Herpetic Whitlow

(See also Overview and Evaluation of Hand Disorders Overview and Evaluation of Hand Disorders Common hand disorders include a variety of deformities, ganglia, infections, Kienböck disease, nerve compression syndromes, noninfectious tenosynovitis, and osteoarthritis. (See also complex... read more .)

Herpetic whitlow may cause intense pain, redness, and swelling of the finger. The digital pulp is not very tense, but can be red and swollen; fever and lymphadenopathy are also possible. 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 Felon A felon is an infection of the pulp space of the fingertip, usually with staphylococci and streptococci. (See also Overview and Evaluation of Hand Disorders.) The most common site is the distal... read more , 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 Acute Paronychia Paronychia is infection of the periungual tissues. Acute paronychia causes redness, warmth, and pain along the nail margin. Diagnosis is by inspection. Treatment is with antistaphylococcal antibiotics... read more 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 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.