Herpetic whitlow

From Wikipedia, the free encyclopedia
Jump to: navigation, search
Herpetic whitlow
Herpetic whitlow in young child.jpg
Herpetic whitlow in a young child who earlier had developed herpes gingivostomatitis.
Classification and external resources
Specialty infectious disease
ICD-10 B00.8
ICD-9-CM 054.6

A herpetic whitlow is a lesion (whitlow) on a finger or thumb caused by the herpes simplex virus. It is a painful infection that typically affects the fingers or thumbs. Occasionally infection occurs on the toes or on the nail cuticle. Herpes whitlow can be caused by infection by HSV-1 or HSV-2.[1] HSV-1 whitlow is often contracted by health care workers that come in contact with the virus; it is most commonly contracted by dental workers and medical workers exposed to oral secretions.[2][3] It is also often observed in thumb-sucking children with primary HSV-1 oral infection (autoinoculation) prior to seroconversion,[1] and in adults aged 20 to 30 following contact with HSV-2-infected genitals.[4] 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. Small, clear vesicles initially form individually, then merge and become cloudy. Associated pain often seems large relative to the physical symptoms. The herpes whitlow lesion usually heals in two to three weeks.[5] It may reside in axillary sensory ganglia to cause recurrent herpetic lesions on that arm or digits.


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 cutting, chewing or sucking of fingernail or thumbnail.

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 of increased exposure to the herpes virus.

Contact sports are also a potential source of infection with herpetic whitlows.[6]


Although it is a self-limited illness, oral or intravenous antiviral treatments, particularly acyclovir, have been used in the management of immunocompromised or severely infected patients. Topical acyclovir has not been shown to be effective in management of herpetic whitlow. Famciclovir has been demonstrated to effectively treat and prevent recurrent episodes[7]. Lancing or surgically debriding the lesion may make it worse by causing a superinfection or encephalitis.[8]

See also[edit]


  1. ^ a b Clark DC (2003). "Common acute hand infections". Am Fam Physician. 68 (11): 2167–76. PMID 14677662. 
  2. ^ Lewis MA (2004). "Herpes simplex virus: an occupational hazard in dentistry". Int Dent J. 54 (2): 103–11. doi:10.2956/indj.2004.54.2.103. PMID 15119801. 
  3. ^ Avitzur Y, Amir J (2002). "Herpetic whitlow infection in a general pediatrician--an occupational hazard". Infection. 30 (4): 234–6. doi:10.1007/s15010-002-2155-5. PMID 12236568. 
  4. ^ Wu IB, Schwartz RA (2007). "Herpetic whitlow". Cutis. 79 (3): 193–6. PMID 17674583. 
  5. ^ Anonymous (1971). "Herpetic whitlow: a medical risk". Br Med J. 4 (5785): 444. doi:10.1136/bmj.4.5785.444. PMC 1799611Freely accessible. PMID 5125276. 
  6. ^ Hoff NP, Gerber PA (2012). "Herpetic whitlow". CMAJ. 184: E924. doi:10.1503/cmaj.111741. PMC 3503926Freely accessible. PMID 22546886. 
  7. ^ Alster, T. S.; Nanni, C. A. (March 1999). "Famciclovir prophylaxis of herpes simplex virus reactivation after laser skin resurfacing". Dermatologic Surgery: Official Publication for American Society for Dermatologic Surgery [et Al.] 25 (3): 242–246. ISSN 1076-0512. PMID 10193975. 
  8. ^ http://www.uptodate.com/contents/overview-of-hand-infections?source=preview&anchor=H27991206&selectedTitle=2~12#H27991206
Photo of a herpetic whitlow with swelling, erythema, and nonpurulent vesicle formation.

External links[edit]