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. [7]
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. [3] 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.
