• Pain and swelling: Patients with herpetic whitlow have swollen fingers with extreme pain. Common digits involved in this disease are thumb and the index finger. 
• Fever and malaise.
• The involved digit appears tender, and edematous.
• Vesicular lesions or ulcers, which are grouped together, with surrounding erythema, are seen. The fluid in these vesicles is often clear.
• In some cases, adenopathy of the axillary nodes may be seen. 
• There may be herpetic lesions in the oral or genital areas [6][7] [8].

• Dentist

  Frequency of herpes labialis and herpes infection of the eye were found be lower in dentists than in the control population. Conversely, herpetic whitlow was found to be more frequent in practicing dentists than in the control population. [ncbi.nlm.nih.gov]

  It is seen in adult healthcare workers such as dentists because of increased exposure to the herpes virus. The use of rubber gloves prevents herpes whitlow in healthcare workers. Updated by: David C. [medlineplus.gov]

  ICD-10 B00.89: Other herpesviral infection ICD-9 054.6 Herpetic whitlow Herpetic felon Herpetic Whitlow Anatomy Herpetic Whitlow Clinical Evaluation Generally occur in patients with occupations involving orotracheal contact such as oral hygenists and dentist [eorif.com]

  It is also seen in adult health care workers such as dentists because of increased exposure to the herpes virus. Contact sports are also a potential source of infection with herpetic whitlows. [en.wikipedia.org]

  Health care workers like dentists are the main sufferers of this condition. It is a very painful condition and can impair daily activities of a person for several days at a stretch. [primehealthchannel.com]

• Swelling of the Finger

  Find a 5-Star Infectious Disease Specialist A whitlow can cause pain, itching, redness or swelling on your fingers. Your fingers may also develop small blisters. [healthgrades.com]

  Initial symptoms of herpetic whitlow may include: a tingling feeling in the affected area pain and swelling of a finger fever and discomfort (in some cases) These symptoms are usually followed by: sudden pain around the nail redness (erythema), swelling [health24.com]

  The virus is characterized as blisters and involve the typical signs of inflammation – redness, heat, swelling and pain on the finger or thumb. Routine use of the hands/fingers would be difficult. [dentalhygienefitness.com]

  (secondary bacterial infection) acyclovir ointment and elevation pulp infection (distal fad pad). abcess of the distal pulp. there is non compliet compartments in the pulp of the finger,so an abcess here is painful. and the resultant swelling can lead [quizlet.com]

• Severe Pain

  If the patient feels the constant, severe pain, analgesics can also be prescribed. [symptoma.com]

  There would be severe pain with inflammation of the fingers. The fingers become tender and edematous and look swollen. It would be difficult to carry on daily routine in using the fingers for writing or holding anything. [diseasespictures.com]

  Simple perforation of the nail over the involved matrix also provided the reduction in pain, which is when followed by nail removal, alleviated all severe pain. [drugsdetails.com]

  The mouth lesions (herpetic gingivostomatitis) consist of painful vesicles on a red, swollen base that occur on the lips, gingiva, oral palate, or tongue. The lesions ulcerate ( Figure 2 ) and the pain can be severe. [aafp.org]

• Fatigue

  Signs and symptoms of a secondary infection include fever, chills, red streaks the length of the arm, lymphadenopathy, and fatigue. [journals.lww.com]

  This tends to happen when you’re tired and fatigued but, in the case of herpetic whitlow, it usually gets into your body through a small lesion on your finger or a crack in your fingernail. [coldsorescured.com]

  In addition to the sores, Preston says she began getting upper respiratory sicknesses, pneumonia, bronchitis, strep, ear infections, and was constantly fatigued. [abcnews.go.com]

  For whitlow, these symptoms usually appear 2 to 20 days after initial exposure, and include: Fever Fatigue Unusual pain Numbness Tingling in the area [3] 3 Observe more typical whitlow symptoms in the disease phase. [4] Once the initial prodrome phase [wikihow.com]

