What is Herpetic Whitlow?
Herpetic Whitlow is a skin condition on the fingers caused by herpes simplex virus. It begins with small reddish raised spots on the skin that worsens and become a disturbing lesion. Unfortunately, those afflicted with this disease will suffer from excruciating pain resulting to interrupt activities of daily living. Herpetic whitlow caused by HSV-1 or HSV-2 affects any age group and gender exposed to this rare but alarming virus. Yearly, occurrences less than 5 cases were documented as per 100,000 populations in the United States.
Causes of Herpetic Whitlow
Presence of Herpes labialis or Herpetic-Gingivostomatitis (HSV-1). Herpetic infections such as herpetic whitlow occur when the virus residing in the mouth and infected saliva come in contact with fingers with open wounds. Consequently, the tendency to herpetic whitlow confirms herpes labialis or herpetic-gingivostomatitis infection as well. The virus then enters the cells of the dermis and subcutaneous tissue. Finally, the onset of clinical manifestations will follow within a matter of days.
Age. Young population usually suffers from a previous oropharyngeal lesion is more likely to be infected due to finger-sucking or thumb-sucking habit.
Occupation. Health care providers and dental workers have a high risk of getting this infection. Unprotected bare hands working on infected oropharyngeal secretion of patients are the reason. Moreover, the importance of gloves and other precautionary measures should be strictly practiced.
Immunocompromised. Repeated infection, unexpected pattern, or extra-ordinary positions are likely indicating an immunodeficient condition. Examination of the presence of HIV is necessary under these circumstances.
HSV-2-infected genitals. In adults, the tendency acquiring herpetic whitlow follows after contact with HSV-2-infected genitals.
Herpetic Whitlow Symptoms
After initial exposure, it is expected that the symptoms will advance from 2 to 20 days. Herpetic whitlow signs and symptoms consist of the following:
- Febrile state and tiredness are one of many forewarning symptoms.
- The unpleasant physical sensation of the infected digit may follow.
- Generally, it progresses to blisters which appear at the end of the first week. These blisters consist of fluid that usually burst and sore.
- Uncommon tenderness of the lymph nodes underneath the armpits may be felt.
The herpes whitlow sufferers usually recover in two to three weeks.
As expected, herpetic whitlow resembles other herpetic infections. It is believed to reoccur under favorable circumstances of poor health. After recovery, the virus lies dormant after migrating to peripheral ganglia and Schwann cells. In contrast to the primary infection recurrences are less distressing and will not last long.
How will you Identify Herpetic Whitlow?
Location and characteristic of the lesion. To determine the presence of the herpetic whitlow, presentation of the lesion found should be considered.
History. A typical history confirms the diagnosis. These include gingivostomatitis in children, genital herpes lesions in adults, and high risk occupation.
Diagnostic Procedure. There are ways to determine the nature of the virus. Among these:
Tzanck Test. In the Tzanck test, a sample of cells is obtained by rubbing the lowest part of an exposed blister. These samples are soaked in a Giemsa reagent, and then placed under the microscope. Positive test shows, presence of multiple nucleated giant cells frequently with visible viral inclusions.
Viral Cultures. The viral culture of a removed vesicle liquid is the most expensive and lengthy test, yet produce a strong diagnosis.
(3) Serum antibody titers, fluorescent antibody testing, DNA hybridizations. Alternatively these tests are either costly or not available.
Herpetic Whitlow Treatment
Recovery from Herpetic whitlow may be obtained without any treatment. Since it is self-limiting, it would require a particular length of time. However, it would be necessary to ask for a medical intervention because of persistent discomfort at this time.
Course of treatment includes:
- Antiviral Medications. To end the stressful experience and to stop the infection from spreading, antiviral agent namely Acyclovir (Zovirax) seems very helpful. As a matter of fact, shortening the length of symptoms is demonstrated by a topical acyclovir. It acts significantly by interrupting with DNA synthesis within the virus therefore, killing it. Likewise, taking oral acyclovir of 800 mg twice daily, just before the onset of symptoms will stop repeating infection.
- Pain relievers. Paracetamol or ibuprofen is also included in the course of treatment to relieve the pain. Read the drug information insert at all times or ask pharmacist’s assistance for any inquiries.
- Antibiotics. Scraping the blisters will make the situation worse. Consequently, herpes encephalitis might set in. In case this complication happens, antibiotic treatment is necessary.
Universal fluid Precautions
Herpes Whitlow is highly communicable even in asymptomatic patients. Therefore, all means of universal fluid precautions should be strictly enforced. With proper hand washing and gloving, the spread of this disease will decrease tremendously. Moreover, information dissemination and warning is imperative in patients suffering from any form of oral, labial, or genital lesions and the significant others against digital and sexual contact with lesions.
Follow-up care for Discharging Patients. This is to monitor full recovery or to check evidence of complication.
Eat well Balanced Diet. The immune system should be boosted to resist the virus.
For instance, you are experiencing the signs and symptoms of herpes whitlow, follow these easy tips;
- Cover the infected area with a plaster
- Stop sharing towels
- Avoid holding hands
- Do not wear contact lenses
Herpes Whitlow Complications
- Pneumonia and Encephalitis. Complications usually are least possible, if the afflicted individuals are not immunocompetent. In case of HSV infection in HIV patients, it is extremely dangerous and cause very bad complications. These dreaded diseases are pneumonia and encephalitis. Hence, it requires immediate medical attention.
- Herpes Encephalitis. Wrong diagnosis that may result to profound surgical incision may lead to poor outcomes. Thus, it only intensifies chances of bacterial super-infection (a rare widespread of infection) and potential development of herpes encephalitis.
- Decrease sensation or heightened perception to pain on Affected Digit. People who experience more than one Herpes Whitlow infection and fully recovered have reported these complaints.
- Scarring of the affected digit
- Risk of Spread. With any HSV infection, there is always a risk that the infection will extend to other fingers or eyes if you come in contact with your infected finger. Mortality related to herpetic whitlow is believed to be insignificant while the prognosis is extremely good in uncomplicated cases.