Finger Blister (ER)

A week ago, a mysterious blister showed up on two-year-old
Mackenzie’s finger, “and the lesion at that time, was
a solitary lesion, and the physician who saw her suspected that
it may have been an infection of the paronychia tissue around the
nail bed,” explains Dr. Mike Ziegler.

She was treated with antibiotics, but after a few days it appeared
to be getting worse. Now, Dr. Ziegler, at Children’s Healthcare
of Atlanta, thinks it might be a herpes virus. “It’s
the virus that can cause lesions in the mouth, blisters, ulcers,
things like that,” he explains, “Basically, children
put their fingers in their mouth and they suck on those fingers,
and the virus is inoculated into the tip of the finger, usually
around the nail bed.”

The treatment usually is Acyclovir, an antiviral medication,
but an examination of her medical history complicates things. “Now
does she have any history of medical problems prior to this?” asks
the doctor. “Um,” Mackenzie’s mom laughs uncomfortably, “yeah,
she’s got a lot of stuff going on.”

Mackenzie has a history of kidney problems, “and anytime
you have a problem with your kidney’s or liver, you have
to be very careful about medications that you administer,” Ziegler
says.

The medication could damage her already fragile kidneys. After
a call to the infectious disease clinic, a decision is made, “their
feeling was that the addition of Acyclovir would have some minimal
benefit,” the doctor tells Mackenzie’s mom, “but
with her renal issues they felt like the risk was high, and they
felt like it was probably not a good idea to start the Acyclovir
right now.”

For now, Mackenzie is sent home, and in seven to ten days her
finger will heal on it’s own.

According to the University of Pennsylvania School of Dental Medicine
(SDM), cold sores and blisters are caused by localized viral infections,
which typically produce clusters of blisters on the lip, inside the mouth,
and sometimes on other areas of the body. The most common viral infection
that causes such sores is the herpes simplex virus type 1 (HSV-1), which
the American Academy of Pediatrics (AAP) says is prevalent during childhood.
The American Medical Association (AMA) reports that more than 90 percent
of adults aged 30 or older have blood tests that show evidence of having
had HSV-1 infection at some time in their lives.

HSV-1 is highly contagious and is spread from person to person
by direct contact with herpes sores or blisters. The AAP says that
most infants are protected by their mothers’ antibodies up to about
age 6 months, but they become susceptible after that period of time.
HSV-1 may also be passed in the saliva of persons with cold sores.
In fact, about 5 to 8 percent of kids pass HSV-1 in their saliva
without having symptoms of cold sores.

How can you determine if your child develops HSV-1? The AMA says
that a child who develops HSV-1 for the first time (primary herpes)
may show the following symptoms:

• Blisters that form on the lips, on the inside of the mouth,
  on the hands, etc.
• Blister that develop into painful ulcers
• Gums that are red and swollen
• A white coating on the tongue
• Fever
• Muscle aches
• Eating difficulties
• A generally ill feeling
• Irritability
• Swollen neck glands

However, many children have such mild symptoms that no one realizes
they have the virus. The AAP reports that once a child has had primary
herpes, he or she becomes a carrier of the virus. This means that the
virus, usually in an inactive state, remains within the child’s
system. During episodes of stress (including other infections), injury
to the mouth, sunburn, allergies and fatigue, the virus can become
reactivated, producing what’s called secondary herpes. The AAP says
that this condition is similar to, but generally milder than, the primary
infection and usually doesn’t occur until later in childhood or adulthood.

Your pediatrician usually can diagnose HSV-1
by simply examining the affected area of skin. Experts at the University
of Pennsylvania SDM say that more sophisticated methods of diagnosis include
virus cultures, immunofluorescence (IF) or immunoperoxidase (IP) studies
to detect HSV-1 in cells scraped from the infected area. But these tests
are usually not necessary in otherwise healthy patients.

Symptoms of HSV-1 may last from three to 14 days, according to
the AMA. If your child has a severe infection or has a weak immune
system, the pediatrician may prescribe an antiviral drug to treat
his or her HSV-1. Although these drugs can relieve symptoms and shorten
the duration of the illness, the AAP says that they are not cures
and do not prevent recurrences.

Most children, however, do not need antiviral therapy since HSV-1
usually runs its course. The AMA cautions that it is important to
keep your child hydrated during this infection. The AMA offers the
following advice to help relieve your child’s discomfort from HSV-1:

• Cool, soft, bland foods are usually better tolerated than other
  foods, but whatever your child will eat or drink is okay while
  he or she has a sore in the mouth. If your child is over a year
  of age, you can offer cool honey. Other foods that may be easy
  to eat include ice cream, mashed potatoes and yogurts.
• If your child is older than 6 months, you may find that applying
  an ice cube directly to his or her cold sore or blister for short
  periods of time can be another way of relieving pain.
• You may give your child acetaminophen (such as Tylenol) for
  his or her pain. As a general rule, aspirin should not be given
  to children with viral infections, since the use of aspirin in
  such cases has been associated with the development of Reye’s syndrome.
• You may use topical therapy – such as lip balm – to
  help relieve discomfort.
• Quiet activities – like board games, puzzles and model
  building – may help to keep your child preoccupied so that
  he or she does not focus on the pain.

While no cure for HSV-1 exists, the Centers for Disease Control
and Prevention says that you can help prevent the spread of the virus
by following these rules:

• Make sure everyone in your home uses good hand-washing practices.
• Be wary of drinking or eating after others.
• Do not kiss someone with cold sores, fever blisters, etc., or
  allow kiss others while you are infected.
• Always wash hands after
  applying medicated ointment to the sores or after touching them.