herpetic whitlow

Last reviewed 01/2018

Herpetic whitlow is a painful cutaneous infection which usually affects the distal phalanx of the fingers and rarely the toes (1).

  • caused by herpes simplex virus (HSV) types I or II (1), and may represent either a primary infection or a secondary recurrence (2)
  • studies have revealed that
    • HSV 1 is responsible for 60% case while HSV 2 is responsible for around 40%
    • HSV 1 infections are seen more often on the hands of medical personnel (inoculated through oral secretions of infected patients) and HSV 2 on the hands of the general population (2,3)
  • it is a recognized occupational hazard amongst medical and dental personnel but with the advent of universal precautions the incidence has decreased (1)

A bimodal age distribution can be observed in:

  • young adults - usually affected by type 2 HSV
  • children - type 1 HSV is usually responsible (from autoinoculation) (4)

Transmission can be through:

  • direct contact with a herpetic lesion
  • contact with infected saliva, semen, cervical fluid
  • autoinoculation e.g. - nail biters with herpes labialis or stomatitis infection (2,3)

The incidence of herpetic whitlow is reported to be 4 cases per 100 000 per year (4)

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