Whitlow presents as pain and swelling of a finger following several days of viral incubation. There may also be associated burning, tingling, or itching sensation of the finger and the presence of vesicular lesions in the affected area. These vesicles usually contain serous fluid and may become purulent only if bacterial superinfection occurs.

The appearance of a painful swollen finger may be preceded for several days by a prodrome of fever, fatigue, or malaise. This represents the incubation period of HSV when the virus is still multiplying and is yet unable to produce a full-blown infection.

The pain and swelling may abate spontaneously after 10 -14 days, and the vesicles start to form crusts and eventually heal.

Malaise, fever, lymphadenitis, or lymphangitis may be associated with herpetic whitlow in certain rare cases [16] [17].

• Pain

  It begins with intense itching and pain, followed by the formation of deep coalescing vesicles. The process is associated with much tissue destruction and may be accompanied by systemic symptoms. [web.archive.org]

  Herpetic whitlow may cause intense pain. The digital pulp is not very tense. Vesicles develop on the volar or dorsal distal phalanx but often not until 2 to 3 days after pain begins. [msdmanuals.com]

  The finger was noted to be more swollen and exquisitely painful with reduced range of movement. [hindawi.com]

  This is still a “rewarding” and useful procedure; at least once you deal with the patient’s pain and anxiety. [acep.org]

• Fever

  A previously healthy 18-year-old woman presented with a 2-week history of fever, malaise, and a painful left middle finger. [nejm.org]

  Herpetic whitlow is most often caused by HSV-1, the type associated with oral herpes, also called 'cold sores' or “fever blisters'. [mediclinicinfohub.co.za]

  […] 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 [orthobullets.com]

  The appearance of a painful swollen finger may be preceded for several days by a prodrome of fever, fatigue, or malaise. [symptoma.com]

• Lymphadenopathy

  Physical examination revealed an area of erythematous, confluent vesicles on the middle phalanx of the finger and associated axillary lymphadenopathy. [nejm.org]

  Regional lymphadenopathy may accompany these findings; however, systemic symptoms are rare [4]. [hindawi.com]

  Fevers, constitutional symptoms, lymphadenopathy can be present. Then appear one or more vesicles that enlarge and can become coalescent. [acep.org]

• Malaise

  A previously healthy 18-year-old woman presented with a 2-week history of fever, malaise, and a painful left middle finger. [nejm.org]

  The appearance of a painful swollen finger may be preceded for several days by a prodrome of fever, fatigue, or malaise. [symptoma.com]

  Background HSV infection of distal finger[1] Usually occurs from contact with oral herpes, or autoinoculation from genital herpes Incubation period of 2-20 days, with possible prodrome of fever or malaise 60% due to HSV-1, 40% due to HSV-2 Clinical Features [wikem.org]

  […] 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 [orthobullets.com]

• Swelling of the Finger

  A 1-year-old girl was admitted to the hospital with 4 days of fever, erythema, and swelling of a finger. The analysis of an oral lesion was positive for herpes simplex virus type 1, confirming a diagnosis of herpetic whitlow. Kensuke Shoji, M.D. [nejm.org]

  [M.E. feloun, malignant] whitlow Infection of the pulp of the finger-tip usually from a deep prick. There is dull pain, redness and swelling of the finger, throbbing and severe tenderness. [medical-dictionary.thefreedictionary.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]

  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 [mediclinicinfohub.co.za]

• Axillary Lymphadenopathy

  Physical examination revealed an area of erythematous, confluent vesicles on the middle phalanx of the finger and associated axillary lymphadenopathy. [nejm.org]

  Lymphangitis and epitrochlear and axillary lymphadenopathy are not uncommon. After 10-14 days, symptoms usually improve significantly and lesions crust over and heal. Viral shedding is believed to resolve at this point. [emedicine.medscape.com]

  Fever, lymphadenitis, epitrochlear and axillary lymphadenopathy may be present[13]. Rarely, lymphedema of the hand and forearm may be present, although reports favor bacterial superinfection in most of these cases. [ncbi.nlm.nih.gov]

• Erythema

  At this time, the patient was irritable, febrile (rectal temperature, 38.3°C), and had erythema of Erythema and blisters of the [jamanetwork.com]

  Its characteristic findings are significant pain and erythema with overlying nonpurulent vesicles. The differential diagnosis includes flexor tenosynovitis. [hindawi.com]

  […] 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 [orthobullets.com]

  A 1-year-old girl was admitted to the hospital with 4 days of fever, erythema, and swelling of a finger. The analysis of an oral lesion was positive for herpes simplex virus type 1, confirming a diagnosis of herpetic whitlow. Kensuke Shoji, M.D. [nejm.org]

  Dorsal and radial side of the patient's little finger, showing yellowish vesicles and erythema. Patient's finger, dorsal view (Figure 1) zoomed in. [ncbi.nlm.nih.gov]

