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Pediatr Dermatol 2019 Mar 11. Epub 2019 Mar 11.

Division of Pediatric Infectious Diseases, Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, California.

Herpetic whitlow of the toe is a common infection in an uncommon location, leading it to be frequently misdiagnosed; however, as the virus responds well to conservative management or antivirals alone, proper identification is necessary to prevent unnecessary interventions. We present a case of herpetic whitlow of the toe with an unusually ominous appearance in a previously healthy and otherwise well-appearing child. This case illustrates the spectrum of herpetic whitlow's clinical presentations and enourages consideration of the disease even for atypical location and severity. Read More

Am Fam Physician 2019 Feb;99(4):228-236

U.S. Marine Corps School of Infantry-East, Camp Geiger, NC, USA.

Acute hand infections are often caused by puncture wounds and are generally classified into superficial or deep infections. Superficial infections occur in the skin and subcutaneous tissues, whereas deep infections can involve the tendon sheaths, adjacent anatomic compartments, deep fascial planes, bursae, joint spaces, and bones. Superficial hand infections are more common than deep infections and are typically managed with elevation, warm soaks, splinting in the position of function, analgesics, and empiric antibiotics when indicated. Read More

J Clin Aesthet Dermatol 2018 Dec 1;11(12):48-51. Epub 2018 Dec 1.

Ms. Krooks, Dr. Weatherall, and Dr. Markowitz are with the Florida Atlantic University Charles E. Schmidt College of Medicine in Boca Raton, Florida.

A 70-year-old, immunocompetent male presented with mildly painful and pruritic erythematous patches and vesicles on the right dorsal aspect of the distal middle finger present for four weeks. Other skin lesions or systemic symptoms were notably absent. The patient failed to respond to valacyclovir, topical triamcinolone acetonide ointment, trimethoprim-sulfamethoxazole, and cephalexin for presumptive diagnoses of recurrent herpetic whitlow, dyshidrotic eczema, and blistering distal dactylitis, respectively. Read More

JAMA Dermatol 2018 Dec;154(12):1487-1488

Department of Dermatology, University of Rochester, Rochester, New York.

N Engl J Med 2018 Feb;378(6):563

Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.

Endocr Metab Immune Disord Drug Targets 2017 ;17(1):3-4

Microbiology and Virology Unit, Bari-Policlinico, Bari, Italy.

Context: Herpetic whitlow is caused by herpes virus (type1 or 2) during primary infection or as result of autoinoculation. Commonly, it is caused by HSV-2 in adults with positive history for genital infection.

Case Description: We report the case of a 44-year-old woman that came to our attention with a 3- year history of recurrent cutaneous eruption on the ring finger of her left hand associated to lymphangitis of the homolateral arm. Read More

Clin Radiol 2017 Apr 6;72(4):338.e1-338.e9. Epub 2017 Jan 6.

The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins University School of Medicine, 601 North Wolfe Street, Baltimore, MD 21287, USA.

Hand and wrist infections can present with a spectrum of manifestations ranging from cellulitis to deep-space collections. The various infectious processes can be categorised as superficial or deep infections based on their respective locations relative to the tendons. Superficial hand infections are located superficial to the tendons and are comprised of cellulitis, lymphangitis, paronychia, pulp-space infections, herpetic whitlow, and include volar as well as dorsal subcutaneous abscesses. Read More

Clin Dermatol 2017 Jan - Feb;35(1):40-49. Epub 2016 Sep 10.

Emeritus Professor of Gazi University, Faculty of Medicine, Department of Dermatology, Beşevler, Ankara, Turkey.

Viruses are considered intracellular obligates with a nucleic acid RNA or DNA. They have the ability to encode proteins involved in viral replication and production of the protective coat within the host cells but require host cell ribosomes and mitochondria for translation. The members of the families Herpesviridae, Poxviridae, Papovaviridae, and Picornaviridae are the most commonly known agents for cutaneous viral diseases, but other virus families, such as Adenoviridae, Togaviridae, Parvoviridae, Paramyxoviridae, Flaviviridae, and Hepadnaviridae, can also infect the skin. Read More

AIDS 2016 09;30(14):2254-6

Gaffree and Guinle University Hospital, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil.

