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
Figure 1: Herpetic Whitlow (image from UpToDate)
Figure 2: Acute Paronychia (image from UpToDate)
Figure 3: Felon (image from UpToDate)
Sebastin, S, Chung KC, Ono S. Overview of hand infections. UpToDate. 2013.
