Clinical features and diagnosis

clinical features and diagnosis

Patients may present with a prodrome of pain, burning sensation, pruritus, and/or tingling sensation of the affected finger or the entire limb (1,2)

• pain is usually out of proportion to physical findings (3)
• this is followed by vesicular eruptions with surrounding erythema and oedema (2)
  • the fingertip is reddened, swollen and acutely tender
  • several vesicles (1-3 mm) form on a base of erythema about 7-10 days after the initial symptoms (4), fluid in these vesicles may be clear initially (3)
  • these may then merge to give bullae like lesions, the fluid may become cloudy or bloody (3,4)
  • the pain and swelling decreases and the vesicles crust over and heal after 10-14 days
• fever, lymphadenitis, and epitrochlear and axillary lymphadenopathy may be seen (3)

Diagnosis is usually obvious from the history and examination. Serum herpes antibodies may assist.

Reference:

• 1. Wu IB, Schwartz RA. Herpetic whitlow. Cutis. 2007;79(3):193-6.
• 2. Smith E et al. Multiple herpetic whitlow lesions in a patient with chronic lymphocytic leukemia. Am J Hematol. 2002;69(4):285-8.
• 3. Clark DC. Common acute hand infections. Am Fam Physician. 2003;68(11):2167-76
• 4. Klotz RW. Herpetic whitlow: an occupational hazard. AANA J. 1990;58(1):8-13