Herpetic Whitlow Treatment & Management

Updated: Jun 14, 2019
  • Author: Michael S Omori, MD; Chief Editor: Steven C Dronen, MD, FAAEM  more...
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Emergency Department Care

Herpetic whitlow is a self-limited disease. Treatment most often is directed toward symptomatic relief.

Acyclovir may be beneficial. Studies of clinical efficacy are limited and treatment suggestions are extrapolated from data regarding response of other HSV infections. In primary infections, topical acyclovir 5% has been demonstrated to shorten the duration of symptoms and viral shedding. Oral acyclovir may prevent recurrence. Doses of 800 mg twice daily initiated during the prodrome may abort the recurrence. Alternative dosing regimens may also be effective. [5]

Famciclovir or valacyclovir may shorten the clinical manifestations of acute occurrence.

Use antibiotic treatment only in cases complicated by bacterial superinfection.

Tense vesicles may be unroofed to help ameliorate symptoms, and wedge resection of the fingernail may be used for the same purpose in cases involving the subungual space.

Deep surgical incision is contraindicated, since this may lead to delayed resolution, bacterial superinfection or systemic spread, and complications such as herpes encephalitis.