A whitlow is a painful and highly contagious infection on the fingers caused by the herpes simplex virus. It is also known as herpetic whitlow or paronychia.
There are two types of herpes simplex virus—type 1 and type 2—and both can cause herpetic whitlow. A whitlow can occur when broken skin on your finger comes in direct contact with body fluids infected with the herpes simplex virus. These body fluids may come from you or someone else. The first bout of whitlow is usually the most troublesome, with recurrences usually being lesser in pain and length. Since about 20 to 50% of cases are recurrences, prevention is key
TO DIAGNOSE WITLOW :
1. Recall if you've had contact with someone who has herpes. Herpes simplex virus is very common and highly contagious.
HSV -1 commonly affects the face, and often causes cold sores (painful blisters on the lips). HSV-2 tends to cause painful genital blisters.HSV-1 can spread through kissing or oral sex, while
HSV-2 can spread through skin to skin contact with infected genitals.
Be aware that HSV can have a long dormant period. You may have contracted herpes long ago, but the virus may have stayed dormant in the nerve cells where it resides. Stress and lack of immunity (getting sick) are common triggers for activation of the virus from the dormant phase.
2. Look for early symptoms. In the "prodrome" or early phase of any disease, symptoms indicate the onset of a condition. For whitlow, these symptoms usually appear 2 to 20 days after initial exposure, and include:
-Fever
-Fatigue
-Unusual pain
-Numbness
-Tingling in the area
3. Observe more typical whitlow symptoms in the disease phase.Once the initial prodrome phase has passed, you will see far more specific symptoms that point clearly to whitlow:
-Swelling, redness, and rash, with fluid filled vesicles around the area.
-The vesicles may rupture, and a white, clear, or bloody fluid will come out.
-These vesicles may merge and take on a black/brown color.
-Ulceration, or a break in the skin, may develop later.
-Symptoms can resolve from anywhere from 10 days to 3 weeks
4. Get a formal medical diagnosis. Since whitlow is a more of a clinical diagnosis, the medical staff might not order any additional tests. Instead, the doctor will take your symptoms and medical history — including an HSV diagnosis — into consideration to diagnose whitlow. They may also take a tube of your blood to order a complete blood count (CBC) with a differential (a count of your white blood cells). This will let them see if you have enough immune cells to fight infections, or if you have an underlying immune dysfunction that causes reoccurring infections.
The doctor may want to test for herpes if you haven't been diagnosed with it. They may analyze your blood for herpes antibodies, order a PCR test (for the detection of herpes DNA), and/or order a viral culture (to see if actual herpes virus is growing from your blood).
INITIAL TREATMENT
There are two types of herpes simplex virus—type 1 and type 2—and both can cause herpetic whitlow. A whitlow can occur when broken skin on your finger comes in direct contact with body fluids infected with the herpes simplex virus. These body fluids may come from you or someone else. The first bout of whitlow is usually the most troublesome, with recurrences usually being lesser in pain and length. Since about 20 to 50% of cases are recurrences, prevention is key
TO DIAGNOSE WITLOW :
1. Recall if you've had contact with someone who has herpes. Herpes simplex virus is very common and highly contagious.
HSV -1 commonly affects the face, and often causes cold sores (painful blisters on the lips). HSV-2 tends to cause painful genital blisters.HSV-1 can spread through kissing or oral sex, while
HSV-2 can spread through skin to skin contact with infected genitals.
Be aware that HSV can have a long dormant period. You may have contracted herpes long ago, but the virus may have stayed dormant in the nerve cells where it resides. Stress and lack of immunity (getting sick) are common triggers for activation of the virus from the dormant phase.
2. Look for early symptoms. In the "prodrome" or early phase of any disease, symptoms indicate the onset of a condition. For whitlow, these symptoms usually appear 2 to 20 days after initial exposure, and include:
-Fever
-Fatigue
-Unusual pain
-Numbness
-Tingling in the area
3. Observe more typical whitlow symptoms in the disease phase.Once the initial prodrome phase has passed, you will see far more specific symptoms that point clearly to whitlow:
-Swelling, redness, and rash, with fluid filled vesicles around the area.
