Definitive diagnostic testing includes the Tzanck test, viral cultures, serum antibody titers, fluorescent antibody testing, or DNA hybridization. In the Tzanck test, smears are obtained by scraping the base of an unroofed vesicle. Smears are Giemsa stained, and a positive test is indicated by light microscopy findings of multinucleated giant cells, often with visible viral inclusions. Viral culture of the aspirated vesicle fluid is the most sensitive assay, but this test is usually more costly and time consuming, requiring 24-48 hours. Serum antibody titers are usually cost prohibitive, as are fluorescent antibody testing and DNA hybridization, which are not commonly available.
Herpetic whitlow is a self-limited disease.
Treatment most often is directed toward symptomatic relief. Acyclovir may be beneficial. Oral acyclovir may prevent recurrence. Doses of 800 mg twice daily initiated during the prodrome may abort the recurrence. Use antibiotic treatment only in cases complicated by bacterial superinfection.