What to know about herpetic whitlow

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Herpetic whitlow develops when HSV enters a finger, particularly the fingertip, often through a small cut in the skin. Less commonly, whitlow can form on a toe.

The virus infects the soft tissue and causes localized:

• pain
• swelling
• fluid-filled blisters

A person may feel a burning or tingling sensation or pain before the finger, or fingertip, swells. At this point, there may be a color change, such as reddening.

Next, one or more blisters appear and fill with liquid or pus. They are typically small and very painful to the touch. These eventually burst and scab over.

A person with herpetic whitlow may also have:

• swollen lymph nodes in the armpit or elbow area
• a fever
• red streaks surrounding or leading away from the affected finger or toe

It may be easy to mistake whitlow for paronychia, which is a bacterial or fungal infection around the nail, or another type of finger infection.

The infection develops 2–20 days after exposure to the virus, and once the infection sets in, the fluid-filled blisters tend to form within 5–6 days.

Overall, the symptoms usually resolve without treatment in 2–4 weeks.

In 30–50% of people with herpetic whitlow, the infection reoccurs over time, often in the same place. The symptoms typically follow a pattern, and the person will feel sensations of tingling, burning, or itching before the blisters form.

When whitlow reappears, it is usually less severe than the first infection. There may be fewer blisters, which may be smaller and less painful.

A person can develop herpetic whitlow through direct contact with skin containing the virus, which might be on the genitals, face, or hands. The transmission might involve:

• touching these areas of someone with active oral or genital sores
• a person touching their own cold or genital sores
• a person sucking their thumb or biting their nails during an oral herpes outbreak

People with certain jobs may have a higher risk of herpes and its complications, such as herpetic whitlow, including medical and dental professionals and anyone else who works closely with people who have herpes.

The following factors can trigger reoccurring flares of HSV infection, including herpetic whitlow:

• a fever
• a reoccurring illness
• excessive stress
• hormonal imbalances
• excessive sun exposure
• surgery
• physical, mental, or emotional trauma
• a weakened immune system

Without treatment, herpetic whitlow tends to go away in 2–4 weeks. To reduce the duration of the symptoms, a person can try antiviral medications.

These limit the appearance of symptoms by up to 4 days. Antiviral medications also prevent the virus from spreading to other parts of the body.

A person sees the best results when they receive treatment within 48 hours of the symptoms appearing.

Antivirals that treat herpetic whitlow include:

• valacyclovir pills
• acyclovir pills
• famciclovir pills
• acyclovir ointment

A key part of treatment involves easing symptoms. This might involve treating pain with an over-the-counter medication, such as acetaminophen (Tylenol) or ibuprofen (Advil).

If a secondary bacterial infection develops in the area of a whitlow infection, antibiotics may also be necessary.

If whitlow reappears, a doctor may prescribe suppressive antiviral medications, which a person takes daily. These may reduce the chances of future outbreaks.

It is worth noting that while antiviral drugs can reduce the frequency and severity of symptoms, there is no cure for an HSV infection.

People can support healing from herpetic whitlow in several ways:

• Cover the infection: Lightly covering the affected area helps keep the virus from spreading.
• Avoid a temptation to drain: Never pop or drain a blister, as this can spread the virus or leave the area open to a secondary infection.
• Wash the hands: Doing so frequently and thoroughly is key, especially before and after touching an area of whitlow. Those working in medical or dental fields should take every precaution, such as working in gloves whenever possible.
• Avoid contact lenses: Using these when whitlow is present can spread the virus to the eyes. Wear glasses until the symptoms resolve.
• Avoid touching the blisters: This is an important way to keep the virus from spreading.
• Tell the doctor or dentist: Letting healthcare providers know about an active outbreak can ensure that they use the right protective measures.

The HSV can stay inactive in the nerve cells for some time. It may or may not reactivate and cause symptoms.

Some with whitlow only have symptoms once, but the infection recurs in 30–50% of people who develop it.

It is best to discuss symptoms and treatment options with a healthcare professional. They can help develop a plan to make treatment as comfortable and effective as possible.