eMedicine Specialties > Emergency Medicine > Infectious Diseases

Herpetic Whitlow: Follow-up

Author: Michael S Omori, MD, Attending Staff, Emergency Medicine Residency, St Vincent Mercy Medical Center; Acting Director, Pediatric Emergency Center, Mercy Children's Hospital; Clinical Assistant Professor, Department of Surgery, University of Toledo Medical Center, The University of Toledo College of Medicine
Contributor Information and Disclosures

Updated: May 27, 2009

Follow-up

Further Outpatient Care

  • Advise routine outpatient follow-up care to ensure resolution of infection and to monitor for evidence of bacterial superinfection.

Inpatient & Outpatient Medications

  • Include analgesics in the treatment of herpetic whitlow.
  • Topical acyclovir may be of benefit in primary infections.5
  • In cases of superinfection, use antibiotics effective against skin pathogens.

Deterrence/Prevention

  • Avoidance of exposure is key to the prevention of herpetic whitlow.
    • Health care workers should use gloves, practice strict hand washing, and scrupulously observe universal fluid precautions.2
    • Studies have demonstrated herpes virus in 2.5% of asymptomatic patients and in 6.5% of hospitalized patients with tracheostomies.
  • Caution patients with oral, labial, or genital lesions and the parents and caregivers of children with lesions against digital contact with lesions.

Complications

  • Complications usually are minimal provided that affected patients are immunocompetent.
  • Misdiagnosis as a bacterial paronychia or felon with resultant deep incision may lead to delayed resolution, increased risk of bacterial superinfection, systemic spread (rare), and possibly development of herpes encephalitis.
  • Hyperesthesia or numbness has been reported in 30-50% of patients between episodes of reactivation.
  • Other potential complications include scarring of the affected digit and ocular spread.

Prognosis

  • Prognosis is excellent in uncomplicated cases, with spontaneous resolution in 3-4 weeks.

Patient Education

  • Advise patients of the likelihood of future recurrence and warn of the possibility of disease spreading to other parts of the body and to other individuals.

Miscellaneous

Medicolegal Pitfalls

  • Misdiagnosis and inadvertent deep incision may result in delayed healing, increased risk of bacterial superinfection or systemic spread, and possibly herpes encephalitis.
 


More on Herpetic Whitlow

Overview: Herpetic Whitlow
Differential Diagnoses & Workup: Herpetic Whitlow
Treatment & Medication: Herpetic Whitlow
Follow-up: Herpetic Whitlow
References
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References

  1. Wu IB, Schwartz RA. Herpetic whitlow. Cutis. Mar 2007;79(3):193-6. [Medline].

  2. Klotz RW. Herpetic whitlow: an occupational hazard. AANA J. Feb 1990;58(1):8-13. [Medline].

  3. Robayna MG, Herranz P, Rubio FA, Pena P, Pena JM, Gonzalez J, et al. Destructive herpetic whitlow in AIDS: report of three cases. Br J Dermatol. Nov 1997;137(5):812-5. [Medline].

  4. El Hachem M, Bernardi S, Giraldi L, Diociaiuti A, Palma P, Castelli-Gattinara G. Herpetic whitlow as a harbinger of pediatric HIV-1 infection. Pediatr Dermatol. Mar-Apr 2005;22(2):119-21. [Medline].

  5. Nikkels AF, Pierard GE. Treatment of mucocutaneous presentations of herpes simplex virus infections. Am J Clin Dermatol. 2002;3(7):475-87. [Medline].

  6. Weisman E, Troncale JA. Herpetic whitlow: a case report. J Fam Pract. Nov 1991;33(5):516, 520. [Medline].

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Further Reading

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Keywords

herpetic whitlow, herpetic infection, hand infection, herpes simplex virus, HSV-1, herpes simplex virus 2, HSV-2, infection of the hand, infection of the finger

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Contributor Information and Disclosures

Author

Michael S Omori, MD, Attending Staff, Emergency Medicine Residency, St Vincent Mercy Medical Center; Acting Director, Pediatric Emergency Center, Mercy Children's Hospital; Clinical Assistant Professor, Department of Surgery, University of Toledo Medical Center, The University of Toledo College of Medicine
Michael S Omori, MD is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Medical Editor

Robin R Hemphill, MD, MPH, Associate Professor, Director, Disaster Preparedness, Department of Emergency Medicine, Vanderbilt University Medical Center
Robin R Hemphill, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Eric L Weiss, MD, DTM&H, Director of Stanford Travel Medicine, Medical Director of Stanford Lifeflight, Assistant Professor, Departments of Emergency Medicine and Infectious Diseases, Stanford University School of Medicine
Eric L Weiss, MD, DTM&H is a member of the following medical societies: American College of Emergency Physicians, American College of Occupational and Environmental Medicine, American Medical Association, American Society of Tropical Medicine and Hygiene, Physicians for Social Responsibility, Southeastern Surgical Congress, Southern Association for Oncology, Southern Clinical Neurological Society, and Wilderness Medical Society
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Steven C Dronen, MD, FAAEM, Director of Emergency Services, Director of Chest Pain Center, Department of Emergency Medicine, Ft Sanders Sevier Medical Center
Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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