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A 4-year-old boy is brought in for possible infection of a finger. It started with a few bumps 3 days ago and has progressed to several small blisters and a crust. He has not had fever or rash elsewhere except he did have a blister on his lip last week when he had a fever and cold symptoms; that blister is mostly healed now. He is now afebrile, nontoxic, and otherwise asymptomatic
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January 11, 2025 at 6:29 pm
E) Reassurance and observation
The photo shows herpetic whitlow. In children, HSV-1 virus is inoculated to the finger (often from sucking on a finger) from an oral lesion. It typically starts with grouped small 1-3 mm vesicles and may progressto crusts and erosions. If the diagnosis is unclear, HSV PCR may be performed by unroofing a lesion and scraping the base. Treatment is not necessary, and it will resolve on its own, although it often takes 2-3 weeks or more. Oral acyclovir or valacyclovir may hasten resolution and shorten the period of contagion. It is unclear whether topical acyclovir provides any benefit. Immunocompromised patients should be treated with antiviral medication. Parents/patients should be cautioned about transmissibility until the lesion heals, both to others and auto-inoculating other sites (particularly problematic would be the eyes).