Herpetic Whitlow Follow-up

  • Author: Michael S Omori, MD; Chief Editor: Steven C Dronen, MD, FAAEM   more...
 
Updated: May 23, 2012
 

Further Outpatient Care

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

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.
Previous
Next

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.
Previous
Next

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.
Previous
Next

Prognosis

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

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.
Previous
 
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.

Specialty Editor Board

Robin R Hemphill, MD, MPH  Associate Professor, Director, Quality and Safety, Department of Emergency Medicine, Emory University School of Medicine

Robin R Hemphill, MD, MPH is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Eric L Weiss, MD, DTM&H  Medical Director, Office of Service Continuity and Disaster Planning, Fellowship Director, Stanford University Medical Center Disaster Medicine Fellowship, Chairman, SUMC and LPCH Bioterrorism and Emergency Preparedness Task Force, Clinical Associate Progressor, Department of Surgery (Emergency Medicine), Stanford University Medical Center

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.

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  Chair, Department of Emergency Medicine, LeConte 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.

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. Cunha BA, ed. Antibiotic Essentials. 7th ed. Sudbury, Mass: Physician's Press; 2008:109.

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

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.