Herpetic Whitlow

1. See Also
   1. Hand Infection
2. Definition
   1. Herpes Simplex Virus infection of the finger tip
3. Causes
   1. Herpes Simplex Virus I Infection (Oral Herpes)
   2. Herpes Simplex Virus II Infection (Genital Herpes)
4. Mechanism
   1. Infection via broken skin
5. Risk Factors
   1. Children with active Herpes Gingivostomatitis
   2. Women with Genital Herpes
   3. Healthcare workers
6. Symptoms
   1. Single digit with pain, itching and swelling
   2. Fever
7. 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
8. Differential Diagnosis
   1. See Hand Infection
   2. Felon
   3. Acute Paronychia
9. Labs
   1. Tzanck Smear
   2. Viral culture
10. 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)
11. 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
12. 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]