• Eruptions

  B00.89 – Other herpesviral infection SNOMEDCT: 43891009 – Herpetic whitlow Look For Subscription Required Diagnostic Pearls Subscription Required Differential Diagnosis & Pitfalls Paronychia Felon Cellulitis or erysipelas Gout Insect bite Fixed drug eruption [visualdx.com]

  Mild, uncomplicated eruptions of herpes simplex require no treatment. Blisters may be covered if desired, for example with a hydrocolloid patch. Severe infection may require treatment with an antiviral agent. [dermnetnz.org]

  The paste can make the abscess to erupt and cause the pus to drain within, and with that, the lifespan of the infection will be shorter. Before going to sleep, you can apply the paste on your finger/toe. [healthandlovepage.com]

  无痛性瘭疽病"英文翻译 painless whitlow disease "│甲床黑瘤, 黑变性瘭疽"英文翻译 subungual melanoma "疱疹性的"英文翻译 herpetic "疱疹性溃疡"英文翻译 herpetic ulcer "疱疹性麻疹"英文翻译 herpetiform measles "疱疹性脑炎"英文翻译 herpes simplex encephalitis; herpetic encephalitis "疱疹性湿疹"英文翻译 kaposi varicelliform eruption [ichacha.net]

  Make a strong solution until it starts to dry up, and dab it on when you can ... use the paste as soon as it starts to dry up, and any time you see it trying to erupt in the future. [herpeslife.com]

• Hunger

  Hunger free Africa – shared vision The partnership will be based on the shared vision that a hunger-free Africa is possible and that concerted efforts can achieve tangible improvements in food security and nutrition reverting the rise in hunger that has [au.int]

  The prevalence of hunger or undernourishment is also higher in SIDS than globally (17.5 percent compared to 10.7 percent), according to the latest SOFI report. [fao.org]

  This underscores the immense challenge of achieving the Sustainable Development Goal of Zero Hunger by 2030. Dr. Patrick I. [sdgsforall.net]

  In the fight against hunger in the world, all countries have a role to play. First of all to maintain and secure sustainable food security for their own people and, secondly, to participate the world market in food stuffs. [stjornarradid.is]

• Irritability

  At this time, the patient was irritable, febrile (rectal temperature, 38.3°C), and had erythema of Erythema and blisters of the [jamanetwork.com]

  The classical vesicles tend to arise after a few days of skin irritation or minor trauma and may include a prodromal period of flu-like symptoms. [hindawi.com]

  At paediatric A&E, you examined a 2 month old baby Carla who was brought in with a one day history of low grade fever, irritability and poor feeding. Explain to the parent why she needs to be admitted and what investigations are needed. [josephmizzi.blogspot.com]

The most specific diagnostic test for herpetic whitlow is viral culture of the vesicle fluid. Tzanck test may be performed by scraping the vesicles and spreading the samples on a glass slide, where they are stained with Giemsa and examined under a microscope. However, the Tzanck test carries a low sensitivity. Other definitive tests include DNA hybridization, polymerase chain reaction, or immunofluorescent microscopy.

HIV testing is recommended for patients with recurrent infections and atypical presentations of whitlow [10] [11].

• Herpes Simplex Virus Type 2

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

  Herpetic whitlow of the toe: an unusual manifestation of infection with herpes simplex virus type 2. Clinical Infectious Diseases, 26: 196-197, 1998. 4. Mohler, A. Herpetic whitlow of the toe. [escholarship.org]

  There are 2 types of HSV: herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2). HSV-1 infections usually occur around the mouth, lips, nose, or face, while HSV-2 infections usually involve the genitals or buttocks. [skinsight.com]

Whitlow does not require any treatment and will resolve spontaneously since it is a self-limited disease. Treatment with antiviral drugs such as topical acyclovir or penciclovir may be applied in order to decrease the duration of the disease, reduce the risk of spreading the virus to other areas of the body, lower the risk of bacterial infection, or decrease viral shedding. Oral acyclovir may also be used to prevent recurrence, and famciclovir or valacyclovir may reduce the duration of clinical recurrence.

Surgical techniques to unroof a vesicle or wedge resection of a nail in subungual infections may be performed in order to provide symptom relief. However, deep surgical incision should not be performed, as this can cause bacterial superinfection or viral encephalitis if the virus spreads through the systemic circulation.

Since melanotic whitlow is a malignant lesion and not an infection, its treatment is similar to those of other forms of skin malignancies. Wide local excision with at least 1-2 cm margins is recommended, whereas extensive or deep lesions should be managed by amputation of the affected digit.

Herpetic whitlow may resolve spontaneously even when left untreated. However, the use of antiviral creams may lessen the symptoms and shorten the course of the disease. This condition does not usually cause complications unless secondary bacterial infection occurs, causing a longer course and additional treatment. In some cases, viral encephalitis may also develop [7] [12].

It is believed that melanotic whitlow carries a similar degree of malignancy compared to other types of melanoma [13]. However, some evidence suggests that it may have a relatively better prognosis [14] [15]. Treatment is ineffective and of no clinical use in cases of metastasis.