• Finger Pain

  Herpetic Whitlow Symptoms Symptoms include: Swelling Finger pain Tenderness Inflammation Blisters or ulcers Swollen lymph nodes This infection normally starts with swelling and inflammation that is painful on one or even more fingers. [byebyedoctor.com]

• Cough

  Some side effects associated with the use of antiviral drugs are nausea, vomiting, dizziness, runny or stuffy nose, cough, diarrhea, headache and some behavioral side effects. [dentalhygienefitness.com]

• Vomiting

  Some side effects associated with the use of antiviral drugs are nausea, vomiting, dizziness, runny or stuffy nose, cough, diarrhea, headache and some behavioral side effects. [dentalhygienefitness.com]

• Blister

  This case has implications for diagnosis and treatment of children's blistering hand diseases. [ncbi.nlm.nih.gov]

  From Wikidata Jump to navigation Jump to search painful blister of the periungual skin that is caused by herpes simplex virus type 1 or 2 Herpetic felon Herpetic whitlow (disorder) edit English herpetic whitlow painful blister of the periungual skin that [wikidata.org]

  You may develop one blister or a cluster of blisters. It can take up to three weeks for the blisters to heal. Eventually, the blister ruptures on its own and a scab forms. Herpetic whitlow can also produce a fever and swollen lymph nodes. [healthline.com]

  Tiny fluid-filled blisters (vesicles) appear on the fingers but sometimes only 2 or 3 days after pain begins. Doctors base the diagnosis of herpetic whitlow on the presence of blisters and lack of firmness. [msdmanuals.com]

• Ulcer

  A14-month-old child presented to our dermatology clinic with a 2-week history of painful swelling of the right forefinger and a painful mouth ulcer ( Figure 1 ). [doi.org]

  The patient may have blisters and ulcerations on the mouth mostly known as “cold sores” which are very painful. Ulcerations are recurrent. The rate of recurrence varies from one individual to another. [healthooze.com]

  We report a 10-year-old girl referred to our department of infectious diseases with recurrent and unresponsive ulcerated and necrotic lesions of the fingers of both hands as a first sign of human immunodeficiency virus infection. [ncbi.nlm.nih.gov]

  Primary herpetic gingivostomatitis caused by herpes simplex virus type 1 shown in (A) a four-year-old girl with lower lip ulcers and crusting on the upper lip, and (B) a two-year-old girl with ulcers on the lower lip and tongue. [aafp.org]

• Confusion

  A very rare form of herpes simplex involves the fingertips (herpetic whitlow) and can be a source of diagnostic confusion. Herpes simplex can be spread by direct contact from any of these sites to the eye by cross-infection or autoinoculation. [ncbi.nlm.nih.gov]

  Not to be confused with a felon. Herpetic whitlow. These can look much worse, especially if the infection is contracted by a toddler with an oral herpes infection who sucks his finger or thumb. ©2008 Jeffrey Hull [drhull.com]

  However, seek immediate medical care (call 911) if your whitlow, or that of someone you are with, is associated with a high fever (higher than 101 degrees Fahrenheit), confusion, or loss of consciousness for even a brief moment. [healthgrades.com]

• Irritability

  Then they become bulbous, red, irritated, AND ITCHY and painful at the same time. Normally when they come around it ends up on both hands. [honeycomb.click]

  These can cause painful and irritating sores. Stage Four : Scabbing or crusting of blisters. This can cause both itching or cracking. Stage Five : When the scab falls off, it’ll begin to heal. [coldsorescured.com]

  Small sized blisters develop on the finger causing pain and irritation. It would cause burning pain and the infected finger will be warm and red in color. For severe cases, the person will lose sensation on the finger causing numbness. [diseaseslab.com]

  Herpetic keratitis leads to irritation of the eyes with small white lesions appearing. There may also be a gritty or itchy sensation in the eye, along with watering. Herpetic encephalitis is most common in people with a diminished immune system. [news-medical.net]

Diagnosis of herpetic whitlow is clinical. The digit affected by herpetic whitlow can be identified by the characteristic lesions. In children, concurrent gingivostomatitis, and among adults, presence of occupational risk factors or concurrent genital infection suggests strong diagnosis.

