Herpes Simplex of the Hand

September 14, 2005
Yelva Lynfield, MD

A 30-year-old anesthesiologist complained of 5 days of pain in the left epitrochlear and axillary regions. A large, tender node was palpable in each site.

A 30-year-old anesthesiologist complained of 5 days of pain in the left epitrochlear and axillary regions. A large, tender node was palpable in each site.

Examination of the hand revealed a cluster of deep-seated vesicles on the palm at the base of the middle finger. Dr Yelva L. Lynfield of Cedarhurst, NY, made the diagnosis of herpes simplex.

Dr Lynfield points out that herpes simplex can inoculate the skin at any site, although the more usual portals are the oral and genital mucosa. On the hand, lesions most commonly arise at the base of the fingernail (herpetic whitlow); the associated pain with tender regional adenopathy mimics bacterial paronychia.

This patient denied any history of herpes simplex lesions. He reported that on occasion he did not wear gloves while performing intubations; thus, he was exposed to the virus in the saliva of affected patients.

He was treated with valacyclovir for 1 week, and all lesions cleared. Herpes simplex may recur on the patient's palm without additional exposure. He was advised to take antiviral medication at the first symptom of reactivation of the latent virus.

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