Herpetic Whitlow

[needtoknowforsure]

I fear that I may have contracted hand herpes via self innoculation. I am a female in my 40’s and have had genital herpes for over 8 years. In late November I masturbated using no protection. Usually when I masturbate, I use saran wrap to protect me from the side that has the herpes, but there have been a handful of times that I have not used anything. The only difference is that this time I was sitting down and I left my sweats on. 2-3 days later I felt a burning, achy feeling on the palm of my right hand (with which I masturbated with). Thinking that it was just hurting from being on the computer a lot that week, I started to rub/massage it with my other hand. This feeling lasted 2-3 days, then for another 2-3 days I began to feel the itchy, tingling feeling in the same hand. Then on the 5th or 6th night (a Sunday) I felt a prickly sensation on my hand, as if I had a piece of insulation glass/splinter near the top of my right palm near the middle finger. When I looked under the light, I could see small pin-head size white dots all around the outer region of the palm of my hand, and each dot felt prickly when I touched it with my other hand. There were about 10 dots including 1-2 on the shaft of my middle finger. I didn’t sleep much that night fearing the worst. By the morning, this prickly sensation had started to have a burning sensation too and my left hand was starting to feel the same. Of course I was distraught at the thought of contracting hand herpes and hardly slept the next 2 nights either. I may have had a fever because I was shivering, but then again I was beside myself with anxiety coupled with lack of sleep. By Wednesday when I saw the dermatologist, the feelings in my hands had intensified, I also had tingling/creepy crawly feeling on 2-3 different spots on my face (each having 3-4 raised dots) and 1 spot on my neck, and the burning prickly feeling had moved up to my forearms as well. Also, the burning sensation was worse when I was laying in bed under the covers. The dermatologist said that there was nothing for her to swab for testing, but that she didn’t believe it to be herpes since hand herpes (self innoculation) was very rare. She ruled out shingles and hand-foot-mouth disease too, but gave me no other possible diagnosis. However, being in the state nearing an anxiety attack, (to appease me, I’m sure) she prescribed me acyclovir. I picked up the prescription, but didn’t want to take it thinking that I could fight this on my own with vitamins (multi; vitamins b, c, d & k2; zinc; probiotics; fish oil, etc.) and supplements (olive leaf extract, lysine, astragalus, & red marine algae) as I’d been doing for many years with good results. Besides, I don’t like going to see the doctor and prefer not to take meds either. I always look for the natural route when possible. By Wednesday evening I had what appeared to be dry skin on the middle portion of the rim of my top lips which I associated with all the nose blowing I had been doing due to the crying. I just kept putting Burts Bee chapstick on my lips. On Thursday night I felt a tingling/creepy crawly feeling on my lips and brushed it with my sweater and it began to hurt. On Friday morning I saw an Infectious Disease specialist thinking that surely they would have some kind of testing that they could do. This was useless because she basically dismissed my symptoms as something else. She said that even if I DID NOT CURRENTLY have hsv2, there would be no reason to test me because 90% of population has it which I know to be incorrect. She basically told me the same thing that the dermatologist did…that it’s highly unlikely to self contaminate myself. She told me that I could take up to 1 mg of acyclovir 3 x/day for 3 days for breakouts, then 500 mg/day for maintenance. So the following day I broke down and started the acyclovir, and within 2-3 days I noticed the symptoms had started to subside. I took 1mg 2x/day for 3 days and then 500 mg once a day for maintenance. Also, on the same evening that I saw the Infectious Disease doctor, the area on my lip started to spread down my lip in the same direction that I had brushed it with my sweatshirt the night before. I heard what the doctors were saying, but all the symptoms were distinctly familiar and matched what I was reading on line about herpes whitlow except for the actual lesions that blister. My lesions on my hand were flat, and nothing on my face was blistering. Because I couldn’t visibly see anything on my face other than raised dots where I felt the tingling/itchy feeling, I was trying to be very careful when washing my face and putting on creams but ended up spreading the legion on my lip even more up towards my nose. Even after being on meds for a day or two, my tongue and throat started displaying symptoms as well which were kind of a raw feeling. I sucked on ice to relieve the symptoms which lasted for about a week before they began to subside. As the week passed, I tried not to think about it, and with each passing day of being on meds, I felt better physically and emotionally. Although I noticed that my hands still had a slightly burned feeling to them, almost a raw kind of feeling, especially after using them to wash dishes, wrap gifts, open a box/bag of chips, hold shopping bag/purse, and with my right hand being a little worse.

