# Herpetic Whitlow (HSV of the finger) - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: Egyptian National Drug Formulary - Antimicrobial 2023, acyclovir monograph (chapter PDF p143), mucocutaneous herpes simplex dosing - Verified date: 2026-08 ## Verified against - Egyptian National Drug Formulary - Antimicrobial 2023, acyclovir monograph (chapter PDF p143), mucocutaneous herpes simplex dosing ## Treatment metadata - Acyclovir — 400 mg — oral.solid ## Complete treatment card ```text HERPETIC WHITLOW (HSV OF THE FINGER) Sources: Egyptian National Drug Formulary - Antimicrobial 2023, acyclovir monograph (chapter PDF p143), mucocutaneous herpes simplex dosing Review status: REVIEWED against the source listed above (2026-08) 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 Source StatPearls "Herpetic Whitlow" - disease-level clinical article Status traced to the source above 1. ACYCLOVIR [1st line] Adult 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 Peds 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. 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. Caution 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. Egypt VIRUSTAT 400 MG 35 TABS. PHAROPHARMA 168.00 EGP (4.80/unit) ZOVIRAX 400MG 10 TAB. GLAXO SMITHKLINE 49.00 EGP (4.90/unit) ACIVIRAX 400MG 30 TABS. MASH PREMIERE 162.00 EGP (5.40/unit) LOVIR 400 MG 10 ORAL DISP. TABS. SUN PHARMA EG... 76.00 EGP BORGAVIRAX 200MG/5ML SUSP. 125 ML BORG 61.00 EGP -> ? strength differs, ? different route - not oral solid VIRUSTAT 200MG/5ML SUSP. 120 ML PHAROPHARMA 61.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)