Transpl Infect Dis 2016 Oct 16;18(5):791-794. Epub 2016 Sep 16.

Department of Pediatric Oncology/Hematology/SCT, Charité-Universitätsmedizin Berlin, Berlin, Germany.

Infections with adenovirus (AdV) and herpesviruses can result in considerable morbidity and mortality in pediatric hematopoietic stem cell transplant (SCT) recipients. Herpes simplex virus (HSV) reactivations are usually prevented by acyclovir (ACV) prophylaxis, whereas cidofovir (CDV) has been used off indication to manage AdV infections. We report a child with myelodysplastic syndrome undergoing multiple SCT, who experienced HSV-1 disease including severe mucositis and herpetic whitlow, as well as high viral load AdV DNAemia. Read More

Clin Case Rep 2015 Jun 22;3(6):461-7. Epub 2015 Apr 22.

Department of Virology, University of Toyama Toyama, 930-0194, Japan.

Herpes simplex virus 2 caused a genital ulcer, and a secondary herpetic whitlow appeared during acyclovir therapy. The secondary and recurrent whitlow isolates were acyclovir-resistant and temperature-sensitive in contrast to a genital isolate. We identified the ribonucleotide reductase mutation responsible for temperature-sensitivity by deep-sequencing analysis. Read More

J Med Case Rep 2015 May 23;9:119. Epub 2015 May 23.

Jeroen Bosch Ziekenhuis 's-Hertogenbosch, Henri Dunantstraat 1, 5223 GZ, 's-Hertogenbosch, The Netherlands.

Introduction: Whitlow is an infection of a finger or around the fingernails, generally caused by bacterium. However, in rare cases, it may also be caused by the herpes simplex virus. As herpetic whitlow is not seen often, it may go under-recognised or be mistaken for a different kind of infection of the finger. Read More

J Cutan Med Surg 2015 Jul-Aug;19(4):397-9. Epub 2015 Mar 3.

Center for Clinical Studies, Houston, TX, USA Dermatological Association of Texas, Houston, TX, USA Department of Dermatology, University of Texas Health Science Center at Houston, Houston, TX, USA.

Background: Blistering distal dactylitis is a localised infection of the anterior pad of the distal phalanx of the digits. It most commonly affects children and uncommonly adults with a history of immunosuppression or trauma.

Objective: A case of blistering distal dactylitis in a 32-year-old male is reported. Read More

Presse Med 2014 Nov 23;43(11):1216-22. Epub 2014 Oct 23.

19 bis, place Jean-Jaurès, 37000 Tours, France. Electronic address:

Paronychia is an inflammation of the folds of tissue surrounding the nail; proximal and/or lateral nail folds. Acute paronychia is mainly due to bacterial infection, Staphyloccus aureus or Streptococcus sometimes viral infection (herpetic whitlow). Chronic paronychia is the result of numerous conditions in which the main factor is the disappearance of the cuticle. Read More

Case Rep Orthop 2014 4;2014:906487. Epub 2014 Nov 4.

Salford Royal Foundation Trust, Manchester, UK.

Herpetic whitlow is an acute viral infection of the hand caused by either herpes simplex virus (HSV) 1 or 2. Its characteristic findings are significant pain and erythema with overlying nonpurulent vesicles. The differential diagnosis includes flexor tenosynovitis. Read More

N Engl J Med 2014 Oct;371(17):e25

University of Rome, Sapienza, Rome, Italy.

Infection 2015 Feb 29;43(1):127-8. Epub 2014 Jul 29.

Medicine E Beilinson Hospital, Rabin Medical Center, 39 Jabotinski Street, 49100, Petah Tikva, Israel,

BMJ Case Rep 2014 Apr 12;2014. Epub 2014 Apr 12.

Department of Pediatric Dentistry, Awadh Dental College, Jamshedpur, Jharkhand, India.

