- 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 up to 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:
- reference:
- Intrathecal Methylprednisolone for Intractable Postherpetic Neuralgia
Herpetic whitlow: herpetic infections of the hand. Louis DA and Sylva J. Orthop Clin N Am. 1979;4:90-94.