What is Herpetic Whitlow and How Do You Treat It?

Herpetic Whitlow (or Whitlow Finger) is a viral infection where small blisters form on the fingers and the fleshy area around the fingertips. These sores or wounds are uncomfortable and painful, and they grow after direct contact with an infected source. The herpes simplex virus (HSV) causes this infection. There are two types of HSV. Type 1 usually affects the area around the mouth, lips, and face, while type 2 usually affects the genitals. Because herpes whitlow is caused by the same virus responsible for cold sores and genital herpes, it is extremely contagious. For that reason, it is essential that you recognize the symptoms of this condition and take steps to protect yourself.

Causes of Herpetic Whitlow

Herpes Simplex Virus 1 on a woman's lip

You can only develop this condition if your finger comes in contact with HSV type 1 or type 2. Some people who have Herpetic Whitlow have a history of cold sores or genital herpes, but this is not always the case. If you have been diagnosed with HSV, herpes whitlow can occur as a secondary infection. This happens after exposing an open wound or sore on a finger to contact with blisters, wounds or sores near the genitals or face areas. Therefore, the virus can get into your body through the cut in your finger. If you do not have a history of HSV, a herpetic whitlow can develop if it comes in contact with herpes sores or blisters on an infected person.

How It Spreads

1. Self-inoculation: This is when the infection develops in a skin wound, for example, by putting your fingers in your mouth in a case where you have HSV-1 herpes.

2. Contagiousness from another person: When someone has the simple herpes virus type 1, they can directly infect other people's fingers if they directly contact the infected person on their mouth or lips.

3. Contact with the genitals: Another cause of herpetic whitlow can be direct hand contact with genitals infected with herpes virus type 2.

4. Contact with secretions: Finally, it can occur from direct contact with oral secretions of a person who has an oropharyngeal infection (affecting the oral mucosa). It happens mainly in nurses, doctors and dentists.


1. Red, swollen tips with extreme pain are the main symptom of herpetic whitlow or whitlow finger.

2. White fluid-carrying blisters developed under the skin are a symptom of herpetic whitlow or white toe.

3. Herpetic whitlow occurs primarily on the thumb, index finger, and other fingers.

Within 2 to 20 days from the initial exposure to HSV, the infected area begins to tingle, burn, and hurt. After a week or two, it becomes redder and swollen in the form of fluid-filled blisters (1-3 mm) grouped on the bright red base. The blisters finally break up and layer over, and then comes to an end over the next two weeks.


Aciclovir creme 5%, for the treatment of herpes viruses such as Herpetic Whitlow
Aciclovir Cream

Herpetic whitlow requires no treatment. The condition usually heals in a few weeks without medication, but prescription antiviral medication can shorten the duration of an infection. Antivirals are only effective when taken within 24 hours of symptom development.

Antivirals also reduce the risk of spreading the infection to other people. If a blister breaks and becomes infected with bacteria, your doctor may prescribe an antibiotic. Herpetic whitlow is a self-limiting disease. But several authors have proposed the effectiveness of oral acyclovir treatment at 5 mg/kg/dose every 8 hours for 7-10 days. Aciclovir at 5% administered topically has also been shown to decrease the duration of symptoms and viral shedding. Antibiotics should be used only in case of bacterial superinfection. A surgical incision is contraindicated.

You can treat herpetic whitlow at home:

  • Take a pain reliever, such as acetaminophen or ibuprofen, to reduce pain and fever.
  • Apply a cold pack several times a day to reduce swelling.
  • Clean the infected area daily and cover it with gauze.


Herpes simplex infections are incredibly contagious, so it is essential to take steps to prevent the spread of the virus during the early phase, that is, when you feel the tingling, burning or itching, and when you have blisters or sores in the active phase of herpetic whitlow. You should follow these steps:

  • Do not share personal care items or towels
  • Keep the affected finger covered with a dressing
  • If you are a health care provider, you should wear gloves
  • Do not pop the blisters (this can make the condition worse)

The virus can still be spread even when there are no visible signs, although this is rare for Herpetic Whitlow patients.

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