A 25-year-old dental radiographer reported to the outpatient department with lesions at the lower and upper lips which had later spread to his finger. On the basis of the given history and clinical features, a diagnosis of primary herpetic infection on the mouth followed by secondary infection on the finger was made and the patient was advised systemic and topical antiviral therapy following which his lesions healed uneventfully. Read More

Pediatr Emerg Med Pract 2014 Jan;11(1):1-19; quiz 19

Herpes simplex virus is a common virus that causes a variety of clinical presentations ranging from mild to life-threatening. Orolabial and genital herpes are common disorders that can often be managed in an outpatient setting; however, some patients do present to the emergency department with those conditions, and emergency clinicians should be aware of possible complications in the pediatric population. Neonatal herpes is a rare disorder, but prompt recognition and initiation of antiviral therapy is imperative, as the morbidity and mortality of the disease is high. Read More

Eur J Rheumatol 2014 Mar 1;1(1):46-47. Epub 2014 Mar 1.

Department of Internal Medicine, Division of Rheumatology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey.

Skin involvement may occur in patients with Wegener's granulomatosis (polyangiitis with granulomatosis; WG) and is more frequent in the generalised form. However, when a patient with vasculitis develops digital ulceration, in addition to disease activation, other pathologies should be considered. One of them may be the herpetic whitlow mimicking paronychia. Read More

Orthop Clin North Am 2013 Oct;44(4):625-34

University of California, San Diego School of Medicine, San Diego, CA, USA.

Many acute hand and upper extremity infections should be treated as surgical emergencies to avoid stiffness, contracture, pain, and amputation. Proper treatment requires understanding of anatomy and how this influences the behavior of certain infections, common offending organisms, antibiotic treatment, management of host factors, and surgical intervention. This article reviews the microbiology, antibiotic coverage, and surgical treatment of the most common infections in the hand: paronychia, felon, herpetic whitlow, flexor tenosynovitis, deep space infections, septic arthritis, bites from humans and animals, necrotizing fasciitis, mycobacterium infections, and fungal infections. Read More

BMJ Case Rep 2013 Jul 31;2013. Epub 2013 Jul 31.

Department of Paediatric Urology, University College London Hospitals NHS Foundation Trust, London, UK.

We present a case of recurrent painful blisters of middle phalanx of the left ring finger of a 15-month-old previously healthy and immunocompetent female child. These lesions initially were confused with infective bacterial whitlow, treated with incision and drainage, and later with cigarette burns which led to referral to child protection team. Paediatric dermatologist finally diagnosed after scrapping and virology culture. Read More

Infection 2013 Dec 7;41(6):1203-4. Epub 2013 May 7.

Dpto Especialidades Médicas, Universidad Europea de Madrid, Madrid, Spain,

Introduction: Infections of the hand may be associated with lymphangitis and lymphadenitis. In most cases, bacterial infections are responsible but these may be also due to viral infections.

Material And Methods: We describe a clinical case of a recurrent infection in the left thumb of a health male. Read More

BMJ Case Rep 2013 Feb 21;2013. Epub 2013 Feb 21.

Department of Paediatrics, Southport and Ormskirk NHS, Ormskirk, UK.

A 9-month-old baby girl presented multiple times with an erythematous, papular and pustular big toe in an otherwise healthy infant. A diagnosis of cellulitis was made and she was started on oral antibiotics, and bacterial swabs were taken. After 2 weeks of worsening appearance she was admitted for intravenous antibiotics. Read More

Paediatr Int Child Health 2012 May;32(2):121-2

Department of Pediatrics, Athens Medical Center, Athens, Greece.

HSV-2 meningitis is uncommon in childhood and is mainly associated with genital lesions or a history of sexual abuse. A 7-year-old boy with recurrent herpetic whitlow developed HSV-2 meningitis. HSV-2 was identified in the CSF by PCR. Read More

CMAJ 2012 Nov 30;184(17):E924. Epub 2012 Apr 30.

Department of Dermatology, Heinrich-Heine University, Düsseldorf, Germany.

Indian Pediatr 2011 Aug;48(8):665

Department of Dermatology and Venereology, Government Medical College and Hospitals, Bellary-583104, India.

Am J Clin Dermatol 2011 Apr;12(2):101-12

Department of Dermatology, University Hospital of Liège, Liège, Belgium.

Nail disorders in children can be divided into seven categories. The first is physiologic alterations, which every physician should be aware of in order to reassure parents. These usually disappear with age and do not require any treatment. Read More

J Hand Surg Am 2011 Feb 24;36(2):340-2. Epub 2010 Dec 24.

