Painful Finger

Background: Herpetic whitlow is a rare cause of finger infection most commonly affecting children. It is a type 1 or 2 Herpes simplex virus infection characterized by significant pain and erythema with overlying non-purulent vesicles. Herpetic whitlow should be suspected based on clinical signs. It is caused by inoculation of the virus through a break in the skin barrier. Eczema and other skin lesions can increase the risk of its appearance.

Case Presentation: We report a case of a previously healthy 16-year-old male adolescent admitted to the hospital with erythema and swelling of the fingers of his both hands. The right fifth finger was very painful and showed, in terminal phalanx, grouped vesicular lesions with clear fluid and surrounding erythema; along multiple other fingers of both hands he showed dyshidrotic eczema lesions. No treatment was applied in the right fifth finger as the diagnosis of herpetic whitlow was assumed. Dyshidrotic eczema finger lesions were treated with topical corticosteroids. At ten-day follow up all skin lesions resolved completely. There were no previously history of herpetic infection and there were no recurrences in the next ten months.

Conclusion: We draw attention to the typical clinical signs and correct management of herpetic whitlow as it may go underdiagnosed and its appearance may mimic a bacterial infection. Treatment is usually symptomatic as lesions are self-limited and unnecessary surgical interventions should be avoided since they can exacerbate symptoms or lead to complications.