Herpetic Whitlow

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Introduction
  • A viral infection of the hand caused by herpes simplex virus (HSV-1)
  • Epidemiology
    • demographics
      • occurs with increased frequency in medical and dental personnel
      • most common infection occurring in a toddler’s and preschooler’s hand
  • Pathophysiology
    • viral shedding occurs while vesicles are forming bullae
Presentation
  • Symptoms
    • intense burning pain followed by erythema
    • malaise
  • Physical exam
    • erythema followed by small, vesicular rash
      • over the course of 2 weeks, the vesicles may come together to form bullae
      • the bullae will crust over and ultimately lead to superficial ulceration
    • fever and lymphadenitis may be found
Studies
  • Tzank smear
    • diagnosis confirmed by culture, antibody titers or Tzank smear
Treatment
  • Nonoperative
    • observation +/- acyclovir
      • indications
        • standard of treatment
      • outcomes
        • self limiting, with resolution of symptoms in 7-10 days
        • acyclovir may shorten the duration of symptoms
        • recurrence may precipitated by fever, stress and sun exposure
  • Operative
    • surgical debridement
      • indications
        • none
          • surgical treatment associated with superinfections, encephalitis, and death and should be avoided
Complications
  • Superinfections
    • often the result of surgical intervention
      • in pediatric patients, an infection of the digits may occur and require treatment with an oral antibiotic (penicillinase resistant) ifor 10 days
 

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