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Herpes Simplex Finger Infections

- See: Diff Dx of Hand Infections

- Discussion:
      - most often involves the tip of the digit;
      - occurs from contact w/ oral tracheal secretions and self inoculation (common w/ dentists);
      - incubation period from two to 14 days;
      - characterized by a painful deep vesicle surrounded by lesser superficial vesicles;
      - sometimes vesicles coalence into large vesicles;
      - spontaneous drainage may occur, w/ turbid fluid (fluid is not purulent);
      - secondary tissue infections are common;

- Lab Studies:
      - Tzank smear w/ Giemsa or Hematoxylin-eosin Staining;
           - biopsy shows Giant cells and Cowdry type A intranuclear inclusion bodies;
      - viral culture: (may take up to 5 days);

- Treatment:
      - self limiting disease of three weeks duraion;
      - incision and drainage is contra-indicated and may lead to encephalitis;
      - medical treatment of zoster:
             - antiviral treatment decreases the formation of new lesions and reduces acute pain
             - acyclovir: 800 mg five times daily for one week;
             - famciclovir: 500 mg three times daily for one week;

- Complications:
    - postherpetic neuralgia:
             - reference:
                    - Intrathecal Methylprednisolone for Intractable Postherpetic Neuralgia

Herpetic whitlow: herpetic infections of the hand. Louis DA and Sylva J. Orthop Clin N Am. 1979;4:90-94.

Pediatric herpetic hand infections.