Recurrent herpes simplex—despite being rarely diagnosed—is not infrequent. Any recurrent blistering process around a finger nail, particularly when accompanied by early lymphangitis and radiating pain, should prompt a cytological examination. The blister roof is opened and a Tzanck smear taken for microscopic investigation as well as for virus culture or molecular biological tests. Early blisters with clear watery contents exhibit mainly keratinocytes, some of which are giant and multinucleated. Securing the blister roof for histological sections may be necessary to rule out an early bullous impetigo (run-around).
Herpes zoster infrequently extends to the digits. Tzanck tests demonstrate an essentially similar picture to that of herpes simplex.
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