Tzanck test, viral cultures, DNA hybridization and antibody testing are some of the known tests. Cost-effective and popular diagnostic tools for herpetic whitlow are polymerase chain reaction (PCR) and immune-fluorescent microscopy. Recurrent infections of herpetic whitlow, unusual locations or/and atypical presentation suggests an immunedeficient condition. HIV testing is therefore recommended in such patients [9].

• Herpes Simplex Virus Type 2

  The patient, a dental assistant at the time of her initial infection, developed herpetic whitlow caused by herpes simplex virus type 2 (HSV-2). [ncbi.nlm.nih.gov]

  Direct fluorescence antibody testing of vesicular fluid was performed and confirmed the presence of herpes simplex virus type 2 (HSV-2). [nejm.org]

  There are two types of Herpetic Whitlow. Herpes simplex virus- type 1 (HSV-1) Herpes simplex virus- type 2 (HSV-2) HVS-1 is mostly contracted by medical workers who may have accidentally acquired it in their line of duty. [healthooze.com]

  Herpetic whitlow in children tends to be associated with gingivostomatitis and herpes simplex virus type 1, whereas adults most commonly harbor herpes simplex virus type 2. Health care professionals are at especially high risk for this infection. [fprmed.com]

  Infection with herpes simplex virus types 1 and 2. N Engl J Med 1973 ; 289 :667-674, 719-725. 781 – 789. 10. Crane, LR, Lerner, AM. Herpetic whitlow: a manifestation of primary infection with herpes simplex virus type 1 or 2. [cambridge.org]

Though herpetic whitlow is a self-limiting condition, treatment is aimed to relieve the patient from the symptoms. Topical acyclovir or penciclover shortens the duration of symptoms, while oral acyclovir prevents recurrence. For acute occurrence, famciclover and valacyclovir are also beneficial. Antibiotic treatment is prescribed in cases of bacterial superinfection [10] [11].

Since herpetic whitlow is a self-limiting condition, the prognosis is good. Unless complicated, the disease can be contained by clinical course with proven drug therapy. Spontaneous resolution within 3-4 weeks is observed in patient with herpetic whitlow [4] [5].

Complications

HSV infection can spread throughout the body. Weakened immune system makes the HSV infection severe, causing complications [1].

Two most important viruses that can cause this disease are herpes simplex virus 1 (HSV-1) and herpes simplex virus-2 (HSV-2). 60% and 40% of all the herpetic whitlow infections are caused by HSV-1 and HSV-2 respectively. Immunocompromised patients, health-care professionals and patients with herpetic lesions (due to autoinoculation) are at a higher risk of infections with these viruses [3].

Approximately 2.4 to 5 cases every 100,000 population have been reported for herpetic whitlow in USA. Though mortality with this disease is almost negligible, morbidity is attributed to the bacterial superinfection as well as iatrogenic complications.

Both male and female are equally affected by this condition. Toddlers and children are more likely to be affected by HSV-1 and HSV-2 viruses, as they are engaged in thumb or finger sucking.

Herpetic whitlow is caused by inoculation of the virus. Once the virus enters and invades the cells of the dermis, clinical infection ensues.

• In children, as the infection involves finger sucking, the autoinoculation by HSV-1 from oropharyngeal lesion is common. 
• In health care workers, inoculation with HSV-1 occurs secondary to the unprotected exposure. Prevention of such infections is possible with the use of gloves. 
• In adults, the source of autoinoculation is genital herpes, and thus the common cause of infection is HSV-2. 

The incubation period of the disease is 2 to 20 days. Initial symptom of the disease is pain and burning or tingling of the infected digit, followed by erythema, and edema. It leads to the formation of 1-3 mm grouped vesicle, which may ulcerate or rupture and contain clear fluid, (which may be cloudy or bloody).