Department of Orthopaedic Surgery, University of Vermont College of Medicine,Burlington, VT 05405, USA.

Am Fam Physician 2010 Nov;82(9):1075-82

Department of Family and Community Medicine, University of Texas Health Science Center, San Antonio, TX 78229, USA.

Nongenital herpes simplex virus type 1 is a common infection usually transmitted during childhood via nonsexual contact. Most of these infections involve the oral mucosa or lips (herpes labialis). The diagnosis of an infection with herpes simplex virus type 1 is usually made by the appearance of the lesions (grouped vesicles or ulcers on an erythematous base) and patient history. Read More

Ann Dermatol 2010 May 18;22(2):194-5. Epub 2010 May 18.

Department of Dermatology, Guri Hospital, Hanyang University College of Medicine, Guri, Korea.

A digital mucous cyst (DMC) is clinically characterized by a round to oval, translucent, smooth nodule localized to the dorsal aspect of the distal digits near the distal interphalangeal joint. It usually presents as a solitary lesion, and multiple lesions are uncommon. An 88-year-old man presented with herpetiform translucent papules on the right thumb. Read More

Mikrobiyol Bul 2010 Jan;44(1):47-56

Kayseri Kadin Dogum ve Cocuk Hastaliklari Hastanesi, Kayseri.

Herpes simplex virus (HSV) infections are a common clinical problem worldwide. HSV infections have a severe and rapidly progressive course especially in immunocompromised patients, leading to significant morbidity and mortality. Therefore, rapid and reliable laboratory diagnosis of HSV infections is of crucial importance for the initiation of early antiviral therapy. Read More

Dermatol Nurs 2008 Dec;20(6):455-8, 461-6

Yale University School of Nursing, New Haven, CT, USA.

This state of the science clinical article focuses on ways clinicians can manage herpes simplex virus-1 (HSV-1) infections in children and adolescents. HSV-1 infections can be transmitted during close contact with asymptomatic and symptomatic individuals (Waggoner-Fountain & Grossman, 2004). Recurrent HSV-1 outbreaks are believed to be caused by various endogenous and exogenous triggers. Read More

Pediatr Nurs 2008 Jul-Aug;34(4):310-8

Yale University School of Nursing, New Haven, CT, USA.

This state of the science clinical article focuses on ways pediatric clinicians can manage herpes simplex virus-1 (HSV-1) infections in children and adolescents. HSV-1 infections can be transmitted during close contact with asymptomatic and symptomatic individuals (Waggoner-Fountain & Grossman, 2004). Recurrent HSV-1 outbreaks are believed to be caused by various endogenous and exogenous triggers. Read More

Ann Fr Anesth Reanim 2008 Apr 18;27(4):350-1. Epub 2008 Apr 18.

Rev Med Interne 2008 Feb 14;29(2):158-60. Epub 2007 Sep 14.

Service de dermatologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges, France.

Upper limb lymphangitis often complicates varied wounds on the hand or forearm and improvement is obtained in a few days with adapted antibiotic therapy. A 28-year-old woman presented since few years episodes of lymphangitis of the arm associated with vesicles on an erythematous base, on the palmar face of the first phalanx of the index finger, spontaneous relief within 10 days, without antibiotic therapy. Herpetic origin was confirmed on viral culture. Read More

J Med Virol 2007 Nov;79(11):1731-40

Department of Dermatology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan.

Herpes simplex virus (HSV)-2 caused a genital ulcer in a 40-year-old allogenic stem cell recipient, and a secondary herpetic whitlow appeared during 2 months of acyclovir (ACV) therapy. Both genital ulcer, and whitlow were cured 3 months later, but 6 months after recovery the whitlow alone recurred. DNA of the genital, first, and recurrent whitlow isolates showed similar endonuclease digestion fragment profiles. Read More

Cutis 2007 Mar;79(3):193-6

UMDNJ-New Jersey Medical School, Newark 07103-2714, USA.

Herpetic whitlow is a painful cutaneous infection that most commonly affects the distal phalanx of the fingers and occasionally the toes. It is caused by herpes simplex virus (HSV) types 1 or 2. Herpetic whitlow has been known mainly for infecting healthcare workers in contact with infected secretions or mucous membranes, but the implementation of universal precautions has resulted in a decrease in the incidence of occupation-related cases. Read More

FEMS Immunol Med Microbiol 2007 Aug 23;50(3):319-23. Epub 2007 Jun 23.

