Herpetic whitlow: Difference between revisions
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==Background== | ==Background== | ||
*[[HSV]] infection of distal finger | *[[HSV]] infection of distal finger<ref>Wu IB, Schwartz RA. Herpetic whitlow. Cutis. Mar 2007;79(3):193-6</ref> | ||
**Usually occurs from contact w/ oral herpes, or autoinoculation from genital herpes | **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 | **Incubation period of 2-20 days, with possible prodrome of fever or malaise | ||
| Line 21: | Line 21: | ||
==Treatment== | ==Treatment== | ||
*Immobilization, elevation, analgesia | *Immobilization, elevation, analgesia | ||
*Acyclovir | ===Anitivirals=== | ||
*Ativirals such as Acyclovir or Valacyclovir may shorten duration of infection<ref name="treatment">Nikkels AF, Pierard GE. Treatment of mucocutaneous presentations of herpes simplex virus infections. Am J Clin Dermatol. 2002;3(7):475-87.</ref> | |||
*Topical acyclovir 5% shortens duration and viral shedding in primary infection<ref name="treatment"></ref> | |||
* | *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 | |||
==See Also== | ==See Also== | ||
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==Source== | ==Source== | ||
<references/> | |||
[[Category:Ortho]] | [[Category:Ortho]] | ||
Revision as of 13:44, 26 August 2014
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
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
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