After 10 to 14 days, there may be improvement in the symptoms of the condition. Viral shedding and complete resolution generally occur after 5 to 7 days. Herpetic whitlow is characterized by a primary infection followed by a latent period and subsequent recurrence (in 20-50% of cases) [1] [2].

Avoiding the exposure to HSV can prevent herpetic whitlow. Having no contact with patients with known infections is important. Health care workers must wear gloves, and wash his hands regularly and thoroughly. Infection by the HSV-1 and HSV-2 can spread to different parts of the body by touching the infected area, sharing towels, contact lenses or flannels. Children must be discouraged to suck the infected finger/thumb.

The painful infection of the hand (distal phalanx), that involves one or more fingers is known as herpetic whitlow. Adamson was the first person to describe the condition in 1909.

In 1959, occupational risk among the health care workers was also included as an important risk factor for this condition. Health care workers and immunocompromised patients are at a higher risk, as they are often exposed to the virus-containing secretions from the patients [1] [2].

Definition

Infection of the digit (thumb and index fingers are common), which appears as a whitlow or infection by the herpes virus is known as herpetic whitlow. Patients with this condition are often presented with severe pain, and swelling. 

Causes

Herpetic whitlow is caused by the two different types of herpes virus namely HSV-1 or HSV-2. Six in every 10 and four in every 10 patients with herpetic whitlow is caused by HSV-1 and HSV-2 respectively.

Symptoms

After approximately 20 days after exposure to the virus, the infected area starts burning, with a tingling sensation and pain. The finger may become red, with appearance of fluid-filled blisters. Complete healing of the condition within 2 weeks is common. Some of the other common symptoms of the condition are fever, swollen lymph nodes and red streaks on the finger. Recurrent infection lasts for 7-10 days. Triggers of the recurrent herpetic whitlow are fever, stress, surgery, exposure to sun or hormonal changes.

Diagnosis

HSV infection can be diagnosed by the serological tests, direct fluorescent antibody test from the cells from the lesion and viral culture. 

Treatment

Usually herpetic whitlow is a self-limiting condition, which resolves within 2-4 weeks. The treatment of herpetic whitlow is aimed at managing the symptoms and recurrence of the disease. Antiviral drugs such as acyclovir are beneficial in such patients. If the patient feels the constant, severe pain, analgesics can also be prescribed.

1. Wu IB, Schwartz RA. Herpetic whitlow. Cutis. Mar 2007;79(3):193-6. 
2. Klotz RW. Herpetic whitlow: an occupational hazard. AANA J. Feb 1990;58(1):8-13. 
3. American Academy of Pediatrics. Herpes simplex. In: Pickering LK, ed. 2003 Red Book: Report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village, IL: American Academy of Pediatrics, 2003:344-353.
4. LaRossa D, Hamilton R. Herpes simplex infections of the digits. Archives of Surger. 1971; 102:600-603.
5. Polayes IM, Arons MS. The treatment of herpetic whitlow-A new surgical concept. Plastic and Reconstructive Surgery. 1980;65(6):811-817. 
6. Stern H. et al. Herpetic whitlow: A form of cross-infection in hospitals. Lancet, 1959; 2:871-874.
7. Lucey J, Baroni M. Herpetic whitlow. AJN. 1984; 84(1):60-61.
8. Eiferman RA. 1982. Herpetic whitlow and ocular infection. Annals of Ophthalmology, 1982; 14(5):453-455.
9. Aberle SW, Puchhammer-Stockl E. Diagnosis of herpesvirus infections of the central nervous system. J Clin Virol. 2002;25:S79-S85
10. Alexander L, Naisbett B. Patient and physician partnerships in managing genital herpes. J Infect Dis. 2002;186:S57-65.
11. Nikkels AF, Pierard GE. Treatment of mucocutaneous presentations of herpes simplex virus infections. Am J Clin Dermatol. 2002;3(7):475-87.