Dermatology: Practical and Conceptual


Image Letter | Dermatol Pract Concept. 2023;13(4):e2023200 1

Hemorrhagic Blister in an Infant 
Iria Neri1, Luca Rapparini1,2, Francesco Paolo Salamone1,2, Miriam Leuzzi1,2, 

Carlotta Gurioli1, Bianca Maria Piraccini1,2

1 Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy

2 Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy

Citation: Neri I, Rapparini L, Salamone FP, Leuzzi M, Gurioli C, Piraccini BM. Hemorrhagic Blister In An Infant.  
Dermatol Pract Concept. 2023;13(4):e2023200. DOI: https://doi.org/10.5826/dpc.1304a200

Accepted: February 14, 2023; Published: October 2023

Copyright: ©2023 Neri et al. This is an open-access article distributed under the terms of the Creative Commons  
Attribution-NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted 
noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited.

Funding: None.

Competing Interests: None.

Authorship: All authors have contributed significantly to this publication.

Corresponding Author: Luca Rapparini, Dermatology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum, 
University of Bologna, Bologna, Italy. Mail: luca.rapparini2@studio.unibo.it. ORCID 0000-0002-4029-941X

Case Presentation

An 8-month-old boy was referred to us for evaluation of a 

large hemorrhagic tense blister with a pink rim involving 

the dorsum of the right hand (Figure 1). He was otherwise 

healthy and had a normal development (findings from his 

physical examination were normal). The parents denied in-

sect bite and frequent sucking of his right hand was reported. 

The diagnosis of solitary mastocytoma with a hemorrhagic 

blister was suspected. The blister was drained and healed in 

seven days. At this time a sharply demarcated pink plaque 

with a leathery texture was evident. Darier’s sign was pos-

itive confirming the diagnosis of mastocytoma. Topical clo-

betasol propionate therapy has been set with benefit.

Teaching Point

Mastocytoma is a variant of cutaneous mastocytosis can 

appear at birth or in the first months of life with indurated, 

erythematous, yellow-brown macules, plaques or nodules 

[1,2]. At the extremities and in sites subjected to friction or 

pressure the lesions may blister as in our case. However, the 

hemorrhagic blister described in diffuse cutaneous mastocy-

tosis are rarely observed in mastocytoma. We have assumed 

that the site and repeated trauma for the habit of sucking the 

hand are the cause of hemorrhagic blister. This lesion in in-

fancy may be mistaken for epidermolysis bullosa, arthropod 

bite reaction or child abuse. 



2 Image Letter | Dermatol Pract Concept. 2023;13(4):e2023200

References

1. Nemat K, Abraham S. Cutaneous mastocytosis in childhood. 

 Allergol Sel. 2022;6(01):1–10. DOI: 10.5414/ALX02304E. 

PMID: 35028497. PMCID: PMC8750954.

2. Valent P, Akin C, Hartmann K, et al. Updated Diagnos-

tic  Criteria and Classification of Mast Cell Disorders: A 

 Consensus Proposal. Hemasphere. 2021;5(11):e646. DOI: 

10.1097/HS9.0000000000000646. PMID: 34901755. PMCID: 

PMC8659997.

Figure 1. Solitary mastocytoma with a hemorrhagic blister.