Table of ContentsView AllTable of ContentsSymptomsRecurring InfectionComplicationsCausesDiagnosisTreatmentCoping
Table of ContentsView All
View All
Table of Contents
Symptoms
Recurring Infection
Complications
Causes
Diagnosis
Treatment
Coping
Herpetic whitlow is a rare complication of herpes simplex virus (HSV) infection that leads to a painful rash in the finger or hand. Sometimes called whitlow finger, it occurs in 2.5 cases per 100,000 people per year.
The HSV infection can be transmitted through direct contact with mouth or genital sores. People with compromised immune systems, like those withhuman immunodeficiency virus (HIV), may be more at risk. Whitlow finger tends to affect children under 10 and young adults ages 20 to 30.
This article explains herpetic whitlow signs and symptoms, causes, and treatment to get rid of herpetic whitlow symptoms. It also lists a few conditions that herpetic whitlow can be mistaken for, and how a healthcare provider can correctly diagnose whitlow finger.
This photo contains content that some people may find graphic or disturbing.See PhotoReproduced with permission from © DermNetdermnetnz.org2023.
This photo contains content that some people may find graphic or disturbing.See Photo
This photo contains content that some people may find graphic or disturbing.
Reproduced with permission from © DermNetdermnetnz.org2023.
Herpetic Whitlow Symptoms
Thesymptomsof herpetic whitlow resemble that of otherherpesinfections. There is a red, blistering rash present, along with pain and sometimes, flu-like symptoms.
Whitlow Finger Rash
Herpetic whitlow occurs as a singlevesicle(a fluid-filled sac or blister that forms beneath the skin) or multiple vesicles on one finger. Rarely, multiple fingers are involved. The vesicles of herpetic whitlow are generally clear or slightly yellowish in appearance and lie over a red base on the finger. Mild swelling surrounding the rash on the finger is also common.
Over a 12-day period or so, the vesicles group together (“cluster”) and eventually morph into shallow sores or ulcers that dry up, crust, and peel off the skin. Sometimes, the vesicles spread into the nail bed, leading to bleeding or bruising around the nailbed.
Whitlow Finger Pain
In addition to the vesicle or vesicles on the finger, people experience burning and/or tingling pain within the affected finger. Interestingly, this pain (similar to other herpes infections) often precedes any skin changes. Some people also experience fever and swollen lymph nodes in the armpit and/or upper limb.
Recurring Herpetic Whitlow Infection
Recurrent infections occur when the herpes simplex virus—which lies dormant in a nerve bundle—emerges and causes symptoms. Like other herpes infections, the good news is that recurrent infections are often milder and last a shorter time.
Complications of Herpetic Whitlow
While it’s uncommon to develop complications from herpetic whitlow if they do occur, they usually include one or more the following:
Rarely, herpetic whitlow causes a disseminated HSV infection—when the virus has spread from its local site to other areas of the body, like the brain or spinal cord. This is a very serious complication and requires hospitalization.
In addition to the vesicle or vesicles on the finger, people experience burning and/or tingling pain within the affected finger. Interestingly, this pain (similar to other herpes infections) often precedes any skin changes. Some people also experience a fever and swollen lymph nodes in the armpit and/or upper limb.
What Can Herpetic Whitlow Be Mistaken For?
Staph Skin Infections and MRSA
Herpetic Whitlow Causes
A person may develop a herpetic whitlow if broken skin on a finger (usually trauma-induced) comes into direct contact with HSV sores or blisters (such as cold sores or genital herpes) on someone else’s body or on their own body.
What happens biologically is that once the skin is broken and HSV enters the body, the virus infects human epithelial cells, replicates, and symptoms occur.
While anyone (children and adults) can get herpetic whitlow,certain factorsincrease a person’s chances of becoming infected:
Is Herpetic Whitlow an STD?In some cases, the herpes simplex virus (HSV) that leads to herpetic whitlow can be transmitted through sexual activity. HSV Type 1 is usually transmitted orally with an initial infection during childhood. HSV Type 2, associated with genital herpes, is a sexually transmitted infection (STI). Either HSV infection can lead to whitlow finger.
