Herpetic whitlow

Background
  • HSV infection of distal finger[1]
    • 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
Whitlow

Clinical Features
Herpetic whitlow
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

Differential Diagnosis

Hand and finger infections

Herpes Simplex Virus-1

Evaluation
  • Clinical diagnosis, based on history and physical exam
  • Available laboratory studies (not required for diagnosis)[2]:
    • Viral culture (gold standard)
    • Direct immunofluorescence
    • Tzanck smear (poor specificity)

Management

Antivirals

Antivirals such as Acyclovir or Valacyclovir may shorten duration of infection[3]

  • Topical acyclovir 5% shortens duration and viral shedding in primary infection[3]
  • Oral acyclovir dosing - 800mg 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

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