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Herpetic Whitlow

Reviewed 06/2019
 


BASICS

DESCRIPTION

  • Painful, self-limited, cutaneous viral infection of the finger(s), caused by herpes simplex virus (HSV-1 or HSV-2) (1)

  • Usually limited to distal phalanx (2); highly contagious and spr...

DIAGNOSIS

Diagnosis is mainly clinical, based on history and physical exam. 

HISTORY

  • Prodromal phase (3 to 7 days): abrupt onset of digital pain described as burning, itching, and tingling of digit or r...

TREATMENT

HW is a self-limited disease. Symptoms should improve after 10 to 14 days, and vesicular lesions should start to dry and crust over, resulting in well-healed skin in 21 to 28 days (5)[C]. 

GENERAL MEASURES

ONGOING CARE

COMPLICATIONS

  • Recurrence of milder symptoms at same location can be triggered by physiologic or psychological stressors (illness, fever, sun exposure, menstruation).

  • Secondary bacterial inf...

REFERENCES

1
Rubright JH, Shafritz AB. The herpetic whitlow. J Hand Surg Am.  2011;36(2):340–342. [View Abstract on OvidMedline]
2
Gill MJ, Arlette J, Tyrrell DL, et al. Herpes simplex virus infecti...

ADDITIONAL READING

  • Avitzur Y, Amir J. Herpetic whitlow infection in a general pediatrician—an occupational hazard. Infection.  2002;30(4):234–236. [View Abstract on OvidMedline]

  • Brkljac M, Bitar S...

CODES

ICD10

B00.89 Other herpesviral infection 

ICD9

054.6 Herpetic whitlow 

SNOMED

43891009 herpetic whitlow (disorder) 

CLINICAL PEARLS

  • Incision and drainage of vesicular lesions is contraindicated because this can cause secondary bacterial infection, delay resolution, and increase risk of systemic symptoms.

  • HW will not...

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