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Herpetic Whitlow

Updated : March 12, 2024





Background

Herpes simplex virus (HSV) is widespread and typically spreads as a result direct physical contact during childhood. The most prevalent sites of infection are oral mucosa (HSV-1) and vaginal mucosa (HSV-2).

Rarely, the infection can be transmitted to the distal phalanx through direct injection, resulting in discomfort, swelling, erythema, and vesicles, a condition known as herpetic whitlow.

Given its similar appearance to paronychia and its drastically different treatment, this diagnosis is of particular importance.

Epidemiology

This infection can affect individuals of any age. However, it is particularly prevalent among children who habitually suck their thumbs and also in medical and dental professionals who are exposed to oral mucosa without wearing gloves.

The prevalence of the infection is highest among respiratory therapists and dental hygienists.

This disease has also been observed in wrestlers, teenagers, and young adults who have been exposed to genital herpes.  The annual incidence has been estimated at 2.4 cases per 100,000 individuals.

Anatomy

Pathophysiology

After exposure, herpes virus types 1 and 2 cause viral invasion and replication in epidermal and dermal cells. Eventually, this may affect the sensory dorsal root ganglion, which establishes latencies for sensory input. Infection often arises between 2 and 20 days after exposure.

In 5 to 6 days, one or more vesicles typically merge into enormous, honeycomb-like bullae around the nail. They may also spread proximally and affect the nail bed. The infection typically cures on its own within two to four weeks.

Etiology

Herpes simplex virus types 1 and 2 cause herpetic whitlow. Exogenous or autogenous inoculations via broken skin are the primary causes of infection. Following primary infection, a patient may get herpetic whitlow due to reactivation of latent virus.

Genetics

Prognostic Factors

Herpetic whitlow is often self-limiting and typically disappears within two to four weeks in cases of original infection. The pain subsides after the acute phase, but the vesicles start to dry and harden. The pain often subsides after 2 weeks, and other changes in the skincontinue to mend thereafter.

There have been instances of persistent scarring, numbness, and hypersensitivity, although fingers and toenails normally heal without further complications. Latent sensory ganglion infection has caused recurrent outbreaks in 30% to 50% of cases.

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

Media Gallary

References

https://www.ncbi.nlm.nih.gov/books/NBK482379/

Herpetic Whitlow

Updated : March 12, 2024




Herpes simplex virus (HSV) is widespread and typically spreads as a result direct physical contact during childhood. The most prevalent sites of infection are oral mucosa (HSV-1) and vaginal mucosa (HSV-2).

Rarely, the infection can be transmitted to the distal phalanx through direct injection, resulting in discomfort, swelling, erythema, and vesicles, a condition known as herpetic whitlow.

Given its similar appearance to paronychia and its drastically different treatment, this diagnosis is of particular importance.

This infection can affect individuals of any age. However, it is particularly prevalent among children who habitually suck their thumbs and also in medical and dental professionals who are exposed to oral mucosa without wearing gloves.

The prevalence of the infection is highest among respiratory therapists and dental hygienists.

This disease has also been observed in wrestlers, teenagers, and young adults who have been exposed to genital herpes.  The annual incidence has been estimated at 2.4 cases per 100,000 individuals.

After exposure, herpes virus types 1 and 2 cause viral invasion and replication in epidermal and dermal cells. Eventually, this may affect the sensory dorsal root ganglion, which establishes latencies for sensory input. Infection often arises between 2 and 20 days after exposure.

In 5 to 6 days, one or more vesicles typically merge into enormous, honeycomb-like bullae around the nail. They may also spread proximally and affect the nail bed. The infection typically cures on its own within two to four weeks.

Herpes simplex virus types 1 and 2 cause herpetic whitlow. Exogenous or autogenous inoculations via broken skin are the primary causes of infection. Following primary infection, a patient may get herpetic whitlow due to reactivation of latent virus.

Herpetic whitlow is often self-limiting and typically disappears within two to four weeks in cases of original infection. The pain subsides after the acute phase, but the vesicles start to dry and harden. The pain often subsides after 2 weeks, and other changes in the skincontinue to mend thereafter.

There have been instances of persistent scarring, numbness, and hypersensitivity, although fingers and toenails normally heal without further complications. Latent sensory ganglion infection has caused recurrent outbreaks in 30% to 50% of cases.

https://www.ncbi.nlm.nih.gov/books/NBK482379/