Herpetic Whitlow

Herpetic whitlow is a viral infection of the distal finger caused by the HSV, usually from contact with oral herpetic infections.
Herpetic whitlow in children tends to be associated with gingivostomatitis and herpes simplex virus type 1, whereas adults most commonly harbor herpes simplex virus type 2.
Health care professionals are at especially high risk for this infection. Care should be taken to wear gloves whenever contact with saliva is possible.

The patient develops a burning, pruritic sensation similar to all herpes simplex infections. On examination, the lesion is erythematous and tender, with vesicular bullae. The finger may be indurated, but is not tense, as is seen in a felon.

Do not mistake herpetic whitlow for a felon because incision and drainage may result in a secondary bacterial infection and prolonged failure to heal. If there is any question concerning the diagnosis of herpetic whitlow, a vesicle may be unroofed, and the drainage fluid may be used for a Tzanck smear to confirm the diagnosis


Herpetic whitlow Acyclovir, 400 mg PO TID x10 d. Herpes simplex No surgical drainage is indicated.