Nail Disorders in Children

Erin L. Luxenberg; Robert A. Silverman


Dermatology Nursing. 2010;22(1) 

In This Article

Herpetic Whitlow


Herpetic whitlow is a painful cutaneous infection that presents as a periungual blister that has the appearance of coalescent tapioca-like vesicles. These vesicles may become turbid and opaque-colored with time. It usually affects the distal phalanx of the fingers near the fingernails; the disease will affect the toes occasionally. The infection causes pain, edema, and erythema at the blister site (see Figure 3).

Figure 3.

Herpetic whitlow


Herpetic whitlow is caused by herpes simplex virus (HSV) type 1 or 2. In children, it is most often caused by autoinoculation of HSV-1 from perioral herpetic blisters (Wu & Schwartz, 2007). Therefore, known exposure or concurrent disease with HSV can aid in expedited diagnosis of herpetic whitlow. Tzanck smear of a fresh lesion demonstrates the classic epithelial multinucleated giant cell with viral inclusions. The diagnosis can also be made by polymerase chain reaction or viral culture.


Warm compresses to the area, topical antibiotics to prevent secondary bacterial infection, and analgesics/anti-inflammatory agents can relieve the pain associated with the blisters. Oral acyclovir can shorten the course of the eruption.

Patient Education

Herpetic whitlow is spread by touch, so children should be discouraged from picking at or playing with any perioral lesions.


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