Define herpetic whitlow and its symptoms, causes, diagnosis, treatment and prevention

Define herpetic whitlow and its symptoms, causes, diagnosis, treatment and prevention

What is herpetic whitlow?

Herpetic whitlow is a very painful infection which represents lesion on a finger or a thumb, and less frequently it happens on the toes or on the cuticle of the nail. It is caused by herpes simplex virus (HSV).It can be caused by infection by two types of herpes simplex virus- HSV-1 and HSV-2 ad the infection is developed after direct contact with an infected sore.

HSV-1 type is one that usually contracted by workers in health care who come in direct contact with virus and its symptoms are visible around mouth, lips and face and most affected are dental and medical workers. HSV-2 type is usually spotted among young people aged 20 to 30 after contact with infected genitals.

Herpetic whitlow can be developed in adult as well in kids and it can be successfully treated in several ways.

Herpetic whitlow is a viral infection where small blisters are formed on the fingers, fleshy area around fingertips and toes.

Due to the fact that herpetic whitlow is caused by the same virus which is responsible for cold sores and genital herpes, it is extremely contagious. That is the reason why the recognizing of the symptoms is very important, and also taking steps for protection.

ICD code for herpetic whitlow

  • ICD-10   B00.8
  • ICD-9-CM    054.6

How does herpetic whitlow start? Symptoms of herpetic whitlow

How do you spread herpetic Whitlow
Herpetic Whitlow’s Picture Credit: James Heilman, MD

First symptoms of herpetic whitlow will usually appear two to twenty days after one has been exposed to a virus. It can be developed on any of the fingers. Even though blisters and clusters are common sign of the infection, infected area will burn or tingle, and infected person may feel pain before any noticeable lesion shows up. After that, the finger will begin to swell and will become red, as the infection is developed. Forming of the blisters will follow, and after that they will begin filling with liquid. There can be only one blister or a group of them can develop. Usually they are very small and painful to the touch.

It can take more than three weeks for blisters to heal.

At the end, blisters will rupture on their own and a scab will be formed. When scab heals, the infection will return to its dormant state.

More serious symptoms that can be caused by virus are fever, swelling of the lymph nodes in the armpits and in the elbow area and red marks surrounding or leading away from the whitlow.

When the infection caused by herpes simplex virus appears on the finger in the form of a whitlow, the symptoms that appear are similar to herpes on any other part of the body.

It’s possible to get recurrent infections after an initial infection, but this is rare. They will usually reappear in the same area where first infection happened. However, recurrent infections of herpetic whitlow are usually less severe and they will heal faster because the body has developed antibodies which will fight the virus.

There are certain factors that can trigger recurrent infection with herpes simplex virus such as herpetic whitlow, including fever or recurring illness, hormonal imbalance, excessive stress, surgery, excessive sun exposure and physical, mental or emotional trauma.

Pattern of recurrent infections is the same as with the primary infection- first tingling sensation, than burning and itching about 24 hours before the sores show up. It will usually last little more than a week and it will not be as strong as primary infection. There will be fewer blisters during a recurrent infection and the blisters will be smaller and less painful.

Is herpetic Whitlow painful
What is a Whitlow on your finger?

How did I get herpetic Whitlow? Causes of herpetic whitlow

There are two types of herpes simplex virus- HSV-1 and HSV-2 type.

Primary source of infection in children is area around the mouth, nose and in general their face and is commonly inferred that the virus is transferred by chewing or sucking of thumb, and children are usually infected by HSV-1 type.

In adults, more common for the primary source is genital region, and the virus correspondent is HSV-2 type.

But, person can develop this condition if your finger comes in contact with type 1 or type 2 herpes simplex virus. Also, some people who have herpetic whitlow have a history of cold sores or genital herpes, but that does not always has to be the case.

If person is diagnosed with HSV, as a secondary infection it can appear herpetic whitlow. That can happen if there is an open cut or sore on a finger or a thumb, and that area come in contact with the blister around the mouth or genital region, because the HSV infections are very contagious.
The virus enters your finger through the cut, but if you do not have history of herpes simplex virus, herpetic whitlow can develop if you come in contact with herpes sores or blisters of other infected person.

