Gutiérrez-Gómez C, Gargollo-Orvañanos C, Javier LF, Ferreira-Aparicio FE

Language: Spanish
References: 3
Page: 117-122
PDF size: 329.43 Kb.

ABSTRACT

In clinical practice we face various pathologies that would be attractive to operate; however, we must be careful when a careful interrogation and physical examination are performed in order not to produce more damage or unnecessary treatment, which is the case of herpes simplex infections in the hand. We present two clinical cases illustrative of this pathology: the herpetic baker and an infection in the palm of the hand with two previous surgical procedures. The herpetic baker refers to a painful skin infection that commonly affects the distal phalanx of the fingers and occasionally the toes. It differs from a felon in as much as the latter involves a suppurating infection of the pulp; viral vesicles can involve any anatomical region of the hand. The diagnosis is clinical and if it is unclear, diagnostic tests; such as: viral culture, serum antibody titers, smears for Tzanck test and detection of antigens in the sample can be included. The most sensitive test is viral culture, which allows the herpes simplex virus 1 or 2 to be typified. Treatment is symptomatic and consists of immobilization, elevation, and analgesia. Dry dressings are preferred to decrease the possibility of spreading the disease. There are reports of complications due to misdiagnoses treated with incisions and attempts of draining. Oral administration of Acyclovir 200 mg, three or four times a day prevents and significantly decreases the rates of recurrence in cases of herpetic whitlow and other nongenital manifestations of herpes simplex virus. Intravenous administration is occasionally suggested in immunosuppressed patients with a disseminated herpes simples virus infection, but it is not regularly recommended in immunocompetent patients. We consider the knowledge of this case important as plastic surgeons, since the first thought would be draining when confusing it with a felon and in that case, far from improving it, the course of the disease will worsen.

REFERENCES

1. Rubright JH, Shafritz AB. The herpetic whitlow. J Hand Surg 2011; 36A: 340-342.

2. Wu I B, Schwartz R. Herpetic whitlow. Cutis 2007; 79: 193-196.

3. Patel R, Kumar H, More B, Patricolo M. Pediatric recurrent herpetic whitlow. BMJ Case Rep 2013; 010207. doi: 10.1136/bcr-2013-010207.