Herpetic whitlow

About herpetic whitlow

Herpetic whitlow usually develops on the end of your finger and can affect more than one finger or your thumb. You’re most likely to get a herpetic whitlow on your index finger or thumb.

Herpetic whitlow is spread by skin-to-skin contact with someone who has HSV and also has the symptoms of it, such as a cold sore. For example, your child can develop herpetic whitlow if he or she has an active cold sore and also sucks his or her thumb. If the skin on your child’s thumb is broken, the virus can spread from the cold sore and infect the skin on their thumb.

As well as the virus spreading from a cold sore it can also spread from contact with genital herpes.

Herpetic whitlow may affect healthcare workers who regularly come into contact with people infected with HSV.

Symptoms of herpetic whitlow

Symptoms of herpetic whitlow include:

  • a burning or tingling sensation
  • swelling
  • one or more small fluid-filled blisters
  • pain, redness and tenderness, which can be severe

You may also have a fever, generally feel unwell and have small swellings in the lymph nodes in your armpits. These symptoms may develop a few days before the ones on your finger or thumb.

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 10 and 14 days. After this, the blisters will crust over and heal, and your symptoms will begin to improve.

Once your skin is infected with HSV, herpetic whitlow can keep coming back. However, the first infection usually has the most severe symptoms. Up to half of all people who get another herpetic whitlow infection have less severe symptoms, which don’t last as long.

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

Complications of herpetic whitlow

If you have an infection that keeps coming back, you may find that your affected finger or thumb becomes overly sensitive or numb in between infections.

With any HSV infection, there is always a risk that the infection will spread. With herpetic whitlow, it’s possible for the infection to spread to your other fingers, or to your eyes if you touch or rub them with your infected finger. If you have repeated infections, scarring can develop on the skin of the affected finger.

If you have a weakened immune system, for example, if you have HIV/AIDS or are taking medicines that suppress your immune system, the HSV infection can be severe and cause serious complications. It’s important to see your GP urgently 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’s caused by HSV-1; in about four in 10 people, it’s caused by HSV-2.

Diagnosis of herpetic whitlow

Your GP will ask about your symptoms and examine you. Your GP may ask if you have ever had any similar-looking infections on your fingers, in your mouth, on your lips or around your genitals.

If you have repeated herpetic whitlow infections, or if the condition doesn’t get better with treatment, your GP may take a swab of your infected finger. This will help to diagnose your condition and decide on treatment.

Treatment for herpetic whitlow

Herpetic whitlow usually clears up within three to four weeks without any treatment. Any treatment your GP gives you will help to relieve your symptoms and stop the development of reoccurring herpetic whitlow.

Medicines

Your GP may prescribe an antiviral medicine called acyclovir (eg Zovirax). You need to take this in the first few days after your symptoms develop for it to be effective.

If your finger or thumb is 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 chances of getting herpetic whitlow by not exposing yourself to HSV. This means not having skin-to-skin contact with people who have cold sores, genital herpes or other herpes simplex infections.

If you’re a healthcare worker, make sure you always wear gloves when touching your patients and wash your hands regularly and thoroughly.

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
  • sharing towels or flannels that have come into contact with the infected area
  • wearing contact lenses (if you have them) – instead, wear your glasses to stop the virus spreading to your eyes

For common questions about Herpetic whitlow, see FAQs.

For sources and links to more information, see Resources.

Why does herpetic whitlow keep coming back?

Answer

The reason why a herpetic whitlow keeps coming back aren’t fully understood. However, you may be more likely to develop another herpetic whitlow if you have an infection, such as a cold or if you’re tired and run down.

Explanation

Once you have been infected with the herpes simplex virus (HSV) it stays in your body for life. It can remain inactive or it can be triggered again, causing your symptoms to come back.

Doctor’s don’t know exactly why HSV keeps coming back, or what triggers another infection. Herpetic whitlow may be triggered when:

  • you have an infection, such as a cold or flu
  • you have an injury or operation where the virus is on your skin
  • you’re rundown or tired
  • your skin is exposed to sunlight

For some people, there is no obvious cause.

Symptoms of a recurrent herpetic whitlow infection are usually less severe and last for a shorter period of time than the first infection.

If you have any further questions, talk to your GP.

As a healthcare worker, how can I prevent myself getting herpetic whitlow?

Answer

If you’re a healthcare worker, you’re more at risk of developing herpetic whitlow, because you may come into contact with people who have active symptoms of the herpes simplex virus (HSV). By wearing gloves and washing your hands you can reduce your risk of developing herpetic whitlow.

Explanation

It's common for some healthcare workers to come into regular contact with people who have HSV. For example, dentists, dental nurses, hygienists and other professionals who examine people’s mouths are at risk of herpetic whitlow through contact with cold sores and herpes in the mouth of their patients.

Sexual health nurses and doctors are potentially at risk because they examine people who have genital herpes. To help reduce the risk of developing herpetic whitlow, make sure you:

  • wear gloves when examining patients
  • keep your hands clean by washing them thoroughly and on a regular basis
  • follow Standard Infection Control Precautions or Universal Precautions at your place of work

What is the difference between a finger pulp infection and herpetic whitlow?

Answer

Finger pulp infections and herpetic whitlow are both infections of the end of your finger. However, they are caused by different infections and therefore need different treatments.

Explanation

A finger pulp infection is sometimes confused with herpetic whitlow. This is because both affect the end of your finger and fingertip and cause redness, swelling and tenderness. It's important that your infection is correctly diagnosed as the treatment for each is different.

The types of infection that cause a finger pulp infection and herpetic whitlow are different, so the way you get them differs. A finger pulp infection is most often caused by the bacterium S. aureus. Infection usually develops after an injury or break in the skin.

Herpetic whitlow is caused by the herpes simplex virus (HSV), which is spread through skin-to-skin contact with an infected area.

Although the symptoms of a finger pulp infection and herpetic whitlow are similar, there are some differences between them. With a finger pulp infection, your fingertip is affected, it's tender to the touch and you may have a large collection of pus (abscess) across the fleshy part. Herpetic whitlow can affect any part of the end of your finger, not just your fingertip, and may affect more than one finger at a time. Usually you have one or a group of small blisters. These will be filled with fluid or pus and may burst and crust over. Herpetic whitlow can be very painful.

A finger pulp infection is usually treated with antibiotics and the abscess on your finger may need to be drained. If you have herpetic whitlow, it usually gets better on its own after about two weeks and you may not need any treatment. However, your GP may prescribe antiviral medicines if the infection can be treated quickly or if it keeps coming back.

If you have any questions or concerns about finger pulp infection or herpetic whitlow, talk to your GP.