Herpetic whitlow – What is, Causes, Symptoms, Treatments and Pictures, Is it contagious?

What is herpetic whitlow?

Herpes whitlow is an infection caused by Herpes simplex virus also known as “cold sore virus”, on the skin near the nail of the thumb or the index finger. The infected finger is known as whitlow finger and an abscess at the end of the finger can be seen.

Here are some features of herpes whitlow:

  1. An intensely painful infection of hands involving fingers mainly terminal phalanx.
  2. Herpes whitlow is more prominent than HSV-2, and approximately 60% of cases suffered from it.
  3. Its symptoms are sometimes referred as “periungual lesions” or lesions around ungual (nail) area.
  4. The virus responsible for herpes gets in through mucous membranes i.e. the moist skin inside the mouth and genital areas.
  5. The virus can be spread by broken skin or lesions on to the fingers, hands, and knees when comes in direct contact with infected person.
  6. A finger sore is also called as a herpetic whitlow.

herpetic whitlow on finger, Causes, Symptoms, Treatments and Pictures, Is it contagious?

How is herpetic whitlow transmitted?

Herpetic whitlow is a transmittable disease and is transmitted by direct contact only. Its transmission is occurred by means of mouth to mouth (mainly by saliva) and ulcerations. It can also be spread even when they are not visible.

The mucous membranes and the moist areas are the most prone areas of the infections. It cannot transmit by indirect contact such as doorknobs or by your petted dog. One should cover it with a bandage until it heals completely, as per physician’s advice. A direct contact is always required for transmission of this virus.

If the infection is left open in the air, even then there are least chances of transmission of this disease. Open and wet lesions are highly contagious. If a person has oral herpes then there are minimal chances of contracting herpes genitalia at the same time. People suffering from immunodeficiency disorders such as AIDS are more vulnerable to herpetic whitlow and the symptoms are more difficult to overcome.

The transmission of this virus is minimal from a pregnant mother to her baby at the time of delivery. Herpes whitlow infection is also common among medical professionals and the risk of catching the herpes virus can be reduced by wearing gloves while examining and treating patients.

What is the mechanism of herpes virus infection development?

The virus is passed directly from the affected area of skin (which could be the genitals, face or hands), by direct skin to skin contact, with friction, when the virus is present.

It can be passed from the face from one person to the genitals of another (or genitals to face) through oral sex when the virus is active.

You can pass it on from the affected area, when the virus is present on the skin surface: from the first warning signs that a recurrence is starting (tingles, burning skin sensations, aches, stabbing pains), through the time when there are sores or blisters, until they have healed and fresh skin has grown back.

About six in ten adults by age 25 carry herpes simplex virus type 1 and one in ten carries type 2. Even more, people carry herpes simplex virus in older age groups – but most don’t know. Only around one in three of those infected – with either type – is aware of this.

Is herpes incurable?

Yes, herpes is incurable. It is a worldwide epidemic. There is no cure for HSV-1. However, medications such as acyclovir (antiviral) are prescribed to reduce the potency of the virus inside the patient’s body.

Herpes is transmitted sexually and lasts for a lifetime. The most affected ones are women as per a survey because the transmission from a man to woman is easier than from woman to man.

What can cause herpetic whitlow?

  • Direct contact with Herpes simplex virus is the main cause of Herpetic Whitlow.
  • There are two types of Herpes simplex virus: HSV 1 and HSV 2.
  • Herpetic whitlow is often associated with oral herpes and often caused by HSV-1 and also called as “cold sores” or “fever blisters”
  • In rare cases, herpetic whitlow can be caused by HSV-2, the virus responsible for genital herpes.
  • Broken skin such as cuts, sores, a torn cuticle or lesions is most common cause to spread the infection.
  • In rare cases, HSV-2 can be passed from mother to child during childbirth, if the pregnant mother developed the lesions shortly before giving the birth.

How is herpes virus spread on hands?

As the virus of herpes whitlow is most prone to moist areas or the mucus membranes, so people who work in certain professions, are more prone to this infection.

