Doppelgangers

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    Doppelgangers

    Herpetic Whitlow

    –       Viral infection of hand caused by inoculation of HSV into broken skin

    • Hand pain disproportionate to clinical presentation
    • Associated with influenza-like illness
    • Clear vesicles coalesce and become purulent but pulp space is soft (versus tense in bacterial infection) (Figure 1)
    • Beware of look-alikes (i.e. paronychia (Figure 2), felon (Figure 3)) as management differs

    –       Treatment

    • Conservative (rest, elevation, NSAIDs)
    • Dry dressing to prevent transmission
    • I&D contraindicated as it may spread infection in healthy tissue and predispose to secondary bacterial infection
    • Topical acyclovir not effective
    • Oral or IV acyclovir recommended only in severe cases or immunocompromise

    Herpetic Whitlow

    Figure 1: Herpetic Whitlow (image from UpToDate)

    Acute Paronychia

    Figure 2: Acute Paronychia (image from UpToDate)

    Felon

    Figure 3: Felon (image from UpToDate)

    Sebastin, S, Chung KC, Ono S. Overview of hand infections. UpToDate. 2013.

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