Herpetic whitlow: Difference between revisions
Neil.m.young (talk | contribs) (Text replacement - "==Diagnosis==" to "==Evaluation==") |
|||
| (2 intermediate revisions by 2 users not shown) | |||
| Line 7: | Line 7: | ||
==Clinical Features== | ==Clinical Features== | ||
[[File:Herpetic whitlow in young child.jpg|thumbnail|Herpetic whitlow]] | [[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 | *Rash develops over 7-10 days, with possible ulceration and rupture | ||
| Line 23: | Line 24: | ||
==Management== | ==Management== | ||
*Immobilization, elevation, analgesia | *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> | *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 | *Oral [[acyclovir]] dosing - 800mg BID initiated during prodrome may prevent recurrence | ||
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.