Herpetic whitlow is an intensely painful viral infection of the hand affecting at least one finger, typically localized to the finger or thumb tip. In ~60% of cases, herpes simplex virus 1 (HSV-1) is the cause; in the remaining 40% of cases, herpes simplex virus 2 (HSV-2) is the causal factor. Patients under the age of 20 are usally infected with HSV-1 while older patients maybe infected with either HSV-1 or HSV-2.3 Adamson first described herpetic whitlow in 1909. In 1959, it was noted to be an occupational risk among health care workers. Herpetic Whitlow is a clinical diagnosis but the diagnosis should be confirmed by a Tzank test and by viral cultures which are the most specific evidence for the diagnosis. 3,4
Incidence and Related Conditions
Differential Diagnosis
Reproduced from the International statistical classification of diseases and related health problems, 10th revision, Fifth edition, 2016. Geneva, World Health Organization, 2016 https://apps.who.int/iris/handle/10665/246208
The typical patient is a health care work such as a nurse in the ICU or a dentist. These workers and any others with repeated exposure to patients' oropharynx are at increased risk for Herpetic Whitlow. Young children represent a second at risk group.
– Acyclovir (oral/topical)
– Famciclovir (oral)
– Valacyclovir (oral)
– Penciclovir (topical)
Wedge resection of fingernail to help ameliorate symptoms in cases involving the subungual space can be consider after starting antiviral medications.
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