Treatment for Recurrent Herpetic Whitlow

Diagnosis and Treatment

False-negative serological results can occur, particularly if testing is performed during the window period or in patients with low viral shedding 1
Episodic antiviral therapy is most effective when started during the prodrome or within 1 day after onset of lesions 1
Recommended regimens for episodic treatment include valacyclovir 500 mg orally twice daily for 5 days 1
Acyclovir 200 mg orally five times daily for 5 days is an alternative regimen for episodic treatment 2

For patients with frequent recurrences (≥6 episodes per year), daily suppressive therapy should be considered 3
Recommended regimens for suppressive therapy include acyclovir 400 mg orally twice daily 2, 3
Daily suppressive therapy reduces the frequency of herpes recurrences by at least 75% among patients with frequent recurrences 3
Safety and efficacy have been documented among persons receiving daily therapy for as long as 5 years 2

Start oral antiviral therapy at the first sign of prodrome or within 24 hours of lesion appearance 1
Use valacyclovir 500 mg twice daily for 5 days or an alternative regimen as listed above for acute episodes 1
Initiate daily suppressive therapy with acyclovir 400 mg twice daily or valacyclovir 500 mg once daily for patients with ≥6 recurrences per year 3

Suppressive treatment reduces but does not eliminate asymptomatic viral shedding or the potential for transmission 3
Resistance to antiviral medications is rare in immunocompetent patients but should be suspected if lesions do not begin to resolve within 7-10 days of therapy 3
Patients should be advised that herpetic whitlow is a recurrent, incurable viral disease, and antiviral medications can control symptoms but do not eradicate the virus 1