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?
Making the diagnosis
The diagnosis of herpetic whitlow is clinical. If the diagnosis is unclear, diagnostic tests can include viral culture, serum antibody titers, a Tzanck smear, lesion specimen antigen testing, or histopathologic examinations. In this case, swab cultures revealed moderate growth of group A b-hemolytic streptococci. Fungal smears and cultures were negative. Histopathology revealed intraepidermal vesiculation with ballooning and reticular degeneration and cytopathic changes of herpetic infection.
The natural history of the untreated, uncomplicated herpetic whitlow is complete clearance within 2 to 3 weeks.4 Rare complications include systemic viremia, ocular infection, nail dystrophy, nail loss, scarring, and localized hyperesthesia or hypoesthesia.2,4,6,7
Treatment with acyclovir
Oral acyclovir (2 g/day in 3 doses for 10 days) taken during the prodromal stage of recurrent HSV-2 herpetic whitlow has been shown to reduce the duration of symptoms from 10.1 to 3.7 days.8 Prophylactic use of oral acyclovir (200 mg, 4 times daily for up to 2 years) has been shown to be effective in suppressing recurrent HSV infection of nongenital skin.9
A good outcome
Our patient was given a 10-day course of acyclovir 400 mg orally 3 times daily and cefadroxil 500 mg orally twice daily (for superimposed bacterial infection). The lesions had completely disappeared upon follow-up 2 weeks later.
CORRESPONDENCE
Ossama Abbas, MD, American University of Beirut Medical Center, Riad El Solh/Beirut, Lebanon; oa009@aub.edu.lb
