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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 fingertip is sore and swollen but is not as firm as in a felon (see Felon). Tiny fluid-filled blisters (vesicles) appear on the fingers but sometimes only 2 or 3 days after pain begins. Doctors base the diagnosis on the vesicles or on a lack of firmness. A herpetic whitlow is often mistaken for a felon. The disorder eventually goes away without treatment but may recur. Drugs applied directly to the skin (topically) can help shorten the length of the first episode. Drugs taken by mouth (such as acyclovir) may prevent recurrences if they are taken immediately after symptoms begin again. People should cover open or draining vesicles to prevent spreading the infection to other people. Surgery is not needed.

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