureus and Staphylococcus epidermidis have also been occasionally yielded on culture, but only in

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