Blisters on Fingertips

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My 8-year-old has outbreaks on his fingertips

Jan 2010

I have already stumped a dermatologist with 30+ years of experience and a pediatrician with just a few years less, so before we see any more doctors....

My 8.5 year old son gets these outbreaks on the Distal Phalanges ( finger tips). The tips get red and swollen, and on index, ring and pinkies he gets blisters. Sometimes they look like whiteheads and sometimes they look like the kind of blisters you get from hiking boots - big and looking to be filled with clear fluid.

The outbreaks happen every 4-6 months. They do not hurt unless they are pressed on.

We have already tracked and are currently tracking food, chemicals, medicines, etc., but this does not seem to correlate with the outbreaks.

Does anyone have any idea what this might be, and what kind of a doctor we would see for further direction? I thank you in advance

Could your son have dishydrotic ezcema? a relatively rare form of dermatitis Look at google images Stacie, MD
Hi, when my husband developed an unusual medical problem, we quickly learned that the best place to have it properly identified and taken care of in the most up-to-date way is a research/teaching hospital, such as UCSF. As a couple of doctors told us, they see more ''zebras'' or unusual issues that a regular doc never does. You can search the USCF Medical Center website for pediatric dermatologists--I did a quick search and came up with one, Mary Williams: . If it were my kid, I'd just call over there for an appt. Sarah
FYI, I am not at all in the medical field. However, my husband has pretty bad eczema and that sounds a lot like one of his symptoms. Unfortunately, while my husband's eczema seems to be stress related, I don't think there is a reliable cure for eczema yet. Kate
Poor little guy! Does he or anyone in the family get cold sores? Cold sores can also be spread to the fingers. This condition is referred to as 'herpes whitlow'. Herpes whitlow commonly occurred in dental personnel before the era of mandatory glove use. The virus is spread from the location of an outbreak by touching the sore(s). The fingers, eyes, and other body areas can accidentally become infected in this way. If you suspect this is the case, you could try cold sore medicine like Abreva and see if it helps. Good luck
I found this on a website... have no idea if it is correct but something to ask your child's dermatologist & pediatrician.
Blistering distal dactylitis (BDD) is a distinct clinical entity that is infrequently reported in the literature. Characteristically, blistering distal dactylitis is described as a localized infection involving the volar fat pad of the distal phalanx of the digits, and it usually presents as a fluid-filled blister. The usual causative organism is group A -hemolytic Streptococcus, but less commonly, Staphyloccous aureus and Staphyloccoccus epidermis are present. The normal age range is reported to be 2 to 16 years old, but there are case reports of this infection in adults. Only one case has been reported in the literature in a child younger than 24 months of age. In this report we describe three cases in children younger than 9 months old. These three cases indicate that BDD can and does occur in children younger than 2 years of age.
Hi my daughter is 10 now but when she was 2 years old she developed blisters that sound alot like your son's and they had little whiteheads too. We lived in Redwood city at the time and the Dr's said it was called Hand, Foot, and Mouth disease. They gave her antibiotics and it went away after a few days please ask if that may be what it is. Hope this helped you. stacia
I did a quick google search on ''blisters on fingertips'' and came up with a number of hits, including the one that seems most likely: herpetic whitlow, a variation of the herpes simplex virus. It's probably not as common as the cold sores that appear around the mouth, but it seems that your dermatologist should have been able to ''finger'' this one, with 30+ years experience... odd. The wiki description says that children can transmit it to their fingers from the mouth by sucking on their fingers. If this is the diagnosis, topical acyclovir can help. hope this helps
Sounds like it could be the cold sore virus (HSV I) taken up residence in the fingertips. It's called ''whitlow''. Kids get it by touching their mouths or sucking their fingers when they have an active cold sore, especially on the first outbreak. If your kid, or anyone in your household has cold sores I would strongly consider this possibility. You can have the liquid from a blister cultured for a positive ID, though false negatives are not uncommon.

It's contagious when active, but luckily your kid is old enough to follow hygiene rules-- don't touch eyes, don't touch others, wash hands often. Oral acyclovir is often effective as a prophylactic. Been There, Done That

You could consider an infectious disease specialist. There is probably someone affiliated with Children's hospital. Off the top of my head - sometimes herpes viruses can present in an atypical manner, especially if the person is immunosuppressed in some way. Have they popped a blister and sent a viral culture? Good luck.
I am on the side of the MD that suggested dishidrotic(also sometimes called pompholyx) eczema. I have it. Have had it for my whole life. It pretty much stays on the bottom of feet, between toes, inside of hand, fingers and between fingers.... It comes and goes and spreads when the blisters open and ooze the clear fluid. I had it often as a kid and then it disappeared for 20 yrs, had a few flares ups, then disppeared for another 10 or so yrs. It seems to be stress related, mostly, but I also sometimes wonder if dairy makes it worse. It seems to flare out of control if I drink certain brands of milk, surprisingly. However, I also can be dairy free and still have issues, albeit far more under control. See if you can try diet changes, like dairy and/or wheat removal. Do add some EFA's to the child's diet. And try rubbing oil on your child's body, such as almond or avocado (I buy the cooking avocado oil and use it!). As you will see in your research, it is the hardest form of eczema to cure. I find that the only thing that works (unfortunately) when it gets out of control, is cortizone ointment. I use it a few times for a couple of days and then back off again. It seems to help. Good luck. Eczema Educated
They tried treatments for dyshidrotic eczema? knows a little derm
I just wanted to second the advice to see someone at UCSF dermatology. My son was finally diagnosed with Cutaneous Lupus, a condition that it is aggravated by exposure to the sun, after many years of being told it's just eczema or psoriasis. It was an intense experience at UCSF because it is a learning hospital and a lot of students wanted to see him, take pictures, etc., but it was worth it to finally get a diagnosis. Please email me if you would like to discuss it further. Jackie