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 | **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 | |||
[[File:Herpetic Witlow 2015-01-06 04-30.jpg|thumb|Whitlow]] | |||
==Clinical Features== | ==Clinical Features== | ||
[[File:Herpetic whitlow in young child.jpg|thumbnail|Herpetic whitlow]] | |||
[[File:PMC4236959 CRIOR2014-906487.003.png|thumb|Herpetic whitlow with erythema and vesicles.]] | |||
*Same burning, pruritic sensation as from other herpes infections | *Same burning, pruritic sensation as from other herpes infections | ||
*Vesicular | *Vesicular bullae | ||
*Finger may be indurated and tender (but should not be tense, as in a felon) | *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 Infection DDX}} | |||
{{HSV-1 DDX}} | |||
== | ==Evaluation== | ||
{{HSV-1 standard diagnosis}} | |||
== | ==Management== | ||
*Immobilization, elevation, [[analgesia]] | |||
===[[Antivirals]]=== | |||
''Antivirals 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 - 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== | ==See Also== | ||
*[[Hand | *[[Hand and finger infections]] | ||
*[[Herpesvirus]] | *[[Herpesvirus]] | ||
== | ==References== | ||
<references/> | |||
[[Category: | [[Category:Orthopedics]] | ||
Latest revision as of 23:20, 19 May 2022
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
Clinical Features
- Same burning, pruritic sensation as from other herpes infections
- Vesicular bullae
- 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
- 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
Herpes Simplex Virus-1
- Eczema herpeticum
- Herpes gingivostomatitis
- Herpes keratitis
- Herpes labialis (cold sore)
- Herpes simplex encephalitis
- Herpetic whitlow
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
- Immobilization, elevation, analgesia
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
- ↑ 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.