Vesicular distal phalangeal inflammation

　　1. Etiology

　　The causative bacteria are beta (β) hemolytic streptococcus, and can also be accompanied by coagulase-positive Staphylococcus aureus infection. In some patients, the lesions can be isolated from the nasal cavity, around the nostrils, and the pharynx can also isolate beta (β) hemolytic streptococcus.

　　2. Pathogenesis

　　Gram-positive cocci, the bacterial culture is beta (β) hemolytic streptococcus, which invades the skin damaged during children's play, causing blisters or pustules.

　　The main complications of this disease are due to infection after skin and mucosal damage, as the integrity of the skin is destroyed, it can cause skin bacterial infection or fungal infection due to scratching by the patient. It usually occurs in individuals with weakened physique, or those who have long-term use of immunosuppressants, or patients with onychomycosis and other fungal infections. If bacterial infection occurs, symptoms such as fever, skin swelling, ulceration, and purulent secretion may be present. Severe cases can lead to sepsis, so it should attract the attention of clinical doctors.

　　It is mostly characterized by blisters or pustules surrounded by erythema, located on the palm side of the single or several fingers from the first to the third phalanges, occasionally the same damage can be seen at the nail groove. It is自觉 painful and itchy, without lymph node enlargement and fever. It commonly occurs in children aged 2 to 12 years, and can also be seen in adults. The smear of vesicle fluid can show a large number of polymorphonuclear leukocytes and Gram-positive cocci, and the bacterial culture is beta (β) hemolytic streptococcus.

　　1. In units prone to purulent skin diseases (such as some factories, agricultural machinery stations, primary schools, etc.), extensive publicity and education on the prevention and treatment of purulent skin diseases should be carried out, regular preventive examinations should be carried out, and all factors conducive to the onset should be eliminated as far as possible.

　　2. Pay attention to skin hygiene, strengthen physical exercise, and enhance the resistance of the skin.

　　3. Maintain the integrity of the skin function. For skin diseases, especially pruritic skin diseases, timely and reasonable treatment should be carried out. Prevent and treat skin damage, avoid scratching and skin friction and other stimulations.

　　4. Clothing, hats, towels, basins, etc. are prohibited from being used together to prevent contact transmission and to isolate the patient appropriately. The dressings and objects used by the patient should be strictly disinfected or incinerated. During the illness, in addition to washing the skin lesions with medicine, it is forbidden to wash the affected parts with tap water to prevent spread.

　　5. It is forbidden to drink alcohol or eat spicy and stimulating foods during the onset. Eat less rich food.

       The diagnosis of bullous distal digital tenosynovitis relies on clinical manifestations, mostly bullae or pustules, surrounded by erythema, located on the palm side of the single or several fingers from the first to the third phalanges. Related examinations are also indispensable, and positive bacterial culture is conducive to diagnosis.

　　In addition to routine treatment, it is forbidden to drink alcohol or eat spicy and stimulating foods during the onset of bullous distal digital tenosynovitis. Avoid greasy, fried, grilled, smoked and other hot foods, such as lamb, ham, smoked meat, fatty meat, etc.

　　Oral or topical antibiotics. Pustule drainage and wet dressing can achieve good effects. For example, 5-10mg/kg of erythromycin orally, 4 times a day, cef拉德琳 5mg/kg per day, divided into 4 doses. Topical 0.5% neomycin ointment or 0.5% pseudomonas acid ointment. The use of antibiotics, pustule drainage, wet dressing, and oral methicillin for 10 days can achieve good effects.