Herpetic Whitlow (Finger Herpes)

Symptoms

1. Prodrome: tingling, burning or itching of the finger for 1 to 2 days.
2. Swelling and redness, with throbbing pain often out of proportion to how it looks.
3. Blisters: clusters of small vesicles, usually on the fingertip or around the nail, with clear, cloudy or bloody fluid. They may merge into larger blisters.
4. Crusting and healing over 2 to 3 weeks.

Some people have fever and swollen lymph nodes in the elbow or armpit, especially with a first infection.

Causes

HSV-1, the usual cause of cold sores, and HSV-2, the usual cause of genital herpes, can both cause whitlow. The virus enters through a cut or break in the skin by:

• children sucking fingers or thumbs during a cold sore outbreak or primary herpes mouth infection
• touching your own cold sores or genital herpes
• contact with an infected person's saliva or lesions without gloves, such as healthcare, dental and respiratory workers

After infection, the virus stays dormant in the nerves and can reactivate, causing recurrences on the same finger, triggered by stress, illness or sun exposure.

Herpetic whitlow vs felon vs paronychia

Telling these apart matters, because cutting into a herpetic whitlow can spread the virus and cause bacterial infection.

Diagnosis

Diagnosis is often made from the appearance and history. A swab from the base of a blister can confirm herpes by PCR testing.

Treatment

• Antiviral tablets such as acyclovir, valacyclovir or famciclovir shorten symptoms and viral shedding, especially if started within 48 hours.
• Pain relief: acetaminophen (paracetamol) or ibuprofen, following the label dose. Elevating the hand helps throbbing.
• Cover the finger with a dry dressing to prevent spread and protect it.
• Do not pop or drain the blisters.
• Antibiotics only if a bacterial infection develops.
• Suppressive antivirals may be offered for frequent recurrences.

Preventing spread

• keep the finger covered until fully healed
• avoid touching your eyes, mouth or genitals with the affected finger
• wash hands often
• healthcare workers should not have direct patient contact until healed, depending on workplace policy
• wear gloves when contacting saliva or herpes lesions
• children with cold sores should be discouraged from finger sucking

Complications

• spread to the eye (herpes keratitis), which can damage vision
• secondary bacterial infection
• recurrent episodes
• rarely, nail damage or numbness
• widespread infection in people with weakened immunity

Frequently asked questions

What does herpetic whitlow look like?

It looks like a swollen, red, painful fingertip with clusters of small blisters filled with clear or cloudy fluid. The blisters may join together and then crust over. It often starts with tingling or burning before the blisters appear.

Is herpetic whitlow contagious?

Yes. The fluid in the blisters contains herpes virus, which can spread to other parts of your body, such as the eyes, or to other people. Keep the finger covered and wash hands often until the blisters have completely healed.

Should herpetic whitlow be drained?

No. Unlike bacterial finger infections, herpetic whitlow should not be cut or drained. This can spread the virus, delay healing and allow bacteria in. Antiviral medicine and pain relief are the right treatment.

Can herpetic whitlow come back?

Yes. The virus remains in the nerves and can reactivate, often on the same finger. Recurrences are usually milder. People with frequent recurrences may benefit from daily suppressive antiviral medicine.