  • Herpes virus does well in moist environments, so people who work in moist conditions like hairdressers, medical and dental workers and thumb sucking children are at high risk of getting the herpes infection.
  • The person who use to do “nail biting” are at higher risk of getting the infection. Nail biting can cause small wounds around the nail and due to moist environment of the mouth, the chance of getting the infection is quite high.
  • The chance of re-infection on any other parts of the body after the first episode is very less. It cannot even spread while applying topical creams on the infected areas.
  • People who are suffering from herpes whitlow should seek immediate medical attention. The herpes infection can spread to entire hand that is very hard to treat and sometimes even requires hand surgery.
  • During your first outbreak of herpes infection, you may notice it in more than one place of the body, such as hands and genital area. Because infected hands can also be involved in sexual activity and chances of transmission is always more at moist areas.

Is herpetic whitlow contagious? Can I transmit herpes virus infection if I have herpetic whitlow?

Herpetic whitlow is extremely contagious. It can last for the lifetime if someone acquires it from childhood. The virus, when active can transmit from genitalia of one person to others, or even by face or mouth during oral sex.

Yes, you can transmit the herpes virus infection from the infected area (such as skin or genitalia).

Can sex transmit the herpetic whitlow?

One can get herpes from the infected person by means of vagina, anus or via oral sex.

The liquid and fluid in herpes lesions carry the herpes simplex virus. This fluid can cause the infection. The infection can also cause skin surface because in viral shedding the infection spread to your sex partner.

It is known that HSV-1 is responsible for genital herpes only, whereas HSV-2 can be passed by vaginal and anal sex. HSV-2 cannot survive on non-living things so one cannot get it from a toilet seat and hot tub.

What are signs and symptoms of herpetic whitlow?

The first warning signs of herpes are tingles, burning sensations, aches, and stabbing pains. Symptoms of herpes infection do not result immediately after attack of virus. The virus remains in the incubation in the affected area – growing there but remain undetectable. It may remain undetectable for about two to twenty days.

Initial symptoms of herpetic whitlow may include:

  • a tingling feeling in the affected area
  • pain and swelling of a finger
  • fever and discomfort (in some cases)

These symptoms are usually followed by:

  • sudden pain around the nail
  • redness (erythema), swelling and warmth around the nail
  • the development of small, barely visible blisters around the nail
  • swelling of the lymph glands in nearby areas such as the elbow and armpit (in some cases)

Over the next 7-10 days, the typical symptoms are:

  • swelling, heat, and a burning sensation in the affected digit
  • The development of visible, blister-like grouped sacs of opaque fluid called vesicles around the nail and on the tip of the finger

Herpetic whitlow diagnosis

Following 4 periods are typical for herpetic whitlow diagnosis:

Incubation period: Herpetic whitlow is an infection in which virus needs to inoculate on the host for some time and after inoculation, the virus starts showing symptoms. Just like, in all mucocutaneous infections, the initiation of herpetic whitlow is caused by viral inoculation of the host through exposure to infected body fluids. The exposure may be caused by a break in the skin, open lesions or via torn cuticle.

Symptomatic period: An incubation period of 2-20 days is common after initial exposure. An early symptom of fever and malaise can be seen. The most often-initial symptoms are pain and burning or tingling of the infected finger. Other symptoms include erythema, edema, and the development of 1- to 3-mm grouped vesicles on an erythematous base, which is followed by next 7-10 days of initial symptoms. These vesicles may ulcerate or rupture and usually contain a clear fluid, although the fluid may appear cloudy or bloody.

Healing period: After a period of 10-14 days, symptoms of infection begin to improve and lesions crust over and heal. After improvement in lesions, viral shedding is believed. After 5 to 7 days complete resolution occurs.

Recurrent period: Herpetic Whitlow is mainly characterized by primary infection, which is followed by a latent period with subsequent recurrences. The symptoms usually occur in primary infection. In 20-50% of cases, milder and short duration recurrences have been observed.

