Herpetic Whitlow 054.6

• synonyms:
• ICD-9 = 054.6 Herpetic whitlow Herpetic felon
• Digital tip, hand and forearm infections caused by herpes simplex virus 1 and 2.

Herpetic Whitlow Anatomy

Herpetic Whitlow Clinical Evaluation

• Generally occur in patients with occupations involving orotracheal contact such as oral hygenists and dentist. Can occur from autoinoculation from genital and oral lesions.
• Painful vesicles from 2-14 days after exposure and susequently unroof forming characteristic ulcers.
• Evaluate for lympadenitis.
• May be associated with fever and malaise.
• Diagnosis can be confirmed with cultures of vesicular fluid, Tzanck smear or a rise in serum antibody titers. Laboratory confirmation is not necesary for characteristic lesions.

Herpetic Whitlow Xray

• Consider A/P and lateral of affected digit. Usually not needed lesions are characteristic. Indicated to rule out foreign body and osteomyelitis if any concern exists

Herpetic Whitlow Classification / Treatment

• Lesions are self-limited and resolve over 7-10 days.

Herpetic Whitlow Follow-up Care

• Lesions are infections until they are completely epithelialized.
• Virus enters latent state after infection and may recure. Recurrences can be induced by psychological or physical stress, fever, other infections, and sun exposure.

Herpetic Whitlow Differential Diagnosis

• Cellulitis
• Paronychia
• Herpetic Whitlow
• Flexor Tendon Tenosynovitis

Herpetic Whitlow Complications

• Superinfection may occur if lesion is mistaken for a felon and is treated with incision and drainage.

Herpetic Whitlow References

• Abrams RA, JAAOS 1996;4:219