Herpetic whitlow is caused by direct transfer of HSV-1 or HSV-2 from herpetic lesions to a finger with a broken skin barrier. This can happen when a person touches a cold sore or genital herpes lesions, allowing the herpes virus to invade the damaged skin layer. The source of the virus may be from the same person (autoinoculation) or another person infected with HSV. Whitlow commonly develops in patients with weakened immune systems since this is a condition that allows latent HSV in the neurons to reactivate.

The estimated incidence of whitlow in the United States is approximately 2.4 to 5 cases per 100,000 population, with no predilection for gender. Toddlers and preschool children are more commonly affected since their age group has a tendency to practice thumb-sucking. In terms of HSV serotypes, HSV-1 infection is more prevalent in medical personnel whereas HSV-2 has a greater tendency to infect the general population [4]. Herpetic whitlow may either be an initial or recurrent infection due to the capacity of HSV to remain latent in the neurons of the peripheral ganglia [5] [6] [7]. However, the rate of recurrence is variable [7] [8], with some patients experiencing more recurrence than others.

Melanotic whitlow accounts for approximately 2.9 to 15% of all melanomas [9] [10], and evidence suggests that around 9% of melanotic whitlow originates in the subungual space [11].

Herpetic whitlow occurs when HSV is inoculated onto a damaged skin barrier through infected bodily fluids. After inoculation, the virus penetrates the deeper skin layers and the subcutaneous tissue, causing clinically significant infection after an incubation ranging from 2-20 days.

Several age groups and patient populations may be affected by the two HSV serotypes. Younger age groups tend to be infected with HSV-1 transmitted by autoinoculation (through thumb-sucking) from herpetic lesions in the mouth such as herpetic gingivostomatitis or herpes labialis. Whitlow in adults are also commonly caused by autoinoculation. However, the virus most often involved in the transmission of the disease is HSV-2 from genital herpes. Healthcare workers are most often infected by HSV-1 resulting from unprotected contact with infected oropharyngeal or genital secretions from patients.

The primary infection with HSV usually produces a highly symptomatic disease. Once HSV penetrates the skin, it can migrate to the Schwann cells and peripheral ganglia and lies dormant until certain conditions allow it to be reactivated. Recurrence of herpetic whitlow is generally milder, less symptomatic, and has a shorter duration than the initial infection in around 20-50% of patients.

Proper handwashing [2] and the use of gloves among medical personnel may decrease the risk of herpetic whitlow. Healthcare workers with active disease should avoid direct contact with patients, especially the immunosuppressed, neonates, pregnant women, transplant patients, or patients with severe burns [18] [19]. Patients with recurrent whitlow should undergo evaluation to detect conditions that affect the immune function.

Whitlow, whitlow finger, or herpetic whitlow is an infection affecting the fingers, usually on the terminal phalanx [1], caused by herpes simplex virus (HSV). It is characterized by painful, itchy, erythematous inflammation of the fingers and may be accompanied by blisters at the site of infection. A serious infection should be suspected in the presence of fever, red streaks on the hands or the arms, and significant lymphadenopathy.

Since the transmission of this condition relies on contact of HSV-infected body fluids with broken skin, herpetic whitlow is considered as an occupational hazard among healthcare workers [2]. It can be caused by both serotypes of HSV, with HSV-1 accounting for 60% of cases and HSV-2 in the remaining 40%.

Although antiviral medications may be given to reduce the symptoms and duration of whitlow, it usually resolves spontaneously after 2 to 3 weeks even without medication. However, HSV may remain dormant or latent in the neurons and may become active in immunodeficient states such as extreme stress or the presence of a previous or existing infection. The same treatment may be given if the whitlow reappears.

A form of melanoma called melanotic whitlow may sometimes be mistaken for herpetic whitlow and is responsible for many misdiagnosed and mistreated cases [3]. Melanotic whitlow differs from herpetic whitlow in the sense that the affected area is hyperpigmented and has a malignant course.

Herpetic whitlow is a disease caused by the herpes virus. It usually affects the fingertips and causes pain, redness, or swelling of the affected fingers, as well as itching or tingling sensations. Blisters with clear fluid may also form.

This disease is transmitted through contact of broken skin with fluids containing herpes virus. Children with cold sores may get this disease if they are fond of thumb-sucking. Persons with genital herpes and healthcare workers may also develop this disease.

A light dressing should be applied on the affected area to prevent spread of the infection. Avoid wearing contact lenses or rubbing your eyes as they may be infected with the herpes virus. Analgesics such as paracetamol or ibuprofen may be taken for pain relief. It is important to note that herpetic whitlow is a self-limited disease, which means that it will resolve spontaneously after 2 or 3 weeks even without medication.

A form of skin cancer called melanotic whitlow has a similar appearance as whitlow except that the affected area of the finger exhibits a darker color (hyperpigmentation). The treatment for this condition is different from herpetic whitlow. Since this is a form of skin cancer, excision of the whole lesion is the most effective treatment. The outcome depends on early detection and correct diagnosis of this condition.

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