- See:
Diff Dx of Hand Infections:
- Discussion:
- most often involves the tip of the digit;
- occurs from contact w/ oral tracheal secretions and self inoculation (common w/ dentists);
- incubation period from two to 14 days;
- characterized by a painful deep vesicle surrounded by lesser superficial vesicles;
- sometimes vesicles coalence into large vesicles;
- spontaneous drainage may occur, w/ turbid fluid (fluid is not purulent);
- secondary tissue infections are common;
- Lab Studies:
- Tzank smear w/ Giemsa or Hematoxylin-eosin Staining;
- biopsy shows Giant cells and Cowdry type A intranuclear inclusion bodies;
- viral culture: (may take upto 5 days);
- Treatment:
- self limiting disease of three weeks duraion;
- incision and drainage is contra-indicated and may lead to encephalitis;
- medical treatment of zoster:
- antiviral treatment decreases the formation of new lesions and reduces acute pain
-
acyclovir: 800 mg five times daily for one week;
- famciclovir: 500 mg three times daily for one week;
- Complications:
- postherpetic neuralgia:
- references:
- Intrathecal Methylprednisolone for Intractable Postherpetic Neuralgia
Naoki Kotani, Tetsuya Kushikata, Hiroshi Hashimoto, Futoshi Kimura, Masatoshi Muraoka, Misako Yodono, Mizue Asai, Akitomo Matsuki
The New England Journal of Medicine -- November 23, 2000 -- Vol. 343, No. 21
Herpetic whitlow: herpetic infections of the hand.
DS Louis and J Sylva.
Orthop. Clin. North Am. Vol 4. p 90-94. 1979.
Pediatric herpetic hand infections.
L. Walker et al.
J. Hand Surgery. Vol 15-A. 1990. p 176-180.
