Visual Diagnosis in Emergency Medicine| Volume 54, ISSUE 5, e111-e112, May 2018

Boy with Hand Blisters

      A 17-month-old boy presented to the Emergency Department (ED) with a minor laceration on the distal portion of his fifth digit, which was sutured and placed in a splint for protection. Two days later, the patient removed the splint himself while playing. His parents noticed a small blister on his thumb and returned to the ED that day. In the ED, the thumb had minor blistering with surrounding erythema. He was afebrile and had an otherwise normal examination. The splint was replaced and he was started on amoxicillin for presumed skin infection. The next morning, 3 days after the initial laceration repair and splinting, the parents were concerned that the child was in pain and his fingers were noticeably swollen. In the ED, the child was irritable but consolable by his parents, and his vital signs were appropriate for his age. The splint was removed, revealing multiple large bullae on his right hand (Figure 1, Figure 2, Figure 3). His hand was tender to palpation and his fingers had decreased range of motion but adequate capillary refill.
      Figure thumbnail gr1
      Figure 1Generalized edema and erythema of the right hand and digits with a 5-cm tense, serous bullae on the dorsal aspect of the thumb. Pen marks the previous border of erythema.
      Figure thumbnail gr2
      Figure 2A 2.5-cm bulla on the lateral aspect of hand proximal to the fifth digit.
      Figure thumbnail gr3
      Figure 3Smaller bullae in the web spaces.
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