Nail Disorders in Children

Erin L. Luxenberg; Robert A. Silverman


Dermatology Nursing. 2010;22(1) 

In This Article

Blistering Distal Dactylitis


While dactylitis refers to nonspecific inflammation of a finger or toe, blistering distal dactylitis specifically refers to a periungual infection, most often caused by group A hemolytic streptococci. The blister is located on the anterior volar fat pad of the distal phalynx (Olivieri, Scarano, Padula, Giasi, & Priolo, 2006). This disease is characterized by a single, purulent, large bulla near the lateral nail folds (see Figure 2).

Figure 2.

Blistering distal dactylitis


Caused by Group A - hemolytic Streptococcus, gram stain of the blister fluid will show grampositive cocci in chains. Occasionally, Staphylococcus aureus can cause blistering distal dactylitis, especially in children with atopic dermatitis.


Blistering distal dactylitis responds best to incision and drainage followed by warm compresses and a course of oral antibiotics. Complications of untreated disease include onychomadesis (proximal separation of the nail plate from the nail bed), onycholysis (distal separation of the nail plate from a disruption at the onychodermal band), or permanent nail dystrophy.

Patient Education

Children should be instructed in good handwashing technique to prevent the spread of infection.


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