Herpetic whitlow. Epidemiology, clinical characteristics, diagnosis, and treatment.

Herpetic whitlow is a herpes simplex virus infection of a distal phalanx. It is characterized by pain, swelling, erythema, and nonpurulent vesicle formation. Herpetic whitlow follows direct inoculation (exogenous or autogenous) or reactivation of latent virus. In children, it most frequently occurs following a primary oral herpes infection. In adolescents, herpetic whitlow is commonly associated with genital herpes infections. In adults, it frequently occurs in medical personnel who have contact with patients' oral secretions or is associated with genital herpes infections. The diagnosis of herpetic whitlow is readily confirmed by Tzanck test and culture. It is important to distinguish herpetic whitlow from bacterial felon or paronychia, as herpetic whitlow is a self-limited infection for which surgical incision is not indicated. We described herpetic whitlow in five children, one adolescent, and two pediatric residents.