Herpetic whitlow

Jump to navigation Jump to search

Sexually transmitted diseases Main Page

Herpes simplex Microchapters

Home

Patient Information

Genital Herpes
Congenital Herpes

Overview

Classification

Orofacial Infection
Anogenital Infection
Ocular Infection
Herpes Encephalitis
Neonatal Herpes
Herpetic Whitlow
Herpes Gladiatorum
Mollaret's Meningitis

Pathophysiology

Epidemiology and Demographics

Asymptomatic Shedding

Recurrences and Triggers

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Direct detection of Genital Lesions

Treatment

Antiviral Therapy

Overview
Antivirals for First Episode of Genital Herpes
Antivirals for Recurrent Genital Herpes

Primary Prevention

Counseling

Herpetic whitlow On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Herpetic whitlow

CDC on Herpetic whitlow

Herpetic whitlow in the news

Blogs on Herpetic whitlow

Directions to Hospitals Treating Herpes simplex

Risk calculators and risk factors for Herpetic whitlow

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

A herpetic whitlow is a lesion on a finger or thumb caused by the herpes simplex virus. 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 increased exposure to the herpes virus.

Pathophysiology

Transmission

It is typically contracted by healthcare workers that come in contact with the virus; it is most commonly contracted by dental workers and medical workers exposed to oral secretions.[1][2] Again, the HSV seronegative person is at highest risk of acquiring this condition. It is often observed in thumb-sucking children with primary HSV-1 infection, and in adults aged 20 to 30 following contact with by HSV-2-infected genitals.[3]

Causes

  • Herpes whitlow is a painful infection that typically manifest itself on fingers or thumbs and occasionally on the toes, or on the nail cuticle, and is caused by HSV-1 or HSV-2.[4]
  • Herpes whitlow is also caused by autoinoculation of HSV into broken skin prior to an infected person developing antibodies against the virus (e.g. during primary infection before seroconversion).[4]
  • If someone has a cold sore and puts their finger in their mouth then a herpes infection whitlow may appear. Herpes whitlows are frequently found among dentists and dental hygienists.[5]

Natural History, Complications and Prognosis

The herpes whitlow lesion usually heals in two to three weeks.[6]

Diagnosis

History and Symptoms

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.

Physical Examination

Extremities

Small, clear vesicles initially form that merge and becomes cloudy. Associated pain often seems large relative to the physical symptoms.

Treatment

Medical Therapy

Although it is a self-limited illness, topical antivirals, particularly topical acyclovir, have been shown to be effective in decreasing the duration of symptoms. One should never try to lance or surgically debride the lesion, as it may make it worse (cause a superinfection or cause encephalitis).

References

  1. Lewis MA (2004). "Herpes simplex virus: an occupational hazard in dentistry". Int Dent J. 54 (2): 103–11. PMID 15119801.
  2. Avitzur Y, Amir J (2002). "Herpetic whitlow infection in a general pediatrician--an occupational hazard". Infection. 30 (4): 234–6. PMID 12236568.
  3. Wu IB, Schwartz RA (2007). "Herpetic whitlow". Cutis. 79 (3): 193–6. PMID 17674583.
  4. 4.0 4.1 Clark DC (2003). "Common acute hand infections". Am Fam Physician. 68 (11): 2167–76. PMID 14677662.
  5. Lewis, M.A. (April 2004). "Herpes simplex virus: an occupational hazard in dentistry". International Dental Journal (2): 103–111. doi:10.2956/indj.2004.54.2.103. Unknown parameter |vol= ignored (|volume= suggested) (help)
  6. Anonymous (1971). "Herpetic whitlow: a medical risk". Br Med J. 4 (5785): 444. PMID 5125276.

Template:STD/STI

Template:WH Template:WS