Herpetic whitlow

Background

• HSV infection of distal finger
  • Usually occurs from contact w/ oral herpes

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)

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
• Prevent autoinoculation or spread to other individuals by applying clean dressing

See Also

• Hand Infections
• Herpesvirus

Source

• Tintinalli