People with weak immune system are more at risk for developing HSV infection.
It is extremely important that the herpetic whitlow is treated properly, because unchecked whitlows put a person at great risk for big infections or severe conditions such as herpetic encephalitis, which represents brain infection with the herpes simplex virus.

whitlow toe


If on a finger or a thumb appear a sore or a blister, it usually is not a cause for concern. Injury, insect bites or friction can be reason for appearance of some sores, but they will typically heal on their own. But, if a person develops painful blisters full of pus, which is called abscess, and the patient is not sure what the reason is, it is necessary to visit a doctor.

Doctor is capable to identify viral infection, just based on the appearance of blisters and sores. If a doctor suspects that there is a viral infection, he will take a skin swab or blood test which will confirm or rule out herpetic whitlow.

Is a herpetic Whitlow contagious? Treatment of the herpetic whitlow

Even though, usually, herpetic whitlow does not require treatment, because the condition will usually heal within a few weeks without medication, prescription of an antiviral drug can shorten the duration of an infection. It is of vital importance to begin antiviral treatment within the first 48 hours of any symptoms occurring. If a person starts an antiviral treatment to treat herpetic whitlow after the initial 48 hours will likely have little effect.

These antiviral drugs are effective in reducing the duration of symptoms in the primary infection as well as in recurrent infections.

Treatment with antiviral drugs 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 human body.
But also, if the person does not take antiviral medications, the herpetic whitlow will heal itself over a few weeks without any drugs.

Antiviral drugs are also there to lower the risk of spreading the infection to other people. If a herpetic whitlow blister ruptures and becomes infected with bacteria, a doctor can prescribe an antibiotic.

Although the herpetic whitlow is self-limited illness, treatments with oral or intravenous antiviral drugs can show good results for severely infected patients. Antiviral drugs that will be commonly used to treat herpetic whitlow include oral valacyclovir, oral acyclovir, also known as best way for treating herpetic whitlow, oral famciclovir, which is perfect for preventing recurrent episodes of whitlow , topical acyclovir ointment, which is only there as accessory in healing and analgesics to numb pain.

Antiviral drugs will typically be used for 1-2 weeks or until the infection clears up.In some rare occasions where people have severe and recurrent outbreaks, a doctor will prescribe very strong suppressive medications. Patients should take lot of these strong suppressive antiviral drugs daily to try to prevent outbreaks.

In some rare occasions where people have severe and recurrent outbreaks, a doctor will prescribe very strong suppressive medications. Patients should take lot of these strong suppressive antiviral drugs daily to try to prevent outbreaks.

It is very important to know that taking antiviral medications will cure herpetic whitlow as one of the symptoms of herpes simplex virus, but it the antiviral drugs will not heal HSV itself.

Also, one more important thing is to know that surgical treatment of the lesion can make thing even worse by developing superinfection or encephalitis.

Person can treat herpetic whitlow by its own with taking a pain reliever such as acetaminophen or ibuprofen to reduce pain and fever, applying an ice compress several times a day to reduce swelling and cleaning the infected area daily and covering it with sterile gauze.

Complications of herpetic whitlow

Due to the contagious nature of this infection, person should keep the blistered area covered until it heals. If they do not do that, the infection could spread to other parts of your body or infect other people. Wearing gloves while cleaning an infected area can also prevent spreading the infection to other parts of patients body. As a precaution, also, patients should not wear contact lenses if they have herpetic whitlow. If a patient touches its eye with an infected finger, the virus could spread to its eye.

can herpetic whitlow spread to other parts of the body

Prevention : Avoiding herpetic whitlow and everyday care

Patients can support the recovery of herpetic whitlow in the home through a several different methods. First of them is covering the infection, which means lightly covering the infected area, because it will help keep the virus from spreading. It is also important for people to abstain from popping or draining the blisters, because this can cause the virus to spread even further or cause a secondary infection. Second, being hygienic. That means that 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 always work with gloves to protect themselves and other people. Then, it is important to switch to glasses, if patient wears contact lenses. Fourth important thing that every patient with herpetic whitlow should do is preventing the spread, by avoiding lesions which is one of the most important steps in keeping virus from spreading. One of the most important matter that will prevent spreading whitlow to other people is telling to people in your surroundings, and also telling to medical or dental professional who works close to them to be aware of HSV presence.

Outlook for herpetic whitlow

Herpes simplex virus can remain inactive in the human body cells for a time and may or may not cause symptoms. In some cases of HSV infections, people will never have a recurring whitlow. In some other cases, whitlows often return and require regular treatment. The best is to talk about the symptoms and treatment options with a qualified health care professional. Together, they can work out a plan that fits the patient’s individual needs and make treatment as comfortable as possible.

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