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Herpetic Whitlow

By David R. Steinberg, MD, Associate Professor, Department of Orthopaedic Surgery, and Director, Hand and Upper Extremity Fellowship, Perelman School of Medicine at the University of Pennsylvania

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Patient Education

Herpetic whitlow is a cutaneous infection of the distal aspect of the finger caused by herpes simplex virus.

Herpetic whitlow may cause intense pain. The digital pulp is not very tense. Vesicles develop on the volar or dorsal distal phalanx but often not until 2 to 3 days after pain begins. The intense pain can simulate a felon, but herpetic whitlow can usually be differentiated by the absence of tenseness in the pulp or the presence of vesicles. Herpetic whitlow can also mimic paronychia or other viral infections in the hand (eg, coxsackievirus). The condition is self-limited but may recur.

Incision and drainage are contraindicated. Topical acyclovir 5% can shorten the duration of a first episode. Oral acyclovir (800 mg po bid) may prevent recurrences if given immediately after onset of symptoms. Open or draining vesicles should be covered to prevent transmission.

Pearls & Pitfalls

  • Before incising a suspected felon or paronychia, consider viral infections such as herpetic whitlow, which should not be incised.

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