Difference between herpetic whitlow, paronychia, and cellulitis 

Following clinical features can be used for herpetic whitlow, paronychia, and cellulitis differentiation:

  • Herpetic whitlow is an infection of thumb or finger mainly index finger. Paronychia is an infection of nail or nail bed. Cellulitis is the infection of deeper layer of the skin.
  • Herpetic whitlow is caused by a virus named Herpes simplex. Paronychia and cellulitis are caused by bacteria.
  • Herpetic whitlow infection is localized on finger. Paronychia infection is localized nail or nail bed. Cellulitis infection can spread through the body very quickly.
  • One can observe clear to yellow lesions with an erythematous base on the fingers or hands in the case of herpetic whitlow. One can observe opaque, purulent fluid along the nail bed, and often surrounded by erythema in the case of paronychia. Cellulitis causes an area of skin (mainly affect lower leg) to suddenly become red ,hot ,swollen ,painful, and tender.
  • Direct transmission from saliva to the hand causes whitlow, patients usually shed virus those are present with whitlow in the case of herpetic whitlow. The bacteria that cause paronychia and cellulitis often live harmlessly on the skin, but they can lead to an infection if they get into a break in your skin.
  • Herpetic whitlow is treated with antiviral drugs. Along with the antibiotics, the incision and drainage is necessary due to increased pressure of the paronychia. Main treatment of cellulitis is antibiotics.

Difference between herpetic whitlow, paronychia, and cellulitis

How long herpetic whitlow lasts?

Herpes whitlow is the infection where the area near the nail of the thumb or the finger gets infected. When you first see the symptoms of herpetic whitlow that is called as primary infection. The symptoms of the herpes infection last between 7 to 10 days. After 10 days, the blisters of the infections begin to heal and it begins to crust and heal symptoms starts to improve.

Herpes encephalitis caused by herpetic whitlow

Whitlow is very important to treat properly because if left untreated it can cause super infection such as herpetic encephalitis (herpes infection in brain).

Herpes encephalitis is a severe brain disease and if left untreated, it can prove fatal over 70%. It can cause respiratory arrest within first 24-72 hours. Acyclovir, a potent antiviral agent beneficial in improving survival rates, along with rapid diagnostic tests, acyclovir also reduced complication rates. Acyclovir is proved so beneficial that the favorable outcome occurred in patients, who are treated with acyclovir within 2 days of getting the infection.

Herpes can also spread in a newborn if a mother is infected with herpes, at the time of delivery and neonatal herpes can cause a range of painful symptoms in the neonate. It can spread to the brain and central nervous system causing encephalitis and meningitis. It can cause mental retardation, cerebral palsy, and death.

How do you treat herpetic whitlow?

Herpes infection is a condition that lasts for seven to ten days but in severe conditions it should be treated with several medications:

Antiviral medications:

  • Acyclovir is best known antiviral drug for the treatment of herpes infection.
  • A dose of 200 mg should be administered for five times a day and 400 mg for three times a day for 5 to 7 days.
  • The treatment should be started within 48 hours of symptoms, as after this period, antiviral will not show any effect.
  • Antiviral drugs are beneficial only for healing herpes, it is neither a cure for herpes nor it is beneficial in preventing future recurrence of herpes infection.
  • A whitlow can be resolves itself in a time period of 2 to 3 weeks.

What are some antiviral agents for herpetic whitlow?

Herpetic whitlow is self-treated disease, and the treatment for this disease provides symptomatic relief. An antiviral drug in the treatment of herpes infection is unlikely to have any effect. These agents may provide a symptomatic relief but one cannot achieve proper cure with these medications. Antiviral drugs do not prevent future outbreaks of herpes simplex infection.

Herpetic whitlow is different from bacterial Whitlow and other infectious diseases because both require different treatment. Antiviral medication effectively used for reducing the duration of symptoms in primary herpes infection and beneficial in preventing recurrent episodes. However, there are no controlled studies showing the optimal doses of antiviral agents for treating herpetic whitlow.

Acyclovir for herpetic whitlow

Herpetic whitlow  is  a cutaneous  manifestation  of  a herpes  simplex  infection and its treatment  with acyclovir  therapy is a widely used chemotherapeutic  alternative.  Acyclovir  is  an  interesting  antiviral  agent that is metabolized by virus-infected cells and very little of the drug is metabolized by normal human cells. Acyclovir can be considered as a effective therapy but not a proper cure for herpes simplex infection.