Once my meds finished (about 3 weeks), I continued taking my vitamins and supplements hoping that these would eliminate or decrease any future outbreaks. But after being off the meds for about 3 days, the symptoms started coming back (on a Thursday) in the same order as before only now I was having the prickly, burning feeling in my legs too. Night time was the worst with the prickly and burning sensation on my arms, neck and legs. I had developed small reddish, pimply looking bumps on my legs, but mostly on the back and sides of my thighs. I attributed this to one night during the first episode while sleeping I woke up in the middle of the night with both hands on each side of my thighs. Even though I was wearing gloves (50% nylon/40% rayon/10% rabbit hair), my palms were sweating against my thighs. Within days, I had developed the pimply looking bumps in the area where my hands were. I think I spread it by pulling my underwear/pants up and down, using a wash cloth when I shower, and rubbing lotion onto my legs with vinyl kitchen gloves. I stopped putting lotion on for about two weeks now, and am more careful when washing and pulling my pants up and down. Also, I felt the tingling/ itchy feeling start to come back on my face, and because I can’t really see the sores I kept spreading it to other parts of my face when washing it or putting creams on ( I’ve been using vinyl kitchen gloves when dealing with my face). In hopes to eliminate the spread, I simply started cleaning my face with rubbing alcohol on a cotton ball and skipped putting cream on (it’s been over a week of this now). After feeling it near the duct of my eye, I feared contracting ocular herpes and knew that I needed to find out if in fact this is herpes. I really hope that it isn’t, but the symptoms are all there. On Friday I started the acyclovir again. On Tuesday I went back to the same dermatologist hoping that she could swab the bumps on my legs and to let her know of my lip legion (that hadn’t gone away–it was just a rough patch of skin), a new legion above my lip that had what appeared to be the beginning of a cluster of blisters, and the symptoms I was feeling inside my mouth as well. She looked at everything, but again said that there was nothing to swab/culture. She basically said that I’m being paranoid and bringing this on myself with anxiety, but I told her that I was feeling better and wasn’t really thinking about it when it came on the second time. Also, that doesn’t explain the first episode where I was not feeling stressed or anxious about anything. She did say that I had keratosis pilaris on my legs, which I’ve never had before. Again to appease me, she prescribed me another dose of acyclovir and told me to stay on it if it’s keeping the symptoms at bay. She told me that if I start to get the symptoms, to take 2 mg valcyclovir and again the same dosage 12 hours later, then just 500 mg/day after that. She told me that I could go to any of the nearby hospitals to check with their dermatology departments to see if they are taking patients with my undiagnosed symptoms. Need less to say, I was very frustrated and felt it was a waste of time and money going to her again. After a week on meds I began to feel better (the prickly and burning sensations began to subside, but came back in my hands for a few days and now is gone). The pain/discomfort in my throat and on my tongue have subsided as well. However, I still have the sore on my lip that hasn’t gone away since I first got it with my first episode. It’s like dry rough skin that kind of hurts. It extends just above my lip onto the skin with a tingling/creepy crawly feeling in that part only, but only appears like slightly rough skin. I also still have the sores/pimples on my neck that itch a little and hurt when rubbed, and they seem to be moving to the back of my head because it feels itchy now too. I also still have a slight burning sensation on my upper arms. Additionally, when I use my hands too much they start to feel kind of raw or have a burning and prickly feeling to them.

