Herpetic whitlow

Herpetic whitlow is a painful cutaneous infection which usually affects the distal phalanx of the fingers and rarely the toes (1).

• caused by herpes simplex virus (HSV) types I or II (1), and may represent either a primary infection or a secondary recurrence (2)
• studies have revealed that
  • HSV 1 is responsible for 60% case while HSV 2 is responsible for around 40%
  • HSV 1 infections are seen more often on the hands of medical personnel (inoculated through oral secretions of infected patients) and HSV 2 on the hands of the general population (2,3)
• it is a recognized occupational hazard amongst medical and dental personnel but with the advent of universal precautions the incidence has decreased (1)

A bimodal age distribution can be observed in:

• young adults - usually affected by type 2 HSV
• children - type 1 HSV is usually responsible (from autoinoculation) (4)

Transmission can be through:

• direct contact with a herpetic lesion
• contact with infected saliva, semen, cervical fluid
• autoinoculation e.g. - nail biters with herpes labialis or stomatitis infection (2,3)

The incidence of herpetic whitlow is reported to be 4 cases per 100 000 per year (4)

Reference:

• 1. Wu IB, Schwartz RA. Herpetic whitlow. Cutis. 2007;79(3):193-6.
• 2. Wilson R, Truesdell AG, Villines TC. Inflammatory lesions on every finger. Am Fam Physician. 2005;72(2):317-8.
• 3. Klotz RW. Herpetic whitlow: an occupational hazard. AANA J. 1990;58(1):8-13
• 4. Bowling JC, Saha M, Bunker CB. Herpetic whitlow: a forgotten diagnosis. Clin Exp Dermatol. 2005;30(5):609-10.