Ten things you should know about herpes dermatitis and herpetic whitlow

Herpes simplex virus 1 and herpes simplex virus 2 (HSV-1 and HSV-2) cause genital herpes and cold sores, but they can affect other areas of the skin, causing rashes and sores that resemble the symptoms of cold sores or genital herpes.

Outbreaks start with pain and tenderness, and sometimes fever. This is followed by a small blister, usually at the base of the fingernail. Later, more blisters develop and join together to form a single sore.

In some cases. blisters may not be visible. The finger may simply appear red and swollen, as though slammed in a door.

The outbreak is usually painful, but it heals in about two weeks.

The herpes virus enters the skin through a small break—usually a torn cuticle.

Children often transfer the virus from their lips or mouth by sucking their fingers or thumb.

Adults are more likely to transfer the virus by touching the area affected by genital herpes.

Health workers such as dentists, dental nurses or anaesthetists, who work frequently with the mouths of their clients, have an increased risk of contracting herpetic whitlow.

The herpes virus may be passed on from sores, rashes, blisters or the secretions in clients’ mouths.

Herpes dermatitis is like an outbreak of herpes occurring on the skin away from the lips, genitals or fingers. It often starts with numbness, tingling or a painful sensation, and is followed by small blisters or sores. These usually form crusts and heal by themselves in about two weeks.

Outbreaks are common on the face or neck. In people with dermatitis, herpes blisters and sores can show up in the area of the dermatitis.

The symptoms are similar to herpes elsewhere: painful or tingling blisters and sores, which take a couple of weeks to heal.

Herpes simplex virus can be transmitted from one person to another in contact sports such as rugby or wrestling. This form of herpes dermatitis is sometimes called herpes gladiatorum. Wrestlers or rugby players with outbreaks of cold sores or herpes gladiatorum should not compete until a health professional confirms that they are no longer likely to be infectious.

People with allergic dermatitis (also called atopic dermatitis or atopic eczema) can sometimes develop severe outbreaks of herpes dermatitis.

This form of dermatitis is called eczema herpeticum. Numerous blisters and scabs appear on the face or other parts of the body. The person is generally unwell, with swollen lymph glands and fever.

Eczema herpeticum is a medical emergency; people with this condition must be treated in hospital with antiviral medications.

The treatment of herpetic whitlow includes oral pain killer medications and an anti viral ointment (aciclovir). In severe cases of herpetic whitlow and in herpes dermatitis, oral anti viral medications may be necessary. If the sores or rash become infected by skin bacteria, the best treatment is oral antibiotics.

The herpes virus is passed on by direct contact. You can reduce the risk of contracting herpetic whitlow or dermatitis by avoiding contact during risk times.

• Avoid touching cold sores or genital herpes outbreaks.
• Health workers should wear gloves when working with the mouths of their clients.
• Encourage children not to suck fingers or thumbs during outbreaks of cold sores or herpes in the mouth.

These measures will reduce the risk, but not completely remove it, because the herpes simplex virus can be passed on even when there are no sores or rash present.