Department of Microbiology, Faculty of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran.

The herpes simplex viruses are important causes of disease worldwide. Herpes simplex virus type 1 (HSV-1) is the primary cause of oral-facial and pharyngeal infections and may cause herpetic whitlow, eye infections as well as severe and sometimes dangerous infections of the eyes and brain. HSV-1 also accounts for 10-15% of all genital herpetic infections. Read More

Clin Exp Dermatol 2005 Sep;30(5):609-10

Department of Dermatology, Chelsea & Westminster Hospital, London, UK.

Pediatr Dermatol 2005 Mar-Apr;22(2):119-21

Department of Dermatology, Bambino Gesu Children's Hospital- Research Institute, Rome, Italy.

Herpetic whitlow applies to a primary or recurrent herpes simplex infection of the fingers. It is a rare condition in immunocompetent patients, and usually has a rapid evolution and prompt response to treatment. We report a 10-year-old girl referred to our department of infectious diseases with recurrent and unresponsive ulcerated and necrotic lesions of the fingers of both hands as a first sign of human immunodeficiency virus infection. Read More

Dermatol Online J 2004 Jul 15;10(1):16. Epub 2004 Jul 15.

Department of Dermatology, Division of Internal Medicine, Tohoku University Graduate School of Medicine.

We report a case of indolent herpetic whitlow of the toe occurring in an elderly male patient with poorly controlled diabetes mellitus. In this case, the mechanism of transmission was not clear, although he was in a habit of taking a hot spring bath. This patient's symptoms were unusual for herpes simplex; he had no pain in the presence of diabetic neuropathy. Read More

Nursing 2004 Jul;34(7):17

Greenbrier Valley Medical Center, Ronceverte, W. Va., USA.

Int Dent J 2004 Apr;54(2):103-11

Dental School, University of Wales College of Medicine, Cardiff, UK.

Approximately 70% of the population in the western world become infected with the herpes simplex virus type 1 (HSV-1) by the second decade of life. This review discusses the role of the HSV-1 as a potential occupational hazard for dental workers, focusing on herpes labialis, herpetic whitlow and keratitis. The risks associated with the dental treatment of patients with HSV-1, both from the perspective of the clinician and the patient are presented. Read More

Am Fam Physician 2003 Dec;68(11):2167-76

Department of Family Practice, Naval Hospital Jacksonville, Jacksonville, Florida 32214, USA.

Hand infections can result in significant morbidity if not appropriately diagnosed and treated. Host factors, location, and circumstances of the infection are important guides to initial treatment strategies. Many hand infections improve with early splinting, elevation, appropriate antibiotics and, if an abscess is present, incision and drainage. Read More

Int J Dermatol 2003 Jun;42(6):496-8

Department of Dermatology, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA.

Isotretinoin is an extremely valuable drug that is occasionally associated with well-known mucocutaneous side-effects, including cheilitis, retinoid dermatitis, palmoplantar desquamation, and photosensitivity. Paronychia has been reported rarely: only two prior cases of herpes simplex infections associated with isotretinoin have been previously reported. We present the first known case of herpetic paronychia occurring in an atopic patient while on isotretinoin therapy for acne. Read More

Infection 2002 Aug;30(4):234-6

The Hospital for Sick Children, Toronto, Ontario, Canada.

Herpetic whitlow is a well-known occupational hazard for medical staff. It has been reported to affect mainly workers in intensive care units who come into close contact with oral secretions. We report herpetic whitlow infection in a general pediatrician in order to increase the awareness to this infectious occupational hazard that might occur in any health care worker who deals with oral secretions. Read More

Am J Clin Dermatol 2002 ;3(7):475-87

Department of Dermatopathology, University Medical Center of Liege, Liege, Belgium.

Infections by herpes simplex virus (HSV) types I and II are diverse and quite frequent. After primary infection, the virus establishes a life-long latency in the sensory ganglia and recrudescences may occur at an unpredictable rate. Recurrent labial and genital herpes infections represent the majority of clinical manifestations of HSV infections. Read More