Painful blisters on the hand
BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f1753 (Published 26 March 2013) Cite this as: BMJ 2013;346:f1753
- Yuliya Velykoredko, year 3 medical student1,
- David N Adam, dermatologist and assistant professor at the University of Toronto2
- 1Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- 2Department of Medicine, Division of Dermatology, St Michael’s Hospital, Toronto, ON, Canada, M5B 1W8
- Correspondence to: D N Adam david.adam{at}utoronto.ca
A 74 year old previously healthy man presented to the emergency department with acute onset of pain and swelling in the right hand. Earlier that evening he had played a game of recreational ice hockey. He did not have a fever and was otherwise well. He had not experienced trauma during the game and his medical history was unremarkable. Physical examination showed large lesions on the right hand (figs 1⇓ and 2⇓).
Fig 1 Volar view of the right hand
Fig 2 Dorsal view of the right hand
Questions
1 What do the images show?
2 What is the diagnosis and what differential diagnoses should be considered?
3 What are the most likely organisms responsible for the condition?
4 What is the appropriate management?
Answers
1 What do the images show?
Short answer
Figure 1 shows large tense bullae with surrounding erythema sparing the index finger. The blisters extend proximally to the metacarpophalangeal joints and affect the volar and dorsal aspects of the fingers (figs 1 and 2).
Long answer
It is important that the skin lesions and their distribution are correctly identified to establish a working differential diagnosis in this case. Well circumscribed, raised, and fluid filled lesions can be classified as vesicles or bullae, depending on size. Vesicles are defined as being less …
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