Herpetic Whitlow in Infants

Epidemiology and Transmission

• In infants, herpetic whitlow typically results from autoinoculation following primary herpetic stomatitis or gingivostomatitis, which is the most common manifestation of HSV in young children, as reported by the Centers for Disease Control and Prevention 1

Diagnosis and Management

• Tzanck preparation can show multinucleated giant cells but does not differentiate HSV from varicella-zoster virus, according to the Centers for Disease Control and Prevention 1
• For HIV-infected or immunocompromised infants with HSV infections, the American Academy of Pediatrics recommends IV acyclovir 5-10 mg/kg/dose three times daily for 7-14 days or oral acyclovir 20 mg/kg/dose three times daily for 7-14 days 2

Prevention and Counseling

• The American Academy of Pediatrics recommends that caregivers with active cold sores avoid kissing or direct facial contact with infants until complete crusting of lesions occurs, typically 4-7 days after rash onset 2
• The Centers for Disease Control and Prevention advises that HSV-1 can be transmitted even without visible cold sores through asymptomatic viral shedding, making hand hygiene critical for all caregivers 2