II. Definition
- Herpes Simplex Virus infection of the finger tip
III. Causes
- Herpes Simplex Virus I Infection (Oral Herpes)
- Herpes Simplex Virus II Infection (Genital Herpes)
IV. Mechanism
- Infection via broken skin
V. Risk Factors
- Children with active Herpes Gingivostomatitis
- Women with Genital Herpes
- Healthcare workers
VI. Symptoms
- Initial outbreak
- Single digit (typically a finger) with pain, itching and swelling
- Fever
- Recurrent outbreak
- Localized mild burning and itching may precede recurrence by up to 2-3 days
VII. Signs
-
Vesicles over an erythematous base (appear after symptom onset above)
- Contain clear fluid which may become opaque and clouded over time
- May coalesce into bullae over 2 weeks
- Forms ulcer with hemorrhagic base
- Lymphadenopathy
VIII. Differential Diagnosis
IX. Labs
- Not indicated in most cases where the diagnosis is clear (clinical diagnosis is the norm)
- Diagnostic testing when indicated
- Tzanck Smear
- Viral culture
- Fluid from lanced Vesicle for HSV PCR
X. Management
- Avoid lancing lesions (aside from diagnostic testing)
- Lancing increases the risk of Bacterial superinfection
- Prevent transmission
- Keep lesion bandaged
- Keep bandages dry
-
Antiviral Agents
- Herpetic Whitlow is self limited and resolves spontaneously without treatment
- Indications
- Recurrent infection
- Immunocompromised status (risk of disseminated HSV)
- Consider in first 48 hours to shorten course
- Agents
- Acyclovir 400 mg PO tid for 7 days
- Famciclovir (Famvir)
- Valacyclovir (Valtrex)
XI. Course
- Resolves spontaneously in 3 to 4 weeks
- Recurs in 20 to 50% of cases
- Recurrence is usually more mild than initial event
XII. References
- Cory in Mandell (2000) Infectious Disease, p. 1569-71
- Antosia in Marx (2002) Rosen's Emergency Medicine, 530
- Clark (2003) Am Fam Physician 68:2167-76 [PubMed]
- Rerucha (2019) Am Fam Physician 99(4):228-36 [PubMed]