Treatment for Recurrent Herpes Whitlow
For a second outbreak of herpes whitlow, the recommended treatment is oral antiviral therapy with valacyclovir 500 mg twice daily for 5 days. 1, 2
Antiviral Treatment Options
- Valacyclovir 500 mg orally twice daily for 5 days is the first-line treatment for recurrent herpes whitlow 1, 3
- Alternative treatment options include:
Timing of Treatment
- Treatment is most effective when started during the prodromal phase or within 1 day after onset of lesions 1, 2
- Patients should be provided with medication or a prescription to initiate treatment at the first sign of prodrome or lesions 1
- Early treatment can significantly reduce the duration of symptoms and viral shedding 5
Clinical Considerations
- Herpetic whitlow can be confused with bacterial infections such as flexor tenosynovitis, which may lead to inappropriate surgical intervention 6
- Avoid surgical incision and drainage as this may spread the infection and delay healing 6, 7
- Topical acyclovir is substantially less effective than oral therapy and is not recommended 5, 4
- For immunocompromised patients with severe disease, intravenous acyclovir may be necessary 5, 8
Long-term Management
- For patients with frequent recurrences (≥6 episodes per year), daily suppressive therapy should be considered 1, 2
- Suppressive therapy options include:
- Suppressive therapy can reduce recurrence frequency by ≥75% 1, 3
- After 1 year of continuous suppressive therapy, consider discontinuation to reassess recurrence frequency 1, 4
Patient Education
- Advise patients that herpes whitlow is a recurrent, incurable viral infection 1, 4
- Antiviral medications control symptoms but do not eradicate the virus or prevent all recurrences 1, 4
- Patients should avoid direct contact with lesions to prevent autoinoculation or transmission to others 9, 7
- Healthcare workers with active lesions should avoid patient care or use gloves when handling secretions 7
- Patients should be informed that recurrent episodes are typically less severe and shorter in duration than the initial episode 10, 9
Treatment Resistance
- Antiviral resistance is rare in immunocompetent patients but more common in immunocompromised individuals 2, 8
- If treatment failure occurs, viral cultures with susceptibility testing should be considered 5, 8
- For acyclovir-resistant herpes, foscarnet 40 mg/kg IV three times daily or 60 mg/kg twice daily is the treatment of choice 5, 8