Very red fingers

Paediatric dermatology

Dr. Emmanuelle Bourrat

Saint-Louis Hospital

The clinical case
Now it's your turn!
Co-prescription and advice

Clinical case presentation

A 6-year-old boy, treated in dermatology for a congenital nevus, took advantage of his annual consultation to show us a peculiar appearance of his fingertips that had been evolving for two weeks. He had no family or personal history of atopic dermatitis or psoriasis. There was no history of a recent febrile exanthem or contact with a caustic product. The child had returned 48 hours earlier from vacation and reported spontaneous improvement since then.

On examination, there was erythematous, desquamating digital pulpitis of the fingertips, involving exclusively the pulpal surface of the third phalanx (second phalanx for the thumbs), while the rest of the skin was strictly normal, including on the feet and toes. Simple questioning about recent summer activities allowed diagnosis.

Your turn

What is your diagnosis?

Select 1 answer(s) from the following choices:

Contact eczema

Psoriatic digital pulpitis

Swimming pool pulpitis

Mercury poisoning (pink disease)

Wrong answer!

Good answer!

Selected diagnosis

This is a case of swimming pool pulpitis, a mechanical dermatitis caused by repeated friction of the palms or fingertips on the rough edge of a pool.

In this young beginner swimmer, the small size of his arms prevented him from gripping the edge of the pool with his full hand, but only with his fingertips. This explains the very distal location of the dermatitis, which usually affects the palms (“pool palms” in the English-language literature). The parents confirmed that the dermatitis began soon after he started intensive use of the pool at the vacation resort and has improved since this activity was stopped.

Explanation of wrong answers

The very distal topography of this fingertip pulp erythema is not suggestive of contact dermatitis.
The absence of distant lesions is not very suggestive of psoriatic digital pulpitis, especially since the nails are normal.
Pink disease is the pediatric manifestation of mercury poisoning in children. It is characterized by severe pain in the extremities (acrodynias) associated with hyperhidrosis and pink erythema of the fingers. The extreme rarity of this poisoning in France and the absence of pain in this child argue against this diagnosis.

Treatment

None, because this benign, painless dermatitis disappeared spontaneously when the child stopped using the pool.

Message from the expert

Dermatoses of the hands and fingers are often caused (contact eczema, irritant dermatitis) or aggravated (atopic eczema, psoriasis) by a hobby, sport or other manual activity, which should be investigated during the history-taking in both children and adults.

References

^{Lacour JP.}^{Juvenile palmar dermatitis acquired at swimming pools}^{Ann Dermatol Venereol. 1995;122(10):695-6.}