II. Definition

  1. Herpes Simplex Virus infection of the finger tip

III. Causes

IV. Mechanism

  1. Infection via broken skin

V. Risk Factors

  1. Children with active Herpes Gingivostomatitis
  2. Women with Genital Herpes
  3. Healthcare workers

VI. Symptoms

  1. Single digit with pain, itching and swelling
  2. Fever

VII. Signs

  1. Vesicles (appear after symptom onset above)
    1. May coalesce over 2 weeks
    2. Forms ulcer with hemorrhagic base
  2. Lymphadenopathy
    1. Epitrochlear Lymphadenopathy
    2. Axillary Lymphadenopathy

VIII. Differential Diagnosis

IX. Labs

  1. Tzanck Smear
  2. Viral culture

X. Management

  1. Prevent transmission
    1. Keep lesion bandaged
  2. Antiviral agents
    1. Indications
      1. Recurrent infection
      2. Immunocompromised status
      3. Consider in first 48 hours to shorten course
    2. Agents
      1. Acyclovir 400 mg PO tid for 7 days
      2. Famciclovir (Famvir)
      3. Valacyclovir (Valtrex)

XI. Course

  1. Resolves spontaneously in 3 to 4 weeks
  2. Recurs in 30 to 50% of cases
    1. Recurrence is usually more mild than initial event

XII. References

  1. Cory in Mandell (2000) Infectious Disease, p. 1569-71
  2. Antosia in Marx (2002) Rosen's Emergency Medicine, 530
  3. Clark (2003) Am Fam Physician 68:2167-76 [PubMed]

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Ontology: Herpetic whitlow (C0153042)

Concepts Disease or Syndrome (T047)
ICD9 054.6
SnomedCT 43891009
Dutch herpetische fijt
French Panaris herpétique
German herpetisches Panaritium
Italian Patereccio erpetico
Portuguese Panarício herpético
Spanish Panadizo herpético, panadizo herpético (trastorno), panadizo herpético
Japanese ヘルペス性ひょう疽, ヘルペスセイヒョウソ
English herpetic felon, herpetic felon (diagnosis), herpetic whitlow, whitlow herpetic, Herpetic whitlow, Herpetic felon, Herpes simplex whitlow, Herpetic whitlow (disorder)
Czech Herpetické panaricium
Hungarian Herpetikus körömágygyulladás