Summary Herpetic Whitlow is a viral infection of the hand caused by herpes simplex virus (HSV-1). Diagnosis is made clinically by presence of a small, vesicular rash and confirmed with a Tzank smear. Treatment is observation with a short course of antiviral antibiotics (acyclovir). Epidemiology Incidence rare 2.4 cases per 100,000 people per year Demographics occurs with increased frequency in medical and dental personnel most common infection occurring in a toddler’s and preschooler’s hand Etiology 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 Diagnosis Clinical and culture-based diagnosis is made with careful history and physical examination and confirmed with a positive 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