  • Mechanism of acyclovir involves its interference with only active viral DNA synthesis due to which it would not have any effect on the latent virus.
  • It is a poor prophylactic agent because it is not able to prevent latent infection from becoming an active infection.
  • Acyclovir in injectable form is most effective in treating herpes simplex and has more profound antiviral effect when given by intravenous route.
  • Acyclovir as a topical ointment has minimal antiviral effect; moreover, this ointment can decrease the amount of virus, which keeps, on shedding in herpes simplex.
  • Whereas topical form known to shortens the duration of symptoms in primary infections; it acts on the virus by interfering with DNA replication and prevents the occurrence of further symptoms.
  • The oral form of acyclovir is beneficial in treating recurrences of genital herpes simplex viral infection.
  • If started initially, immediately after onset of symptoms, oral acyclovir inhibits HSV-1 and HSV-2 thereby prevents recurrences of herpes infection and inhibits

acyclovir cream for herpetic whitlow

Famciclovir for herpetic whitlow

  • Famciclovir is another antiviral agent that has a role in the prevention of HSV infection.
  • It acts by transforming into panciclovir and inhibits viral polymerase thereby inhibits viral DNA replication (involved in DNA synthesis).
  • Famcyclovir is effectively used against herpes simplex and varicella-zoaster virus. However, the dose adjustment is needed in patients with renal insufficiency or hepatic disease.
  • It is considered superior over valacyclovir (a prodrug of acyclovir) because of superior bioavailability (77% for famciclovir vs 54% valacyclovir).
  • Possesses longer intracellular half-life, superior efficacy in localized infection, potential for reducing the viral latency in the primary infection.

Valacyclovir for herpetic whitlow

  • Valacyclovir is an oral prodrug formulation of acyclovir that provides up to 5 times greater acyclovir bioavailability.
  • Valacyclovir effectively suppresses recurrent herpes labialis outbreaks when administered more conveniently as 500 mg once a day over 4 months.
  • An effective therapy for ocular HSV infections due to improved bioavailability of acyclovir when administered orally.
  • Once daily dose is beneficial in suppressive management of recurrent genital herpes.
  • It is as effective as acyclovir in primary and recurrent infections with an advantage of convenient dosage regimen.

Does herpetic whitlow need any surgery treatments?

Herpes simplex virus causes cutaneous lesions, which are acquired by skin, contact; humans are the only host of this virus. Few characteristics of herpes lesions are painful swelling, erythema, vesicles and ulcerations that are responsible for severe pain. Paronychium, eponychium and subungual matrix are the main areas of cutaneous infection.

Immobilization and elevation of affected digit, unroofing of blebs and use of topical antibiotics known to provide little relief.  In surgical treatment, pain can be relieved immediately by removing the portion over affected nail bed by means of decompression of nail bed. Simple perforation of the nail over the involved matrix also provided the reduction in pain, which is when followed by nail removal, alleviated all severe pain.

Natural remedies for herpetic whitlow

Ice packs are superior than any remedy for reducing herpes pain to maximal extent.


  1. A soaked cotton ball with some baking soda on it, is beneficial in providing relief in herpes infected area. One should use fresh cotton balls every time treating with this method.
  2. A solution of lukewarm water and oatmeal/cornstarch should be made and cotton ball should be soaked in this solution. An application of this solution is useful in relieve itching of sores.

Application of extracts:

  1. Carrot extract is a great remedy that provides relief in swelling and pain associated with herpes lesions. In this, one should wrap grated carrots in a cloth and place them on affected area.
  2. Grape extract, honey, olive oil, olive leaf extract, marshmallow roots, and tea tree oil is beneficial in facilitating the process of healing of lesions and sores.
  3. Another best home remedy is application of tea bags. Tea bags possess powerful anti-inflammatory and antiviral properties that are beneficial in relieving herpes sores.
  4. A poultice made up of a cup of hot olive oil and some lavender oil + bees wax is a great remedy to get rid of outbreaks of herpes at home. Application of this poultice after cooling provides great relief to patient suffering from herpes.

Essential Oils:

  1. A mixture of eucalyptus oil and bergamot oil is beneficial in treating herpes sores.
  2. Herpes can be cured by using herbal teas like peppermint tea, chamomile tea, black tea. Symptoms such fever and pain can be reduced to a great extent with these herbal teas.

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