Recurrent vesicular eruption on the right hand
The 8-year-old boy was otherwise healthy. So what was causing these painful lesions to erupt on his hand?
The diagnosis: Herpetic whitlow
Herpetic whitlow, or herpes simplex virus (HSV) infection of the hand, was first reported by Adamson in 1909.1 Herpes infection of the hand classically has a bimodal age distribution. It may be seen in children younger than 10 years of age or in adults between 20 and 30 years of age.2 In children, it is caused almost exclusively by HSV-1, whereas in adults it can be caused by HSV-1 or HSV-2.2,3
HSV infection of the hand classically occurs as a result of autoinoculation following herpetic gingivostomatitis. After inoculation, the virus has an incubation period of 2 to 20 days before vesicles appear.4 The appearance of the lesions is associated with intense throbbing pain. Fever and systemic symptoms are rare.
What you’ll see. Patients with herpetic whitlow will develop a single vesicle or cluster of vesicles on a single digit a few days after their skin has been irritated or exposed to minor trauma.2,4 Vesicles are typically clear in color and have an erythematous base. However, they are often superinfected with bacteria and may exhibit signs of impetiginization. The most common location of the vesicles is on the terminal phalanx of the thumb, index, or middle finger.3
