GUESS THAT DIAGNOSIS: Painful, Burning Finger with Several Small Blisters


GUESS THAT DIAGNOSIS: Painful, Burning Finger with Several Small Blisters



Patient comes in with a swollen, erythematous, and painful right finger. The finger has several small vesicles (blisters). They also complain of tingling and a burning sensation in that same finger. Patient has a cold sore noted on their lower lip. On examination, their radial pulse is 2+ bilaterally. Capillary refill is less than 3 seconds. They did have a low grade fever a few days ago but no other complaints.



Herpetic Whitlow

DIFFERENTIAL DIAGNOSIS: Paronychia, hand foot mouth, pustular psoriasis, pulp abscess

CAUSE: Herpes Simplex virus 1 (causes the majority of cases 60%) and Herpes Simplex Virus 2

NOTES: If there are vesicles on multiple fingers, coxsackie virus (hand foot mouth specifically), should be suspected ,as herpetic whitlow usually only affects 1 finger. (4)

S/S: Painful, tingling, burning sensation on finger. May also have a low grade fever. Sometimes lymphadenitis is also seen. The pain is usually severe. Often the appearance can mimic a bacterial infection. Usually only one finger is affected

TEST: Tzanck smear

RISK FACTORS TO DEVELOP: Open wound on fingers- specifically a torn cuticle, children who suck their fingers, primary herpes oropharyngeal lesion

TREATMENT: Sometimes with oral or topical antiviral (acyclovir, valacyclovir, or famciclovir). Antivirals help to decrease the duration of symptoms. Antivirals are most effective when taken early after symptoms start. Anti-inflammatories also work well. Usually symptoms resolve in 2-3 weeks.

COMPLICATIONS: Secondary bacterial infections


  1. Picture: James Heilma “This file is licensed under the Creative Commons Attribution-Share Alike 3.0 Unported license.”
  2. Epocrates:I highly recommend signing up for Epocrates. There is a free (drugs) and a paid version- runs anywhere from 150-180 per year-but so worth it! I have been using it for years and years and couldn’t go without it! I use it more than any other medical app.
  3. Herpetic Whitlow Updated: Apr 13, 2017 Author: Michael S Omori, MD 
  4. Herpetic Whitlow Up to Date
DISCLAIMER: The information posted is not intended to be medical advice. This is simply for educational purposesonly. This information is intended for medical professionals & students only. All patients should ALWAYS check with their primary care provider with any questions regarding their health. This is not intended to guide in medical decisions or treatment in any way. As always, medical professionals should call the on call provider if any clarifications are needed. State and hospital protocols should always be followed accordingly. Med Made Ez (MME) disclaims any liability for the decisions you make based on this information.

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