July 2001

Case submitted by Stephen Schleicher, MD

		CASE: A 24-year-old health-care worker has a rash on his finger. Approximately six months earlier, a similar eruption had developed at the same site. On each occasion the dermatitis was preceded by an itching sensation. Examination of the finger reveals two erythematous, vesicular patches affecting the ventral and lateral surface of the right thumb. No other lesions are present.
What is your diagnosis?
		Cutaneous herpes simplex infection is caused by a DNA virus and most frequently manifests as a localized grouping of vesicles on an erythematous base. Prodromal itching and burning are commonly reported symptoms, and recurrence at the site of primary contact is a hallmark of the virus. Herpes simplex, characterized by erythema and vesiculation, that occurs on the fingers is usually referred to as herpetic whitlow. The condition, which is an occupational hazard for medical and dental practitioners, underscores the necessity for wearing gloves to prevent transmission.

---

Dr. Schleicher is director of the DermDx Centers for Dermatology of Northeastern Pennsylvania and a clinical instructor of dermatology at Graduate Hospital's City Line Campus in Philadelphia, kings College in Wilkes-Barre, and Beaver College in Glenside, Pennsylvania. He is also a member of the EMERGENCY MEDICINE editorial board.