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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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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 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 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 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 Acute 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.

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