Following dog bites to both hands and a visit to her local Emergency Department, a 37-year-old female patient presented to Primary Care with tender, erythematous lesions at the bite sites. This was diagnosed as blistering dactylitis, a condition that occurs following a superficial bacterial infection of the fingers, typically by β-hemolytic streptococci, or Staphylococcus aureus. The condition may present in a variety of ways, depending on the stage of infection. Blistering dactylitis typically begins with an acute blistering phase that affects the pads of the fingers, which may be tender, erythematous and swollen. Blisters may be very small and they may burst before they are noticed. During the healing phase, patients may observe peeling at the periphery of the bite sites. A bacterial culture should be performed on the blister fluid, or at the site of injury during the initial consultation. If dog bite wounds are present as they were in this patient, they should be thoroughly irrigated. Blistering dactylitis is treated with oral antibiotics. If dog bites are involved, the chosen antibiotic should have coverage against components of dogs’ oral flora, which can usually be achieved by β-lactams, or amoxicillin-clavulanic acid. A rabies vaccination is also indicated. When it is due to other causes, antibiotic choice should be empirical. Patients should be monitored for recovery and healing.
KeywordsBlistering dactylitis Bullous Bulla Bullae Bacterial infection Blister Streptococcus Staphylococcus Bites MRSA Antibiotics Rabies Tetanus
Open Access This chapter is distributed under the terms of the Creative Commons Attribution Noncommercial License, which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.