Herpetic whitlow

Published by Bupa's Health Information Team, February 2011.

This factsheet is for people who have herpetic whitlow, or who would like information about it.

Herpetic whitlow is an intensely painful skin infection that can affect the end of any finger close to the nail. It’s caused by the herpes simplex virus.

About herpetic whitlow

Herpetic whitlow is a skin infection caused by the herpes simplex virus (HSV). You usually get it on the end of your finger, most often on your index finger, or on your thumb. It can affect more than one of your fingers at a time.

Herpetic whitlow can be spread through skin-to-skin contact from another person who has ‘active’ symptoms of HSV. For example, if you have a cut in your finger or a torn cuticle (the strip of hardened skin at the base and sides of your fingernail), and you come into contact with someone who has an open HSV blister. HSV can also spread to your finger or thumb from a different part of your body that is infected, such as your genitals (genital herpes). This is known as autoinoculation.

Herpetic whitlow is most likely to affect healthcare workers who regularly come into contact with people infected with HSV. It can also affect children who have cold sores (oral herpes) and suck their fingers or thumb.

Symptoms of herpetic whitlow

Symptoms of herpetic whitlow mostly affect your finger or thumb. They include:

• a burning or tingling sensation
• swelling and redness
• itching
• one or a group of small fluid- or pus-filled blisters
• pain, which can be severe

You may also have a fever, generally feel unwell and have small swellings under your armpits in your lymph nodes, but this is uncommon.

The symptoms of herpetic whitlow don’t always start as soon as you have been exposed to HSV. It’s common for the virus to remain ‘inactive’ in your skin for up to three weeks and not cause any symptoms. Once symptoms do start, they usually last between seven and 10 days. After this, the blisters will begin to crust over and heal, and your symptoms will begin to improve.

Up to half of all people who get another herpetic whitlow infection after the initial one (recurrent infection) have less severe symptoms that don’t last as long.

If you have any of these symptoms, see your GP.

Complications of herpetic whitlow

If you have a recurrent infection, you may find that your affected finger or thumb becomes overly sensitive or numb once your symptoms have gone.

With any HSV infection, there is always a risk that the infection will spread. In herpetic whitlow, it’s possible for the infection to spread to other fingers, or to your eyes if you touch or rub them with your infected finger.

If you have a weakened immune system, for example if you have HIV/AIDS or are taking medicines that suppress the immune system, the HSV infection can be severe and cause serious complications such as pneumonia or encephalitis (inflammation of your brain). It’s therefore important to seek urgent medical advice if your immune system is weakened and you have symptoms of herpetic whitlow.

Causes of herpetic whitlow

Herpetic whitlow can be caused by two different types of herpes simplex virus – either HSV-1 or HSV-2. In most people with herpetic whitlow (about six in 10), it is caused by HSV-1; in about four in 10 people it is caused by HSV-2.

In children, herpetic whitlow is almost always caused by HSV-1. This can happen, for example, if a child has a cold sore (oral herpes) and sucks his or her thumb or fingers. The HSV can then spread through a small cut in the skin.

Diagnosis of herpetic whitlow

Your GP will examine your hand and ask you about your symptoms. He or she may also ask you if you have ever had any similar-looking infections on your fingers, in your mouth, on your lips or around your genitals. This will help your GP to diagnose the cause of your condition.

Treatment for herpetic whitlow

Herpetic whitlow usually clears up by itself within three to four weeks, so any treatments you get from your GP will be to relieve your symptoms and to stop the infection spreading to other areas of your body.

Medicines

Your GP may prescribe you a medicine called acyclovir (eg Zovirax) to help your symptoms go away more quickly or to prevent any complications and recurrent infection.

If your affected finger or thumb is particularly painful, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Prevention of herpetic whitlow

You can reduce your risk of getting herpetic whitlow by avoiding exposure to people with active symptoms of HSV. For example, if you are a healthcare worker and regularly come into contact with people who have open HSV-infected sores, you should always wear gloves and wash your hands thoroughly.

If your child has cold sores around his or her mouth, make sure you wash your hands immediately after you have put treatment on them.

You can also get herpetic whitlow from people with genital herpes, so it is best to avoid sexual contact until the infection has cleared up.

If you develop herpetic whitlow, you can stop the infection spreading to other areas of your body or to other people by not:

• touching the infected area – instead, cover it with a plaster
• holding hands
• sharing towels or flannels that have come into contact with the infected area
• wearing contact lenses (if you have them) – instead, wear your glasses because it is possible to contaminate your lenses with HSV and spread it to your eyes

For common questions about Herpetic whitlow, see Common questions.

For sources and links to more information, see Resources.