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%.

Types of Human Herpes Virus

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.

Mortality/Morbidity

  • Mortality related to herpetic whitlow can be presumed to be negligible.
  • Morbidity is related primarily to bacterial super infection or to iatrogenic complications due to a misguided incision and drainage resulting from incorrect diagnosis of the infection as a bacterial paronychia. These complications may include delayed resolution, increased incidence of bacterial superinfection, and, rarely, systemic spread and the development of herpes encephalitis.

History

  • Patients present with complaints of pain and swelling of a finger, typically with characteristic vesicular lesions. The most commonly involved digits are the thumb and index fingers.
  • History of a prodrome of fever or malaise may precede the onset of symptoms by several days.
  • Similar previous problems in the same digit suggest that the patient is presenting with an episode of reactivation and recurrence.
  • Patients should be questioned about any recent possible exposure.
    • Health care workers with a history of exposure to oral or genital secretions are at risk.
    • Patients in the general population with a history of caring for or coming in contact with someone that has typical lesions are at risk.
    • Since autoinoculation is a common route, especially in children, ask about recent episodes consistent with herpes labialis or herpetic gingivostomatitis. In adults, inquire about a history of symptoms consistent with genital herpes

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Herpetic Whitlow Picture

Herpetic whitlow picture

Herpes Treatment- A beautiful melange of time-tested resonance homeopathic medicines and homotoxological remedies so as to stimulate the immune system to heal itself following nature's laws.

Symptoms caused by HSV 1 infection (HSV 1 is known to affect the following areas of the body.)