Mouth sores can lead to finger infection

It wasn't fun having recurring cold sores, but it was truly mortifying to discover that her painful mouth sores were caused by the herpes virus.

Yes, the 16-year-old knew it wasn't "that kind' of herpes, but still.

It was enough to make one bite one's nails in distress. Which of course the teen did, eventually leading to another uncomfortable medical problem, herpetic whitlow.

While the name sounds somewhat poetic, with just a hint of western twang, herpetic whitlow is actually an annoying and painful viral infection of the fingers.

There are several modes of transmission of these herpetic infections to open or broken down skin, including sucking or chewing on fingers while battling oral sores, known as "autoinoculation," or in the case of health professionals, using ungloved fingers during the inspection or treatment of an infected patient's mouth.

In their article in Pediatrics in Review, Drs. Daniel Ruderfer and Leonard Krilov note that herpetic whitlow can be caused by either herpes simplex virus 1 or 2. These two viral strains are known to cause infection in both oral and genital sites, with HSV-1 more often affecting oral areas and HSV-2 more commonly found in genital regions.

Dermatology researchers Ines Wu and Robert Schwartz, writing in the journal Cutis, explain that herpetic whitlow often starts with a burning, itching and tingling sensation of the finger or entire arm, followed by redness, swelling, and pain in the affected finger.

The viral lesions of herpetic whitlow typically crop up on the last portion of a finger and are deep and painful and frequently confused with bacterial finger infections.

Wu and Schwartz find that the two types of infections can be visually sorted out since a bacterial lesion, which is pus-filled, will look cloudy early on. A herpetic lesion, filled with a clear or light bloody-yellow liquid, can change to a thicker cloudy appearance only later in its course if a secondary bacterial infection develops.

The dermatology duo describe herpetic whitlow episodes as "self-limited," with lesions crusting in about 10 days and clearing within two to three weeks in most otherwise healthy individuals.

Unfortunately, about 20 percent of patients will experience a recurrence of the finger lesions, usually back at the original site of infection, but generally not as severe as in the primary event.

Some complications of herpetic whitlow include nail damage or loss, bacterial superinfection, and secondary spread of viral infection to the eye.

In the online reference Medscape, Dr. Michael Omori and colleagues note that health care workers can avoid contracting herpetic whitlow by following universal precautions, wearing gloves, and washing hands thoroughly.

Parents and children can prevent exposure by avoiding direct finger contact with any oral, lip, or genital lesions.

The main treatment for herpetic whitlow involves pain control.

Omori's group finds that in primary infections, the topical antiviral medication acyclovir may shorten symptoms and viral shedding. Oral antivirals may also help shorten the course of illness and help prevent recurrences.

Since antibiotics do not treat viruses and will not treat the viruses which cause herpetic whitlow, antibiotic use should be reserved for cases with diagnosed bacterial superinfection.

• Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights

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