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Herpetic Whitlow

By

David R. Steinberg

, MD, Perelman School of Medicine at the University of Pennsylvania

Last full review/revision May 2020| Content last modified May 2020
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Topic Resources

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.

Pearls & Pitfalls

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

Incision and drainage are contraindicated. Topical acyclovir 5% can shorten the duration of a first episode. Oral acyclovir (800 mg orally 2 times a day) may prevent recurrences if given immediately after onset of symptoms. Open or draining vesicles should be covered to prevent transmission.

Drugs Mentioned In This Article

Drug Name Select Trade
ZOVIRAX
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