Herpetic whitlow results from autoinoculation of type 1 or type 2 herpes simplex virus into broken skin and may occur as a complication of primary oral or genital herpes lesions.
Clinical findings
Self-limited and resolves in two to three weeks
- Abrupt onset of edema, erythema, and significant localized tenderness of the infected finger (pain is out of proportion to the physical findings)
- Fever, lymphadenitis, and epitrochlear and axillary lymphadenopathy
- Initially,
- Small, clear vesicles present
Diagnosis
- Tzanck test
- Scraping of an ulcer base to look for Tzanck cells
- Viral culture
- DNA amplification technique
Management
- Within first 48 hours of symptom onset:
- Acyclovir (Zovirax)
- Famciclovir (Famvir)
- Valacyclovir (Valtrex)
- Prevent incision and drainage
- May cause viremia or bacterial infection