red sore bumps on hand - chillblains? hand, foot, § mouth disease?

[Asiapanic]

Happy holidays and thanks for your help.

A 34-yr old white male living in rural Japan, I noticed 2-3 days ago a red bump, looked to be coming from under the skin on 1 finger.  Over time noticed more - on both hands.  Today, on left hand: 4 on index (2 on outside side, 1 the inside side, 1 on outside knuckle), 1 on palm, thumb-side of center.  On my right: 2 on middle (1 below upper joint, index side; other palm-side knucklemost section); 1 palm below pinky knuckle.  Small; size varies, but ca. sm. letter "o".  Raised but to tell need to see in profile vs. from above.  Over time recede & a flesh-colored (fluid-filled?) center becomes more noticeable.  Don't itch.  In early stage if I touched one directly, even by accident, I felt a sharp jolt of pain, strong but not staggering.  Over time, lose color, height, & sensitivity; by today PM I can massage most w/o discomfort.  Tried taking pictures but they didn't turn out well.  

Last night I thought I was beginning to feel a similar pain on a toe; next AM roof of mouth was red/sore, ditto those two little areas near the canines, also a bump on the lower left inner cheek wall.  Phlegm was clear AM, but PM on the yellow side.

You may recall that out of guilt etc. I worry about herpes.  I don't think it would present this way & don't think I have it (a few mo.s ago blood test was neg., but I don't think Japan does type-specific), but given my habit of worrying, & tomorrow non-emergency care across Japan begins a week's holiday, I wanted to show a dr. & make sure not contagious as I change dtr.s diapers, etc.  Derm. is hrs. away so I went to my GP.  Consultation was in Japanese, in which I am good but not fluent.

My 2 ideas were:
(1) Chillblains - weather & our old house are cold & dry; we mostly use cold water to wash hands & dishes.  Mouth - probably scraped/burned my mouth at diner the night before.

(2) Hand, foot, & mouth disease - currently spreading among kids here, & last wk. I played Santa at 4 schools, including a day care where 1 kid has it.  My dtr goes to that day care & has a cold now (cough last night - but due to dry heated air? - sneezing/runny nose now; no fever, no bumps like mine).

GP looked at & felt hands, less carefully at feet, hardly in mouth.  Said: Neither.  HFM or other internal cause would be more dramatic or widespread.  Diagnosis - External contact, maybe small dust-sized mite bit me.  Not contagious to touch.  Treatment: Wait; will go away on their own; might re-occur if I get re-bit/cut, else not.

Sounds conceivable: I did just start using an old blanket which had been lying around & didn't hang it out in the sun & air beforehand.  Or maybe bathtub fungus got in cracks in dry skin?  

But I wanted to confirm (1) not something scary (herpes), contagious to the touch (warts), or weird (old tack poked thru a fingernail -> tetanus?); (2) not HFM or chillblains; (3) proposed treatment is sufficient; (4) prevention tips?

Thanks again.

[Alan Rockoff, MD]

The widespread distribution suggests a viral cause, though not herpes, which doesn't affect such distant areas all at once.  Which virus I can't say, though hand-foot-mouth sounds plausible.  Basically, it doesn't matter, since it will likely go away shortly with no treatment in any case.  Warts are not at all likely and are not contagious to touch.  Mites don't sound possible.  Chilblains are firm and not blistery, but the bumps you describe don't really sound like blisters.  If they are chilblains, all you need to or can do is warm the areas.  I think the GP's advice to watch and wait is sound.

Best.

Dr. Rockoff

[Asiapanic]

Dear Dr. Rockoff,

Thanks for your speedy and detailed reply.  

The bumps have continued their fade-out.  None is painful to touch anymore.  Most have a dull red center now, surrounded by a pinkish circle.  Only one (inside left index finger) looks like it has a yellowy/fleshy-colored central "sac" that protrudes more pronouncedly; it looks mostly the same as it did yesterday, it seems.  I have resisted the temptation to try to pop it, so I can't tell you what is inside.  None seem to be "scabbing over" -- it just looks like the skin swelled in these varied areas, producing more or less redness and pain, and now is receding, leaving red circular discolorations in its wake.  On top, they feel no different than other parts of my skin - if you run a fingertip across one, they just feel like little solid bumps, not especially wet, dry, sticky, itchy, scabby, anything.  

