Herpetic whitlow in a 20-month-old child

Herpetic whitlow is a skin lesion caused by the herpes simplex virus (HSV), usually type 1 in the paediatric population. Providers must be aware of this lesion to avoid making an incorrect diagnosis and initiating unnecessary or even harmful treatments.

The usual presentation is a lesion with clustered vesicles, typically located on the first or second toe. In paediatric patients, it is often the result of autoinoculation from HSV gingivostomatitis lesions, so when this lesion is suspected, it is important to carry out a complete physical examination including the oropharynx.

The course is self-limiting, although on occasion treatment with oral acyclovir becomes necessary. Drainage of the lesion is contraindicated because it could lead to dissemination of HSV with severe consequences.