Herpetic whitlow

A herpetic whitlow is a lesion (whitlow) on a finger or thumb caused by the herpes simplex virus. It is a painful infection that typically affects the fingers or thumbs. Occasionally infection occurs on the toes or on the nail cuticle. Herpes whitlow can be caused by infection by HSV-1 or HSV-2.^[1] HSV-1 whitlow is often contracted by health care workers that come in contact with the virus; it is most commonly contracted by dental workers and medical workers exposed to oral secretions.^[2][3] It is also often observed in thumb-sucking children with primary HSV-1 oral infection (autoinoculation) prior to seroconversion,^[1] and in adults aged 20 to 30 following contact with HSV-2-infected genitals.^[4] Symptoms of herpetic whitlow include swelling, reddening and tenderness of the skin of infected finger. This may be accompanied by fever and swollen lymph nodes. Small, clear vesicles initially form individually, then merge and become cloudy. Associated pain often seems large relative to the physical symptoms. The herpes whitlow lesion usually heals in two to three weeks.^[5]

Causes

In children the primary source of infection is the orofacial area, and it is commonly inferred that the virus (in this case commonly HSV-1) is transferred by the chewing or sucking of fingers or thumbs.

In adults it is more common for the primary source to be the genital region, with a corresponding preponderance of HSV-2. It is also seen in adult health care workers such as dentists because of increased exposure to the herpes virus.

Treatment

Although it is a self-limited illness, antiviral treatments applied to the infected skin, particularly topical acyclovir, have been shown to be effective in decreasing the duration of symptoms. Lancing or surgically debriding the lesion may make it worse by causing a superinfection or encephalitis.

See also

• Herpes simplex

References