-The vesicles may rupture, and a white, clear, or bloody fluid will come out.
-These vesicles may merge and take on a black/brown color.
-Ulceration, or a break in the skin, may develop later.
-Symptoms can resolve from anywhere from 10 days to 3 weeks
4. Get a formal medical diagnosis. Since whitlow is a more of a clinical diagnosis, the medical staff might not order any additional tests. Instead, the doctor will take your symptoms and medical history — including an HSV diagnosis — into consideration to diagnose whitlow. They may also take a tube of your blood to order a complete blood count (CBC) with a differential (a count of your white blood cells). This will let them see if you have enough immune cells to fight infections, or if you have an underlying immune dysfunction that causes reoccurring infections.
The doctor may want to test for herpes if you haven't been diagnosed with it. They may analyze your blood for herpes antibodies, order a PCR test (for the detection of herpes DNA), and/or order a viral culture (to see if actual herpes virus is growing from your blood).
INITIAL TREATMENT
- Take antiviral medication. If whitlow is diagnosed within 48 hours after the symptoms start, the doctor can prescribe antiviral medication to you.The medicine might be topical (a cream) or oral (pills), but will lessen the severity of the infection and promote quicker healing. Thus, it's crucial that you seek immediate medical advice.Commonly prescribed medications include topical acyclovir 5%, oral acyclovir, oral Famciclovir or valacyclovir.Take the medications as advised by your doctor or pharmacist or nurse consultant.Dosages will be adjusted for children, but the treatments will remain the same.
- Take precautions to prevent spreading the infection. Since the virus can spread through contact, your healthcare provider may advise you not to touch others, or even to avoid yourself with the infected finger. Specifically avoid touching body parts that contain fluids or bodily secretions. These include the eyes, mouth, tongue, genitals, ears, and breast.If you wear contacts, don't wear them until the infection has resolved. Touching the contacts, then inserting them into your eyes could infect the eye.
- Wrap the infected area. Your healthcare provider may wrap the infected area with a bandage, cloth, or any form of dry wrap with medical tape. You can do this easily at home, too, by buying the bandages or wraps from your local pharmacy. To keep the wrap fresh, change it daily. To be extra safe, your doctor may advise you to both wrap the infected area and wear a glove over it.
- Monitor children closely. It can be difficult enough to be conscious of your hands as an adult, but children often find it quite difficult. You don't want them sucking on infected fingers, touching their eyes, or any other areas of the body that contain or carry bodily fluids. Even after wrapping the infected area, watch them closely to make sure everything is as it should be.
- Get pain medication if necessary.The doctor may provide or advise you to use over the counter pain medication like Advil, Tylenol, ibuprofen or aspirin. They should ease pain while the infection heals by reducing inflammation to the area. If you saw a doctor within 48 hours of noticing the symptoms, the doctor might not recommend anything beyond pain medication.Children and teenagers with viral infections are advised not to take aspirin. There's a risk of developing a multi-organ fatal condition known as Reye’s syndrome.Seek expert medical advice before taking over the counter pain meds for viral infections.Take all medications as described either by your healthcare provider or on the label. Be careful not to exceed the maximum daily dose.
- Ask the doctor to test for bacterial infection.If you try to burst or drain the vesicles on your finger on your own, you give debris and bacteria opportunity to invade. Whitlow is a viral infection, but you can compound the issue with a bacterial infection (this can appear dark, have an odor, and may have a whitish pus discharge).The doctors will order a complete blood count with differential (to detect immune cells or white blood cells) if they suspect bacterial infection.The white blood cells will be high if you have a bacterial infection.They may reorder this test after you've completed your antibiotic course to check for normal levels of white blood cells. This isn't always necessary if symptoms have calmed and they have no further suspicion.
