Herpetic whitlow is an infection of the herpes virus around the fingernail. In children, this is often caused by thumb sucking or finger sucking while they have a cold sore. 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.
Herpetic whitlow is an intense painful infection of the hand involving 1 or more fingers that typically affects the terminal phalanx. Herpes simplex virus 1 (HSV-1) is the cause in approximately 60% of cases of herpetic whitlow, and herpes simplex virus 2 (HSV-2) is the cause in the remaining 40%.
- HHV 1 – Herpes Simplex Virus 1 (HSV 1)
- HHV 2 – Herpes Simplex Virus 2 (HSV 2)
- HHV 3 -Herpes Zoster Virus (VZV)
- HHV 4 – Ebstein Barr Virus (EBV)
- HHV 5 – Cytomegolovirus (CMV)
- HHV 6 – Human B-cell Lymphotrophic
- HHV 7 – Causes Symptoms Similar to the HHV-6
- HHV 8 – It is a Type of Rhadinovirus
Pathophysiology of Herpetic Whitlow
As in other mucocutaneous herpetic infections, herpetic whitlow is initiated by viral inoculation of the host through exposure to infected body fluids via a break in the skin, most commonly a torn cuticle. The virus then invades the cells of the dermis and subcutaneous tissue, and clinical infection ensues within a matter of days.
In the general adult population, herpetic whitlow is most often due to autoinoculation from genital herpes; therefore, it is most frequently secondary to infection with HSV-2.
Subsequent to the initial exposure, an incubation period of 2-20 days is common. Although a prodrome of fever and malaise may be observed, mostly the initial symptoms are pain and burning or tingling of the infected digit. This usually is followed by erythema, edema, and the development of 1- to 3-mm grouped vesicles on an erythematous base over the next 7-10 days. These vesicles may ulcerate or rupture and usually contain clear fluid, although the fluid may appear cloudy or bloody. 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. Complete resolution occurs over subsequent 5-7 days.
As is typical of other herpetic infections, herpetic whitlow is characterized by a primary infection, which may be followed by a latent period with subsequent recurrences. After the initial infection, the virus enters cutaneous nerve endings and migrates to the peripheral ganglia and Schwann cells where it lies dormant. The primary infection usually is the most symptomatic. Recurrences observed in 20-50% of cases are usually milder and shorter in duration.
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Herpetic Whitlow Picture
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Symptoms caused by HSV 1 infection (HSV 1 is known to affect the following areas of the body.)