As for other parts of my body, no more bumps have appeared than the several on each hand I described.  I kept waiting to see one on one of my toes, but none ever appeared.  The roof of my mouth is less red and painful than it was, and the two side parts are totally better.  The bump on the inner mouth has always been a firm, smooth, broad, oval-shaped reddish one, close to the apposite gumline, rather than white and angry-painful like a cankersour.  

A little over a half-day after I wrote the first letter - i.e. about five hours ago, right after dinner -- I felt a sort of wave of ill-feeling come over me - yukky / a bit queasy / tired / cruddy, I wouldn't say achy but maybe irritable.  I took it easy for the rest of the evening and that feeling passed, but now (late in the evening) I have a sore throat - like a lump in my throat when I swallow, hurts a tad if I talk (I'll bet you wish it hurt when I type so I would shut up).  

So in the end the bumps seem to have been confined to my two hands, and are fading away, while these other cold symptoms are developing.  Are different fingers on two separate hands "distant" enough to rule out herpes?  Sorry to be hung up on that.  Of course viruses cause flus and things, my daughter is sick and I probably just have her cold, and it is the end of the day when throats are dry, but I've read that "flu-like symptoms" are associated with herpes onsets so I am afraid I am a bit jumpy when I have them at the same time as some skin event.  Because I thought I understood the Japanese GP to say that my case wasn't widespread enough to look viral-caused to him, the vagueness in my fear-prone mind about how widespread/distant is widespread enough to be viral without being herpes is unsettling.  

May I just verify your opinion?  In light of all this, you would still maintain: The cause is (1) probably viral, but (2) not herpes no way stop obsessing.  They are (3) not contagious to touch, and (4) the fact that I have got a cold/flu starting at the same time is perfectly consistent with a non-herpes diagnosis, it could be one of a bunch of other little viral things that my body will probably fight off in time for New Year's champagne.  If and when they go away, I should (5) not give them another thought.  The lingering of one spot or another for a week, a continued sore throat, feeling tired, a momentary twinge on an arm or itch on the waistline -- none of this is worth getting upset about.  Danger signs would be (6) more pain, a host more bumps, scabbing, unmistakable blisters, drastic stuff like that - and none of that is expected, but if anything like that happens, run to the doctor.  

Thanks and I apologize for needing the extra reassurance.

[Alan Rockoff, MD]

Flu-like symptoms are indeed consistent with a viral (non-herpes) diagnosis, as si a sore throat.  Having the bumps on the hands and feet is too widespread a distribution for herpes to be a consideration.  Waiting it out seems advisable.

Dr. Rockoff

[lauren12336]

I have had these types of bumps, from what you're describing, for years ever since I was little.  I still get them occasionally -- I'm 17--, mostly on my fingers behind the cuticles, sometimes other places on my fingers.  I do also get them on my toes and sometimes, it seems, on my tongue.  I have never been able to find some type of pattern for the breakouts, though i think i do get them more often in the spring.  I always thought, because of them appearing on feet, hands, and mouth, that it might be some mutated, recurring form of HFM disease, which i did have as a child.

[lauren12336]

As far as contagious, no one else in my family has ever gotten them. sometimes it seems like i'm having an "outbreak" with up to about 10 bumps fingers and toes total, but i've never had problems with them scabbing and they've never oozed or anything.  I did show my doctor them one time, not that there was much to see, and she didn't really have an explanation either

[deena1234]

I too have often wondered about what these were.  I have been told by an MD that it was HFM, but was under the impression that you would only get that once in your life.  Mine recoccur frequently.  Does anyone know if this is normal.  I have never had them anywhere but on my hands, and they have never been associated with flulike symptoms.

[kat474]

A related discussion, little blistey red bumps all over body was started.