A seven-year-old, non-atopic girl presented with a painful eruption over
right thumb of two days duration. She had fever, vesicular eruptions over
lips and oral cavity, three days prior to the onset. She had a habit of
thumb-sucking. Cutaneous examination showed multiple grouped vesicles over
dorsa of right thumb and primary herpetic gingivostomatitis (Fig.
1). Tender submental and right epitrochlear lymphadenopathy was
present. Other cutaneous and systemic examination was normal. A diagnosis
of herpetic whitlow was confirmed by tzanck smear. Patient was started on
tablet acyclovir (30mg/kg/day) for seven days with complete resolution.
 |
|
Fig 1. Grouped vesicles/erosions over lower
lip and right thumb.
|
Herpetic whitlow refers to herpes simplex virus
infection of digits. In children, it commonly occurs from primary herpetic
gingivostomatitis due to auto-inoculation from finger/thumb sucking or
nail biting. Fingers (thumb), palms and wrists are involved in decreasing
order of frequency. Fever, constitutional symptoms, painful erythematous
swelling with vesicles/pustules appears over infected site. Painful
regional lymphadenopathy/lymphangitis may be present. Spontaneous
resolution may occur in 18-20 days. Differential diagnosis for primary
herpetic gingivostomatitis includes streptococcal infections, aphthous
stomatitis, herpangina, diphtheria, erythema multiforme and
Stevens-Johnson syndrome. Herpetic whitlow needs to be differentiated from
bacterial paronychia, felon, blistering distal dactylitis, bullous
impetigo and other staphylococcal pyodermas. Complications include local
hypoesthesia, and secondary ocular and genital disease. Systemic acyclovir
may be used and counseling must be done to avoid thumb-sucking for
preventing recurrences