Is Herpetic Whitlow an STD?
In some cases, the herpes simplex virus (HSV) that leads to herpetic whitlow can be transmitted through sexual activity. HSV Type 1 is usually transmitted orally with an initial infection during childhood. HSV Type 2, associated with genital herpes, is a sexually transmitted infection (STI). Either HSV infection can lead to whitlow finger.
HSV-1 vs. HSV-2: What Are the Differences?
How Herpetic Whitlow Is Diagnosed
Is There a Cure for Herpes? Treatments and Outlook
Viral Culture
A viral culture entails opening the sore with a sterile scalpel blade or needle, rubbing the sore with a sterile swab to soak up the fluid from the vesicle base, placing the swab in a container, and sending it off to a laboratory.
Once in the lab, the swab contents will be swiped onto a dish where they can be monitored for the growth of the herpes virus. Typically, it takes one to four days for results from a viral culture to be reported back to your healthcare provider. A positive result means that the herpes virus grew within the laboratory dish.
Blood Test
Sometimes, instead of a viral culture—like if your sore cannot be properly swabbed or you are concerned you were exposed to herpes (but have no symptoms)—your practitioner may opt for a blood test to look for antibodies to the herpes virus.
Bear in mind that a blood test is not as sensitive (meaning its effectiveness for ruling in a diagnosis) as viral culture. In addition, it takes about one to two weeks for your body to produce antibodies against the herpes virus, once infected. With that, it’s best to wait a few weeks after possible exposure to avoid obtaining a false negative.
Tzanck Smear
Another test, called aTzancksmear, is not specific for the herpes virus, but it is inexpensive and rapid.During this test, a healthcare provider will use a small blade to open and scrape the sore, smearing a cell sample onto a glass slide.
After staining the slide (called the Wright-Giemsa stain), it can be examined under a microscope for Tzanck cells present with the herpes simplex virus. Keep in mind though, these cells do not exclusively occur with the herpes simplex virus. They may occur with other infections, like varicella (chickenpox),herpes zoster(shingles), andcytomegalovirus(CMV).
Herpetic Whitlow Treatment
The treatment of herpetic whitlow typically entails simple, self-care measures, as the infection will heal on its own within two to four weeks. Sometimes, though, medication is recommended, especially if the infection is severe or yourimmune systemis suppressed.
Antiviral Medications
Keep in mind that these antiviral agents are not curative; rather, they work to shorten the duration of symptoms from a herpes simplex infection.
Rarely would an antiviral, like acyclovir, be given through the vein (called intravenous acyclovir). This is generally only done to treat a disseminated HSV infection or if a person has a severely weakened immune system.
Suppressive Therapy
Although not well studied specifically for herpetic whitlow, in some instances, your healthcare provider may recommend taking a daily antiviral medication to prevent recurrent infections.
While not FDA-approved for herpes infections, suppressive therapy may decrease the number of herpetic whitlow recurrences and decrease viral shedding (the release of the herpes virus from the affected human cells).
Coping With Herpetic Whitlow
To ease the inflammation and associated swelling and pain of herpetic whitlow, your healthcare provider may recommend elevating your finger and taking an over-the-counternonsteroidal anti-inflammatory drug (NSAID),like ibuprofen. Cool compresses applied to the finger can also be soothing.
In order to prevent a bacterialsecondary infection, it’s important to gently clean the affected area on your finger every day. After cleaning, apply a dry dressing over the rash. The dressing will not only prevent bacteria from getting into the sore(s) but will also prevent the spread of the herpes virus.
In addition to dry dressing, your practitioner may also recommend wearing a protective glove to further decrease the risk of transmission.
There are few good ways to prevent herpetic whitlow, which can recur. The same treatments, however, can be used with subsequent episodes of recurring whitlow finger.
