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)


Figure 3: Felon (image from UpToDate)

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