Herpetic Whitlow: An Occupational Hazard
The Herpes Simplex Virus Infection of the Fingers
Oct 21, 2008
Herpetic whitlow is a very painful infection caused by herpes simplex virus, typically affecting the distal phalanx of the fingers. Adamson first described herpetic whitlow in 1909, and in 1959, it was noted to be an occupational hazard among health care workers.
Herpetic whitlow occurs in infants and children who suck their fingers and transfer the virus when they have cold sores (autoinoculation). Healthcare workers, especially dentists, nurses, and other doctors are more at risk of contracting the herpetic whitlow as an occupational hazard from the patients. Herpetic whitlow is also an occupational hazard of beauty therapists and masseurs.
Herpes simplex virus (HSV) is of two types: HSV 1 and HSV 2. HSV 1 usually causes herpes infections in and around the mouth, nose and face, while HSV 2 causes what is known as herpes genitalis on the genitals and the anal area and buttocks. Both viruses can rarely cause infections in other areas as well. In children and health workers herpetic whitlow is caused by HSV 1 while in other adult populations, it is caused by HSV 2. The ratio of HSV 1 to 2 is calculated to be 60:40 in the causation of herpetic whitlow.
Sign and Symptoms of Herpetic Whitlow
Following exposure to virus from cold sores or genital herpes (herpes genitalis), which enters through a cut, abrasion in the skin or a torn cuticle, after about 2-20 days, patients may experience pain and burning on the infected finger. Most commonly affected fingers are the thumb and index finger, for obvious reasons. If it is the first attack, fever and body pain may be experienced 2 days prior to the appearance of the rash. The rash starts as redness, swelling and appearance of grouped, fluid filled small blisters (called vesicles) over 5-7 days. The vesicles are extremely painful and the pain may shoot up the arm. Most patients will also have lymph node swelling above the elbows or the armpits. Over another week, the vesicles dry up, form crusts and heal by themselves. Triggering events like exposure to sun, heat, extreme cold, stress, irritants etc may produce recurrences.
Treatment of Herpetic Whitlow
- Painkillers like paracetamol, ibuprofen or diclofenac will relieve the pain to an extent
- Cool compresses and ice packs will reduce the swelling and discomfort in the initial stages
- Topical antiviral creams like acyclovir can help in earlier healing
- In severe attacks and primary attacks, early institution of oral antiviral medication like acyclovir, famcyclovir, valacyclovir etc will help in earlier resolution of the lesions. This will also help in preventing further infection to other people, as the virus is highly contagious.
- In recurrent attacks, when the prodromal symptoms of pain and burning sensation start, early intake of oral antivirals will abort the painful eruptions in most cases.
Prevention of Herpetic Whitlow
- Health workers should always wear gloves while examining patients who have active cold sores or genital herpes
- Avoid sharing towels, glassware etc
- Never pop the vesicle: this will increase the discomfort and increase chances of transmission to others
- Always cover the affected finger with a cotton finger cover or bandage.
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