What’s to know about herpetic whitlow?

Herpetic whitlow: Symptoms, causes, and treatment

By Jon

Reviewed by
Alana Biggers, MD, MPH
whitlow or whitlow finger is a painful infection that may cause other symptoms
to show up. The infection may appear in adults or children, and there are
several ways to treat it.
whitlow is an infection created by the herpes simplex virus (HSV). The
infection produces a painful wound called a whitlow on the fingers.
Caused by
the herpes simplex virus (HSV), herpetic whitlow occurs mostly on the fleshy
part of the index finger or thumb. Sometimes herpetic whitlow can develop on
the toes.
article explores the symptoms, causes, and various treatment methods for this
painful infection.

When the
herpes simplex virus infection appears on the finger in the form of a whitlow, the
symptoms are similar to herpes on other parts of the body:

  • Timing: The
    first symptoms usually appear 2-20 days after the person is exposed to the
    herpes simplex virus.
  • Sensation:
    The infected area will burn or tingle, and the person may begin to experience
    pain before any noticeable lesion shows up.
  • Infection:
    The finger will then begin to swell and redden as the infection develops.
    Blisters will appear and begin to fill with liquid or pus. There may be just
    one blister, or a group of them may develop. They are typically small and very
    painful to the touch.
  • Rupture:
    These blisters will then burst and scab over in the weeks to come. Once the
    scabs heal, the infection returns to its dormant state.
symptoms may appear at any time during the infection, including:

  • swollen
    lymph nodes in the armpits or elbow area
  • a fever
  • red marks
    surrounding or leading away from the whitlow

The sores
that the infection creates may recur in some people over time. Whitlows will
usually reappear in the same area as the primary infection.

There may
be certain factors which trigger recurrent HSV infections, such as herpetic
whitlow, including:

  • fever or
    recurring illness
  • excessive
  • hormonal
  • excessive
    sun exposure
  • surgery
  • physical,
    mental, or emotional trauma
infections will also typically follow a pattern similar to the primary
infection. People will feel sensations of tingling, burning, or itching about
24 hours before the sores show up.
A recurrent
infection usually lasts little more than a week and is not as strong as the
primary infection. There may be fewer blisters during a recurrent infection,
and those blisters may also be smaller and less painful.
Causes and
risk factors

HSV is the
virus that commonly causes cold sores and genital herpes. It is also the cause
of herpetic whitlow.
There are
two types of HSV; HSV-1 and HSV-2. HSV-1 infections usually occur around the
face, in the mouth, nose or lips. HSV-2 infections typically involve the area
around the genitals.
infection can occur in men and women of all ages, though symptoms caused by
HSV-1 appear to be more common in children and young adults.
Certain professionals
may be more at risk for HSV-1 and complications, such as herpetic whitlow.
These people may include medical or dental professionals and anyone who works
in close collaboration with people who have the infection.
The rest of
the population is commonly infected by HSV-2, often through sexual contact.
People with weakened immune systems are more at risk for becoming infected with
whitlow is very contagious. Infections are easily spread by coming into direct
contact with the infected sores or blisters of someone with herpetic whitlow. A
person can also infect themselves if they touch one of their own cold sores or
genital herpes sores with their fingers.
It is vital
that the whitlow is treated properly. Unchecked whitlows put a person at risk
for superinfections or conditions, such as herpetic encephalitis, which is a
herpes infection in the brain.
medications are often used to treat herpetic whitlow. These antivirals are
effective in reducing the duration of symptoms in the primary infection as well
as in recurrent infections.
It is
crucial to begin antiviral treatment within the first 48 hours of any symptoms
occurring. Using an antiviral to treat herpetic whitlow after the initial 48
hours will likely have little effect.
treatment is used to help reduce the healing time and time spent in pain.
Antiviral treatment may also reduce the risk for the virus to spread to other
parts of the body.
However, if
the person does not take antiviral medications, the whitlow will heal itself
over a few weeks without any drugs.
agents that are commonly used to treat herpetic whitlow include:

  • oral
  • oral
  • oral
  • topical
    acyclovir ointment
  • analgesics
    to numb pain
medications are typically used for 1-2 weeks or until the infection clears up.
In cases where the whitlow develops a secondary bacterial infection,
antibiotics may also be necessary.
On rare
occasions, where people have severe recurrent outbreaks, a doctor may prescribe
suppressive medications. People should take these suppressive antiviral
medications daily to try to decrease outbreaks.
It is
important to note that antiviral medications can help treat an HSV outbreak,
such as a herpetic whitlow, but they do not prevent future outbreaks. Antiviral
drugs are not a treatment for HSV itself, only the symptoms.
Home care

People can
support the recovery of herpetic whitlow in the home through a few different

  • Covering
    the infection: Lightly covering the infected area can help keep the virus from
    spreading. It is also important for people to refrain from popping or draining
    the blisters. This can cause the virus to spread even further or cause a
    secondary infection.
  • Being
    hygienic: People should follow proper hygiene at all times, especially after
    coming into contact with the whitlow. People working in the medical or dental
    field should always follow basic hygiene rules and work with gloves whenever
    possible to protect themselves and other people.
  • Switching
    to glasses: People who wear contacts may want to switch to glasses until the
    infection heals to avoid it spreading to the eyes. Many people take over the
    counter drugs or use ice packs to lessen the pain of the whitlow as well.
  • Preventing
    spread: Avoiding contact with lesions is an important step in keeping the virus
    from spreading.
  • Telling key
    people: People with HSV should also tell any medical or dental professional who
    works close to them about the virus so they can take measures to avoid it.

simplex virus can remain inactive in the nerve cells for a time, and may or may
not cause symptoms.
In some
cases, people never have a recurring whitlow. In others, whitlows often return
and require regular treatment.
It is best for people to
discuss their symptoms and treatment options with a qualified health care
professional. Together they can work out a plan that fits the person’s
individual needs and makes treatment as comfortable as possible.
Kayode Ojo
Kayode Emmanuel Ojo is the Co-Founder and Managing Director at SHEFFA Limited. He is presently studying Computer Science at the National Open University, Victoria Island, Lagos.