Herpetic whitlow: Difference between revisions
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*Symptoms improve, crust over, and heal after 10-14 days with viral shedding terminating at this point | *Symptoms improve, crust over, and heal after 10-14 days with viral shedding terminating at this point | ||
*Complete resolution by 15-21 days | *Complete resolution by 15-21 days | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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{{HSV-1 DDX}} | {{HSV-1 DDX}} | ||
==Diagnosis== | |||
*If unsure of diagnosis can unroof a vesicle and send fluid for a Tzanck smear | |||
==Treatment== | ==Treatment== | ||
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*[[Herpesvirus]] | *[[Herpesvirus]] | ||
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<references/> | <references/> | ||
[[Category:Ortho]] | [[Category:Ortho]] | ||
Revision as of 13:11, 20 July 2015
Background
- HSV infection of distal finger[1]
- Usually occurs from contact w/ oral herpes, or autoinoculation from genital herpes
- Incubation period of 2-20 days, with possible prodrome of fever or malaise
- 60% due to HSV-1, 40% due to HSV-2
Clinical Features
- Same burning, pruritic sensation as from other herpes infections
- Vesicular ullae
- Finger may be indurated and tender (but should not be tense, as in a felon)
- Rash develops over 7-10 days, with possible ulceration and rupture
- Symptoms improve, crust over, and heal after 10-14 days with viral shedding terminating at this point
- Complete resolution by 15-21 days
Differential Diagnosis
Hand and finger infections
- Bed bugs
- Closed fist infection (Fight Bite)
- Hand cellulitis
- Hand deep space infection
- Hand-foot-and-mouth disease
- Herpetic whitlow
- Felon
- Flexor tenosynovitis
- Paronychia
- Scabies
- Sporotrichosis
Look-Alikes
Herpes Simplex Virus-1
- Eczema herpeticum
- Herpes gingivostomatitis
- Herpes keratitis
- Herpes labialis (cold sore)
- Herpes simplex encephalitis
- Herpetic whitlow
Diagnosis
- If unsure of diagnosis can unroof a vesicle and send fluid for a Tzanck smear
Treatment
- Immobilization, elevation, analgesia
Anitivirals
- Ativirals such as Acyclovir or Valacyclovir may shorten duration of infection[2]
- Topical acyclovir 5% shortens duration and viral shedding in primary infection[2]
- Oral acyclovir dosing - 800 mg BID initiated during prodrome may prevent recurrence
Secondary Prevention
- Application of clean dressings to involved digits is important to prevent autoinoculation or spread to other individuals