musculoskeletal and connective tissue disorders
Herpetic Whitlow
Introduction
Herpetic whitlow is a cutaneous infection of the distal aspect of the finger caused by herpes simplex virus. (See also Overview and Evaluation of Hand Disorders .) Herpetic whitlow may cause intense pain, redness, and swelling of the finger. The digital pulp is not very tense, but can be red and swollen; fever and lymphadenopathy are also possible. Vesicles develop on the volar or dorsal distal phalanx but often not until 2 to 3 days after pain begins. The intense pain can simulate a Felon , but herpetic whitlow can usually be differentiated by the absence of tenseness in the pulp or the presence of vesicles. Herpetic whitlow can also mimic Before incising a suspected felon or paronychia, consider viral infections such as herpetic whitlow, which shouldnotbe incised. Incision and drainage are contraindicated. Topicalacyclovir5% can shorten the duration of a first episode. Oralacyclovir(800 mg orally 2 times a day) may prevent recurrences if given immediately after onset of symptoms. Open or draining vesicles should be covered to prevent transmission. 