- HSV infection of distal finger
- Usually occurs from contact with 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
Herpetic whitlow with erythema and vesicles.
- 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
- Clinical diagnosis, based on history and physical exam
- Available laboratory studies (not required for diagnosis):
- Viral culture (gold standard)
- Direct immunofluorescence
- Tzanck smear (poor specificity)
Antivirals such as Acyclovir or Valacyclovir may shorten duration of infection
- Topical acyclovir 5% shortens duration and viral shedding in primary infection
- Oral acyclovir dosing - 800mg BID initiated during prodrome may prevent recurrence
- Application of clean dressings to involved digits is important to prevent autoinoculation or spread to other individuals
- ↑ Wu IB, Schwartz RA. Herpetic whitlow. Cutis. Mar 2007;79(3):193-6
- ↑ Mohan RPS, Verma S, Singh U, Agarwal N. Acute primary herpetic gingivostomatitis. BMJ Case Reports. 2013;2013:bcr2013200074. doi:10.1136/bcr-2013-200074.
- ↑ 3.0 3.1 Nikkels AF, Pierard GE. Treatment of mucocutaneous presentations of herpes simplex virus infections. Am J Clin Dermatol. 2002;3(7):475-87.