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PM Pediatrics
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Dr. Christina Johns
Senior Medical Advisor, PM Pediatrics

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Herpetic Whitwhat?

I met Jackson a while ago at work. He was 20 months old at the time and came in with a blistery red rash around the tip of his right middle finger only. Nowhere else. And his nail & nailbed were fine. Weird, huh? Random one finger.

Lots of young children suck on their fingers.

Lots of parents spend a good deal of time trying to get their kids NOT to do this as they get older because they are concerned about potential disruption of the teeth. But there’s more to it than that. I’ve seen several finger-sucking children lately who also have the bad luck of having cold sores, and put those two things together and you get a painful, blistery, red infection on your finger that’s caused by Herpes. Yep, herpes. Not THAT kind of herpes, said she.

As most people know there are different types of Herpes Simplex viruses that infect different body parts. HSV type 1 is the virus that causes cold sores on the mouth, and when children have that and then suck on their fingers, they inoculate the virus into the skin layers, extending the infection from the mouth to the finger(s). And that’s exactly what happened to Jackson. He was fussy and annoyed since that finger hurt a lot, and therefore he couldn’t really self-soothe. The rash can look quite gnarly (technical term) and angry and it became a frightening emergency for Jackson’s family because he was so upset that they didn’t know what to do. And of course it all came to a head around bedtime, as it always does, doesn’t it? (Been there.)

There’s no magic medicine

or fix for this herpetic infection, called Herpetic Whitlow. It will go away all on its own in time with simple supportive care and STOPPING SUCKING ON THE FINGERS! Some parents will bandage the infected finger to help prevent this. Giving the anti-viral medicine acyclovir in the first few days may help shorten the course of illness, but even without any medicine the infection will resolve on its own. The most important thing is to keep the area clean so it doesn’t get super infected with bacteria.

After wrapping his finger, I’m not sure if Jackson was more irritated by the tender rash itself or by the fact he just couldn’t get at that finger to suck on it like he usually did. Before he left I think we were agreeing to disagree that sucking on that finger wasn’t such a good idea (you can guess where he stood on that), and he high fived me with a gigantic white wrapped finger that, while looking pretty hilarious, did the trick.

Go to previous article: Monday Night Poetry — Ticks are just plain ICK

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