Summary
Herpetic whitlow causes a painful rash on the finger due to herpes simplex virus (HSV) infection. It’s a skin condition that is more likely to occur in people with immune system compromise. Also likely are recurring infections, especially at times of illness or stress when symptoms re-emerge.
The blisters and rash are typically easy to treat and resolve quickly if you keep the skin clean and avoid scratching or disrupting the site. Over-the-counter pain relief will help, although some people may need to take antiviral drugs or other medications.
Herpetic whitlow can mimic other infectious conditions, like bacterial cellulitis. Be sure to see a healthcare provider to ensure the proper diagnosis and treatment for your condition.
5 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Foret T, Coutier F, Razafindramaro N, Golden C, Faure C.Atypical paronychia: don’t forget herpesvirus.Dermatol Online J. 2021 Jan 15;27(1):13030/qt88z306fm. PMID: 33560799.Lima RB, Borges MAP, Araújo LF, Martins CJ.Herpetic whitlow in a child with AIDS: the importance of Tzanck test in the diagnosis.An Bras Dermatol. 2021 Jul-Aug;96(4):477-481. doi: 10.1016/j.abd.2020.08.017.Gathier PJ, Schönberger TJA.A man with an infected finger: a case report.J Med Case Rep. 2015;9:119. doi:10.1186/s13256-015-0589-5DermNet New Zealand.Paronychia.National Health Service.Herpetic whitlow (whitlow finger).Additional ReadingAmerican Academy of Dermatology Association.Herpes Simplex: Diagnosis and Treatment.
5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Foret T, Coutier F, Razafindramaro N, Golden C, Faure C.Atypical paronychia: don’t forget herpesvirus.Dermatol Online J. 2021 Jan 15;27(1):13030/qt88z306fm. PMID: 33560799.Lima RB, Borges MAP, Araújo LF, Martins CJ.Herpetic whitlow in a child with AIDS: the importance of Tzanck test in the diagnosis.An Bras Dermatol. 2021 Jul-Aug;96(4):477-481. doi: 10.1016/j.abd.2020.08.017.Gathier PJ, Schönberger TJA.A man with an infected finger: a case report.J Med Case Rep. 2015;9:119. doi:10.1186/s13256-015-0589-5DermNet New Zealand.Paronychia.National Health Service.Herpetic whitlow (whitlow finger).Additional ReadingAmerican Academy of Dermatology Association.Herpes Simplex: Diagnosis and Treatment.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Foret T, Coutier F, Razafindramaro N, Golden C, Faure C.Atypical paronychia: don’t forget herpesvirus.Dermatol Online J. 2021 Jan 15;27(1):13030/qt88z306fm. PMID: 33560799.Lima RB, Borges MAP, Araújo LF, Martins CJ.Herpetic whitlow in a child with AIDS: the importance of Tzanck test in the diagnosis.An Bras Dermatol. 2021 Jul-Aug;96(4):477-481. doi: 10.1016/j.abd.2020.08.017.Gathier PJ, Schönberger TJA.A man with an infected finger: a case report.J Med Case Rep. 2015;9:119. doi:10.1186/s13256-015-0589-5DermNet New Zealand.Paronychia.National Health Service.Herpetic whitlow (whitlow finger).
Foret T, Coutier F, Razafindramaro N, Golden C, Faure C.Atypical paronychia: don’t forget herpesvirus.Dermatol Online J. 2021 Jan 15;27(1):13030/qt88z306fm. PMID: 33560799.
Lima RB, Borges MAP, Araújo LF, Martins CJ.Herpetic whitlow in a child with AIDS: the importance of Tzanck test in the diagnosis.An Bras Dermatol. 2021 Jul-Aug;96(4):477-481. doi: 10.1016/j.abd.2020.08.017.
Gathier PJ, Schönberger TJA.A man with an infected finger: a case report.J Med Case Rep. 2015;9:119. doi:10.1186/s13256-015-0589-5
DermNet New Zealand.Paronychia.
National Health Service.Herpetic whitlow (whitlow finger).
American Academy of Dermatology Association.Herpes Simplex: Diagnosis and Treatment.
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
