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

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

Diagnosis

• If unsure of diagnosis can unroof a vesicle and send fluid for a Tzanck smear

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

Treatment

• Immobilization, elevation, analgesia
• Acyclovir/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
• Prevent autoinoculation or spread to other individuals by applying clean dressing

See Also

• Hand Infections
• Herpesvirus

Source

• Tintinalli
• 1.Wu IB, Schwartz RA. Herpetic whitlow. Cutis. Mar 2007;79(3):193-6
• 2.Nikkels AF, Pierard GE. Treatment of mucocutaneous presentations of herpes simplex virus infections. Am J Clin Dermatol. 2002;3(7):475-87.