An on-line doctor said that it could be hand foot mouth disease, dermatitis herpetiformis, chronic vesicular hand dermatitis, pompholyx, or porphyria. I’ve read the symptoms for all these and have looked at the pictures, but I still feel that it’s hand/body herpes.

From what I’ve read, the virus dies outside the body within 10 seconds depending on the temperature. Since the virus lives longer outside the body in a warmer environment, wouldn’t it make sense that because I had my sweats on that the virus had more time to penetrate the skin on my hand since it was in a very warm environment? Another theory is that I may have unknowingly had a cut on hand. I do remember clipping nail cuticles around that time…. So here are my questions:

1. Does this sound like hand/body herpes? Have you ever had any patients with these white dots that don’t fully develop into blisters? My rationalization is that if there are people out there who get no symptoms at all, why can’t there be people that get partial symptoms?

2. If this is not herpes, why do most of my symptoms subside when I’m on valcyclovir? And why did they come back when I stopped the meds?

3. How long does the virus live outside the body? Do both hsv1 and hsv2 live outside the body the same amount of time? How long does it survive on chapstick?

4. Is it true that hsv2 on the face has less severe outbreaks/episodes, and same for hsv1 on the genitals?

5. Does the virus die with water alone due to the chlorine?

6. Even if you don’t believe it to be hand/body herpes, what are your recommendations on avoiding transmission to others? I have kids and am in constant fear of transmitting it to them and other family members. Can I share a kitchen towel? How long does the virus live outside the body? Assuming that I have hand herpes, if I touch something and my kids touch it immediately after I do, assuming they don’t have any cuts on their hands, can they contract hand herpes? What if they touch an object immediately after I touch it and then immediately put their finger in their eye, mouth or lips?

7. How do I go about getting a swab kit? How much per swab testing?

[Terri Warren]

I just got home from work – very long day. I will answer your post in the morning, promise

Terri

[Terri Warren]

Well, you aren’t going to like what I have to say but I’ll answer you anyway.

Autoinnoculation, infecting another location on your body after being infected at a primary location, almost always happens (and it doesn’t happen often) within the first four months of the initial infection. After that, the immune system recognizes any intrusion of virus and stops that virus from infecting a new area of the body. If this was not true, we would see children, who frequently acquire oral HSV, infecting all sort of new areas of their bodies, which we do NOT see.

1. Does this sound like hand/body herpes? Have you ever had any patients with these white dots that don’t fully develop into blisters? My rationalization is that if there are people out there who get no symptoms at all, why can’t there be people that get partial symptoms?

No. These lesions sound nothing at all like herpes.

2. If this is not herpes, why do most of my symptoms subside when I’m on valcyclovir? And why did they come back when I stopped the meds?

I don’t have an answer for that. It is possible that you have some other viral illness and somehow the herpes medicines crosses over and help that infection as well?

3. How long does the virus live outside the body? Do both hsv1 and hsv2 live outside the body the same amount of time? How long does it survive on chapstick?

Studies vary on that from minutes to hours. Chapstick and lipstick sharing does concern me because those substances stay moist which the virus likes.

4. Is it true that hsv2 on the face has less severe outbreaks/episodes, and same for hsv1 on the genitals?

Very very few outbreaks with HSV 2 oral infection, yes

5. Does the virus die with water alone due to the chlorine?

Yes

6. Even if you don’t believe it to be hand/body herpes, what are your recommendations on avoiding transmission to others? I have kids and am in constant fear of transmitting it to them and other family members. Can I share a kitchen towel? How long does the virus live outside the body? Assuming that I have hand herpes, if I touch something and my kids touch it immediately after I do, assuming they don’t have any cuts on their hands, can they contract hand herpes? What if they touch an object immediately after I touch it and then immediately put their finger in their eye, mouth or lips?

