Forum for Nordic Dermato-Venereology Nr 4, 2019 | Page 30

Georg Authried and Mathias Tiedemann Svendsen – Bullae on the index finger in a boy suffering from recurrent cold sores: A Quiz
B ullae on the I ndex F inger in a B oy S uffering
R ecurrent C old S ores : A C ommentary
from
After treatment with an oral solution of acyclovir 200 mg 4
times daily for 10 days, the symptoms from the upper lip and
finger cleared.
Diagnosis: Herpetic whitlow
Herpetic whitlow is an uncommon painful condition, due
to a primary inoculation of herpes simplex virus from her-
pes labialis and presents as single or grouped blisters on the
fingers. Herpes virus type 1 or 2 can be found in cytological
examination of the blister floor. Typical entrance is from biting
skin on the hands or in healthcare workers (1), but has also
been observed in contact sports disciplines, e.g. in wrestlers
(2) and rugby players (3). In rare cases, spread of herpes virus
from a herpetic whitlow has been observed (4).
R eferences
1. Gill MJ, Arlette J, Buchan KA. Herpes simplex virus infection of
the hand. J Am Acad Dermatol 1990; 22: 111–116.
2. Anderson BJ. The epidemiology and clinical analysis of several
outbreaks of herpes gladiatorum. Med Sci Sports Exerc 2003; 35:
1809–1814.
3. White WB, Grant Kels JM. Transmission of herpes simplex virus
type 1 infection in rugby players. JAMA 1984; 252: 533–535.
4. Karpathios T, Moustaki M, Yiallouros P, Sarifi F, Tzanakaki G, Fret-
zayas A. HSV 2 meningitis disseminated from a herpetic whitlow.
Paediatr Int Child Health 2012; 32: 121–122.
Herpes simplex virus type 1 (HSV-1) was detected in a skin
swab from the bulla on the finger by the help of polymerase
chain reaction (8.8 × 10 8 copies/ml).
Answers to CME on pages 145–146
Case 25: 2 (tortuous capillaries with varying diameter, pigment lumps)
Case 26: 3 (uniform globular pigment pattern)
Case 27: 2 (blurred blue-white area at the periphery of a globular melanocytic lesion)
Case 28: 2 (irregular pigmentation in a hypopigmented area)
140
Q uiz
Forum for Nord Derm Ven 2019, Vol. 24, No. 4