Herpetic Whitlow

A 40-year-old dental assistant requested a prescription for antibiotics to treat the acute outbreak of painful, deep blisters that had recurred on her index finger. Prior eruptions of similar lesions had been diagnosed as staphylococcal infections and were treated with antibiotics.

A 1-cm collection of fluid-filled intradermal vesicles on a slightly erythematous area of the patient's finger was noted. No nodes were palpable. Material from the base of a fresh vesicle was used for a Tzanck test and a tissue culture, which yielded Herpesvirus hominis, herpes simplex virus. Herpetic whitlow was diagnosed.

Herpetic whitlow is somewhat common in dental and medical personnel, who contract herpes simplex from H hominis found in their patients' saliva. Without laboratory confirmation, the cause of the lesions may be incorrectly attributed to a bacterial agent and treated with antibiotics. However, a herpes simplex virus infection must be considered if vesiculation recurs in the same location and prodromal tingling and pain arise at the site.

Prophylactic valacyclovir was prescribed for this patient. She was advised to wear latex gloves to prevent transmission of the virus.