An 8-year-old boy was treated for a 4-day history of pain and paresthesia of the right thumb, following a Herpes labialis infection. The thumb appeared inflamed and swollen, with vesicular eruptions. The most likely cause of the infection was thumb sucking, but it could also be due to the prior HSV1 or HSV2 infection in genital secretions.
Herpetic whitlow was first reported as an occupational hazard for health care workers1,3. It is often misdiagnosed as a bacterial infection, although herpetic whitlow is caused by herpes simplex virus 1 (HSV1) in 60 percent of cases, and by herpes simplex virus 2 (HSV2) in the remaining 40 percent of cases2,3. Thumb sucking causes autoinoculation from primary oropharyngeal lesions in children with herpetic gingivostomatitis or herpes labialis. Children and health care workers are usually infected with HSV11,2,3. Signs and symptoms of herpetic whitlow include edema, erythema, and significant localized tenderness of the infected finger. The diagnosis is made based on examination, history, and laboratory tests, the definitive tests being viral cultures and the Tzanck test. Herpetic whitlow is a self-limiting disease, and is usually treated with anti-viral medications to relieve symptoms.
The involved finger is often exquisitely tender and quite edematous; however, in contrast to felon, the pulp space usually is not tensely swollen3. The pain may be out of proportion to the visible symptoms. Examination usually reveals the characteristic grouped vesicular lesions or ulcers with surrounding erythema. The fluid within the vesicles is usually clear, but it may appear cloudy or hemorrhagic. The infectious process may be extended into the subungual space. Lymphangitic streaking and possible adenopathy of the epitrochlear and axillary nodes may be found. There are often preexisting herpetic lesions in the oral cavity or on the genitals.
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