I don’t believe that you have hand herpes so I would advise you to live normally without being concerned about any of the issues that you raise in this paragraph

7. How do I go about getting a swab kit? How much per swab test

Each swab kit from our clinic costs $75. We can ship out PCR swab kits but honestly, I think this would be a complete and total waste of money.

You have been told by so many providers that this is not herpes yet you seem dead set on believing that it is. Do you really believe that your diagnostic abilities are better than all of them? I don’t think so. I feel like you are really suffering with these beliefs that you hold and I’m so sorry for your anguish, but really, I think you are wrong here.

Terri

[needtoknowforsure]

Hi Terri, I have an appointment to see the dermatologist on Monday. I’m hoping that she can do a skin biopsy on my neck and I want it to be tested for herpes. If needed, can she send the biopsy to your clinic? I know that you don’t think that what I have is herpes, but this would greatly reduce my anxiety about what I have on my hand. I just want to make sure that if she tells me that there is no place that she can send the biopsy to to get tested for herpes that I may possibly have a back-up place to send it to. I’m just trying to cover all my bases.

If she can send it to your clinic, what are the directions as to how she needs to send it? Packed in ice, overnight, etc.

As always, thanks for your responses.

[Terri Warren]

No, she should send the biopsy to a lab that she uses. But you can certainly post the results of the biopsy here Remember that a biopsy of a herpes lesion would not give you typing, only whether it might be herpes or not. Our clinic sees patients, it is not a lab in the way a biopsy needs to be run.

Terri

[needtoknowforsure]

Hi Terri, I just wanted to let you and anyone else who reads this know my diagnosis. It has now been 5 weeks since i received a diagnosis on my biopsies from my neck and legs. My neck rash is some form of eczema and my leg rash is some form of folliculitis, both of which I probably brought on myself with all the worrying, anxiety and lack of sleep. As for my hands, it seems that the dermatologist was correct in thinking that it was contact dermatitis. Since I really had no legions to do a biopsy on my hands when I had the other biopsies, she just told me that if my hands got worse to come in to see her at at that time. After getting my neck and leg diagnosis, I immediately started the Rx creams on those areas. I stopped using latex and nitrile gloves and saran wrap as these seemed to exasperate my symptoms on my hands. After 5 weeks, the symptoms on my hands have gotten considerably better. It’s taking time, but it’s definitely going away. I’ve always used latex gloves to wash dishes and clean the bathrooms, but apparently you can develop an allergic reaction to anything at any time in your life.

All that worrying for nothing, but it seemed to be such a coincidence that I was positive that it was herpetic whitlow. I felt that I was the first person to have these atypical auto innoculation symptoms. Now I know that you and all the doctors were giving me correct information, but I had tunnel vision. Thanks so much for answering my questions and talking with me about my results I had done through your office.

[needtoknowforsure]

Here are my last set of questions:

1. Any suggestions for a new relationship with a former lover who has tested positive for hsv1 but has never had symptoms and tested negative for hsv2? As you know, i have both oral hsv1 and genital hsv2, both with symptoms. Any good books/websites on these type of relationships?

2. If a person is positive for hsv1 but has never had an outbreak, does this mean that this person will not have outbreaks if they contract hsv2?

3. What is the best test to take to find out if you have herpes? And how long should one wait after their last sexual encounter to get an accurate diagnosis? He’s been out of his former long term relationship for about 2 months.

[Terri Warren]

So glad you are feeling reassured about your skin conditions.

In terms of reading, I, of course, like my book The Good News About the Bad News. It has two chapters dealing with this topic and I think it would be useful for both of you.

No. Just because they don’t have outbreaks with HSV 1 says nothing about whether they will with HSV 2.

The absolute best test is the herpes western blot. An acceptable alternative particularly for HSV 2 would be the IgG antibody test. It is best to wait 4 months from any possible exposure (i.e. the last sexual encounter.

If you have more questions feel free to renew your subscription.

Terri

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