Herpetic whitlow

Background

• HSV infection of distal finger
  • 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

Whitlow

Clinical Features

Herpetic whitlow

• 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

• Digital mixoid cyst

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

• Topical acyclovir 5% shortens duration and viral shedding in primary infection
• 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

Disposition

• Outpatient managment

See Also

• Hand and finger infections
• Herpesvirus