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Herpetic whitlow - Nail and Distal Digit
See also in: Overview,Cellulitis DDx
Other Resources UpToDate PubMed

Herpetic whitlow - Nail and Distal Digit

See also in: Overview,Cellulitis DDx
Contributors: Susan Burgin MD, Bertrand Richert MD, Robert Baran MD
Other Resources UpToDate PubMed

Synopsis

Herpetic whitlow, or distal digital herpes simplex virus (HSV), is an uncommon infection occurring on the fingers or periungually, either from HSV1 or HSV2. Herpetic whitlow from HSV1 usually affects children and dental and medical personnel who do not regularly wear gloves. Toe involvement has been reported in infants from toe sucking. Digital-to-genital contact of HSV2 is also a mode of transmission.

After an incubation period of 3-7 days, during which there may be local erythema and edema as well as tenderness, a group of vesicles appears around the perionychium and on the volar digital skin. Vesicles may progress to erosions or may become pustular first and simulate a felon. Lesions may involve the distal-free edge of the nail and extend into the nail bed, which often results in hemorrhage. Swelling of the hand with lymphatic streaking may also occur.

Recurrences of herpetic whitlow may be seen, especially in immunosuppressed individuals.

Codes

ICD10CM:
B00.89 – Other herpesviral infection

SNOMEDCT:
43891009 – Herpetic whitlow

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Bacterial paronychia
  • Felon
  • Cellulitis or Erysipelas
  • Arthropod bite or sting
  • Fixed drug eruption
  • Tinea manus
  • Blistering distal dactylitis
  • Erysipeloid
  • Orf
  • Milker
  • "Seal finger" – Etiologic agent likely Mycoplasma spp.
  • Mycobacterium marinum infection
  • Cat-scratch disease
  • Sporotrichosis

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:01/29/2017
Last Updated:11/12/2019
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Patient Information for Herpetic whitlow - Nail and Distal Digit
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Herpetic whitlow - Nail and Distal Digit
See also in: Overview,Cellulitis DDx
A medical illustration showing key findings of Herpetic whitlow : Axillary lymphadenopathy, Hand edema, Painful skin lesions, Periungual fingers, Vesicles
Clinical image of Herpetic whitlow - imageId=133823. Click to open in gallery.  caption: 'A cluster of cloudy vesicles and some small crusts on a brightly erythematous base on the finger.'
A cluster of cloudy vesicles and some small crusts on a brightly erythematous base on the finger.
Copyright © 2024 VisualDx®. All rights reserved.