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Is blistering distal dactylitis a variant of bullous impetigo?

Blistering distal dactylitis (BDD) manifests as acral oval bullae 10-30 mm in diameter, and is caused by infection with Gram-positive bacteria. BDD was first linked to infection with group A beta-haemolytic streptococcus in children, but has more recently linked to Staphylococcus aureus and noted in adults. BDD most commonly occurs as bullae on the volar fat pads of the fingers but can occur on the proximal phalangeal and palmar areas of the hands and can manifest as multiple bullae. The bullae can evolve into erosions over the course of several days. BDD can coexist with and may be secondary to clinically imperceptible infections of the nasopharynx, conjunctiva or anus, which underlines the need for systemic antibiotic therapy. Multiple bullae appear to be a predictor that S. aureus is the causative agent of a case of BDD. When BDD is suspected, treatment involves: (i) incision and drainage of bullae, (ii) wet to dry compresses to dry the eroded areas, and (iii) a course of a beta-lactamase-resistant antibiotics, necessary because S. aureus, now found to be a common cause of BDD, is usually resistant to penicillin. No treatment failures have been reported.

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