What's to know about herpetic whitlow?
Herpetic 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.
This article explores the symptoms, causes, and various treatment methods for this painful infection.
Herpetic whitlow lesions are generally small and very painful.
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.
Other 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 stress
- hormonal imbalance
- excessive sun exposure
- physical, mental, or emotional trauma
Recurrent 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
Medical and dental professionals have a higher risk of coming in contact with HSV-1.
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.
The 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 HSV.
Herpetic 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.
Antiviral 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.
Antiviral 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.
Treatment for herpetic whitlow can involve oral medications and topical creams.
Antiviral agents that are commonly used to treat herpetic whitlow include:
- oral valacyclovir
- oral acyclovir
- oral famciclovir
- topical acyclovir ointment
- analgesics to numb pain
Antiviral 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.
People can support the recovery of herpetic whitlow in the home through a few different methods:
- 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.
Herpes 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.