Prepared by Seung Young Huh, MD, Resident, and Mohamud R. Daya, MD, MS,
Faculty and Attending Physician, Department of Emergency Medicine, Oregon Health & Science University, Portland, Ore

A 37-year-old woman presents to the emergency department complaining of painful blisters on her fingertips. Four days ago, while installing some carpet, she rummaged an old hardware container at a salvage yard. The next day she noticed blisters on the tips of her thumbs and on the index and middle fingers of both hands (Figure). She attempted to drain these using a needle; the blisters expressed purulent material. She was seen 2 days ago at another facility, where incision and drainage were performed on one of the blisters, and trimethoprim/ sulfamethoxazole (Bactrim, Septra) was prescribed. The patient denies any history of intravenous (IV) drug abuse.

What?s Your Diagnosis?

Herpetic whitlow

Bullous impetigo

Blistering distal dactylitis

Friction burns