Dawaa Reference

infectious

Herpetic Whitlow (HSV of the finger)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources1 source

Egyptian National Drug Formulary - Antimicrobial 2023, acyclovir monograph (chapter PDF p143), mucocutaneous herpes simplex dosing

Verified against1 document
  • Egyptian National Drug Formulary - Antimicrobial 2023, acyclovir monograph (chapter PDF p143), mucocutaneous herpes simplex dosing

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (4)

  • Patients often deny an injury, though local trauma, especially to the nail cuticle, commonly comes before the infection
  • Pain and tingling in the finger typically come before any visible skin change [tingling]
  • Pain is often disproportionately severe, particularly when the nail bed is affected
  • Fever and swollen glands near the elbow or armpit can accompany the finger infection [fever · lymphadenopathy]

Signs — what you find (5)

  • Contact with cold sores or genital herpes is a common source, and coexisting mouth lesions suggest self-inoculation
  • Local redness, swelling, and tenderness with an initial crop of vesicles appear along the pulp and side of the finger, usually in just one finger [blisters · redness · vesicles]
  • Vesicles merge into large, honeycomb-shaped blisters that can spread into the nail bed [blisters · vesicles]
  • Vesicle fluid starts clear and can turn cloudy or bloody as it progresses, but true pus points to a bacterial superinfection [blisters · pus · vesicles]
  • Ulceration and tissue death can appear in immunocompromised patients, particularly with a CD4 count under 50 [necrosis]

Tests (5)

  • Diagnosis is usually made from the look of the lesions and the history alone
  • Viral culture from an unroofed vesicle is only about 50% sensitive overall, but reaches 89% positive in the first 24 to 48 hours
  • PCR testing is far more sensitive than viral culture
  • A Tzanck smear looking for multinucleated giant cells is about 70% sensitive and highly specific
  • HIV testing should be considered when the presentation is atypical or infections recur

If not this — what else fits (5)

  • Herpetic whitlow is most often mistaken for paronychia, a localised bacterial infection of the nail fold
  • It can also be mistaken for a bacterial felon, a pus collection in the finger pulp
  • The pale-yellow vesicles can look like a pus-forming infection, but incising or aspirating them does not yield true pus
  • Herpes zoster of the hand is set apart by involving the whole dermatome, not just one finger
  • Rarely, a primary gonococcal or Mycobacterium marinum infection of the finger can mimic herpetic whitlow

SourceStatPearls "Herpetic Whitlow" - disease-level clinical article

Presentation findings are traced to the source above.

1

ACYCLOVIR

1st line

Strength400 mg

Formoral.solid

Adult dose and duration

400 mg three times daily, or 200 mg five times daily, for 7 to 10 days. Start as early as possible - it works best within 48 hours of the first symptom x 7 to 10 days

Paediatric dose

Paediatric aciclovir is dosed by age band and by indication in the formulary, and it does not band whitlow. Dose from the child's weight and age against the formulary's mucocutaneous herpes simplex figures rather than from the figures here.

Dose source

Egyptian National Drug Formulary - Antimicrobial 2023, acyclovir monograph (chapter PDF p143), mucocutaneous herpes simplex dosing

Why

The formulary does not name herpetic whitlow. This is its dose for mucocutaneous herpes simplex, and whitlow is a cutaneous HSV infection of the finger. No Egyptian source names the condition separately, and the entry says so rather than implying one does.

Cautions
  • DO NOT INCISE OR DRAIN IT. Whitlow is viral, incision does not help, and it risks spreading the infection and causing herpetic encephalitis in the operator or the patient.
  • It is commonly mistaken for a bacterial paronychia or felon, which ARE drained - the difference is grouped vesicles on an erythematous base, and often severe pain out of proportion to what is visible.
  • Occupational in dentists, nurses and anyone working near the mouth; it is a recognised reason for time away from clinical work while lesions are open.
  • Cover the lesion. It sheds virus and is contagious until crusted.
  • The formulary does not name whitlow - this is its mucocutaneous herpes simplex regimen.
  • Recurrent or severe attacks, or any immunosuppression, need specialist advice.
Egyptian brands
Egyptian brandManufacturerIndicative price
VIRUSTAT 400 MG 35 TABS.PHAROPHARMA168.00 EGP (4.80/unit)
ZOVIRAX 400MG 10 TAB.GLAXO SMITHKLINE49.00 EGP (4.90/unit)
ACIVIRAX 400MG 30 TABS.MASH PREMIERE162.00 EGP (5.40/unit)
LOVIR 400 MG 10 ORAL DISP. TABS.SUN PHARMA EGYPT LIMITED > RANBAXY76.00 EGP
BORGAVIRAX 200MG/5ML SUSP. 125 ML? strength differs? different route - not oral solidBORG61.00 EGP
VIRUSTAT 200MG/5ML SUSP. 120 ML? strength differs? different route - not oral solidPHAROPHARMA61.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.