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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

Herpetic whitlow is a viral infection of the fingertip.

Herpes simplex virus (similar to the one that causes fever blisters) may cause an intense, painful skin infection. The virus enters through a break in the skin. The fingertip is sore and swollen but is not as firm as in a felon. Tiny fluid-filled blisters (vesicles) appear on the fingers but sometimes only 2 or 3 days after pain begins.

Doctors base the diagnosis of herpetic whitlow on the presence of blisters and lack of firmness. A herpetic whitlow may be mistaken for a felon or other viral infection of the hand.

Treatment

  • Antiviral drugs

The disorder eventually goes away without treatment but may return. Drugs applied directly to the skin (topically) can help shorten the length of the first episode. Drugs taken by mouth (such as acyclovir) on a long-term basis may prevent further episodes in people who have already had repeated episodes. People should cover open or draining blisters to prevent spreading the infection to other people. Surgery is not needed.

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