Whitlow

Original Editor - Kehinde Fatola
Top Contributors - Kehinde Fatola and Shaimaa Eldib

Introduction

Whitlow.jpg

Whitlow is a very painful and infectious viral disease of the thumb and fingertips. Rarely, it infects the toes and nail cuticle. [1] It is a self-limiting disease and it is of two types - Herpetic Whitlow and Melanotic Whitlow. Herpetic whitlow is more prevalent of the two. It is a disease of the hand.

Mechanism of Injury / Pathological Process

Herpetic whitlow is caused by the Herpetic Simplex Virus (HSV). HSV is of two types - type 1 and type 2. [2] They are both known to cause whitlow. Herpetic whitlow is caused when a wounded and exposed skin comes in contact with body fluids contaminated with HSV. It may also be caused by bacterial fingertip infection. [3]

Risk factors include;

  • Human Immunodeficiency Virus (HIV) infection
  • Nail biting habit
  • Wounded finger with exposed skin surface
  • Career in health care profession

Clinical Presentation

The finger may present with; [4]

  • Tingling
  • Itchy feeling
  • Burning sensation
  • Blisters
  • Redness, warmth or swelling

The body may present generally with; [4]

  • Fever
  • Lymphangitis
  • Blisters and sores on other parts of the body
  • Enlarged lymph nodes in the arm

High fever (temperature over 101°F) and confusion/lack of consciousness may indicate serious infection/progression of the disease.

Management / Interventions

Although, there is no known cure of the disease and the disease is a self-limiting one, therefore, it usually resolve within two to three weeks. However, certain measures may be undertaken to improve the symptoms. These include; [4][5]

  • Topical anaesthetics to reduce pain and itching
  • Antiviral medications
  • Analgesics to reduce pain and fever (if present)
  • Electrotherapy

Not much research work has been done on Physiotherapy and Whitlow.

Complications

Untreated whitlow can come with serious complications which include; [4]

  • Encephalitis
  • Meningitis
  • Tenosynovitis
  • Pain and discomfort
  • Spread of infection
  • Skin ulcerations and infections

References

  1. Clark DC. Common acute hand infections. American Family Physician. 2003;68 (11):2167–76.
  2. Wu IB, Schwartz RA. Herpetic Whitlow. Cutis. 2007;79(3): 193–6.
  3. Hoff NP, Gerber PA. "Herpetic whitlow". Canadian Medical Association Jouurnal. 2012;184: E924
  4. 4.0 4.1 4.2 4.3 Lloyd WC. Whitlow. Available from; https://www.healthgrades.com/right-care/infections-and-contagious-diseases/whitlow (Accessed 19/Oct/2020)
  5. Ismailov TA, Yevdulov OV, Khazamova MA, Gidurimova DA. Experimental Investigations of Thermoelectric Device for the Therapy of Whitlow. Journal of Thermoelectricity. 2013;4:78-84