Differential Diagnosis for a 4-year-old Girl with Blisters on Her Left Hand
- Single most likely diagnosis:
- Impetigo: The presence of golden-yellow crusting on the vesicles and pustules, especially in the web spaces and over the joints, is highly suggestive of impetigo, a common bacterial skin infection in children. The patient's history of eczema and the appearance of the lesions support this diagnosis.
- Other Likely diagnoses:
- Eczema herpeticum: Given the patient's history of eczema and the presence of vesicles and pustules, eczema herpeticum (a disseminated herpes simplex infection in the setting of eczema) is a possible diagnosis. The fever and the appearance of the lesions also support this possibility.
- Contact dermatitis: The patient's history of eczema and the presence of erythema, dryness, and scaling on the hand suggest contact dermatitis as a possible diagnosis. However, the presence of golden-yellow crusting and the specific distribution of the lesions make this less likely.
- Dyshidrotic eczema: This condition is characterized by small, itchy vesicles on the hands and feet, often accompanied by erythema and scaling. While the patient's symptoms could be consistent with dyshidrotic eczema, the presence of golden-yellow crusting and the specific distribution of the lesions make impetigo more likely.
- Do Not Miss diagnoses:
- Cellulitis: Although less likely given the specific appearance of the lesions, cellulitis is a serious infection that requires prompt treatment. The presence of fever and erythema supports the possibility of cellulitis, and it should not be missed.
- Necrotizing fasciitis: This is a rare but life-threatening condition that requires immediate attention. While the patient's symptoms do not strongly suggest necrotizing fasciitis, it is essential to consider this diagnosis in any case of skin infection with fever and erythema.
- Rare diagnoses:
- Pemphigus vulgaris: This is a rare autoimmune blistering disease that can present with vesicles and pustules on the skin. However, it is unlikely in a 4-year-old child and would typically be accompanied by other systemic symptoms.
- Bullous pemphigoid: Another rare autoimmune blistering disease, bullous pemphigoid is characterized by large, tense blisters on the skin. While it is possible in children, it is much less common than other diagnoses listed here.