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Herpetic Whitlow
Aka: Herpetic Whitlow
- See Also
- Hand Infection
- Herpes Simplex Virus
- Definition
- Herpes Simplex Virus infection of the finger tip
- Causes
- Herpes Simplex Virus I Infection (Oral Herpes)
- Herpes Simplex Virus II Infection (Genital Herpes)
- Mechanism
- Infection via broken skin
- Risk Factors
- Children with active Herpes Gingivostomatitis
- Women with Genital Herpes
- Healthcare workers
- 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
- 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
- Epitrochlear Lymphadenopathy
- Axillary Lymphadenopathy
- Differential Diagnosis
- See Hand Infection
- Felon
- Acute Paronychia
- Cellulitis
- Tuft Fracture
- 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
- 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)
- Course
- Resolves spontaneously in 3 to 4 weeks
- Recurs in 20 to 50% of cases
- Recurrence is usually more mild than initial event
- 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]