Whitlow: Causes, Treatment, and Prevention Tips

Whitlow is a highly contagious infection caused by the herpes simplex virus (HSV). It is also known as “herpetic whitlow.” Both types of HSV — type 1 and type 2 — can cause herpetic whitlow. The infection causes painful blisters or sores on your fingers as well as swelling and skin discoloration. Antiviral medications and antibiotics are the most common treatments for whitlow.

Read on to learn more about what causes whitlow, what it looks like, how to treat it, and how to prevent it.

Acquiring one of the two types of HSV causes whitlow. Type 1 is known as HSV-1, and type 2 is known as HSV-2.

People often contract HSV during childhood. According to a 2018 report from the Centers for Disease Control and Prevention (CDC), HSV-1 is more common than HSV-2. However, the rates of both types in people ages 14–49 years have decreased since 1999.

HSV-1 usually transmits through contact with the saliva or mouth sores of a person who has the infection. HSV-2, on the other hand, primarily transmits through contact with genitalia during sex with someone who has the infection.

Transmission from a birthing parent to a child during delivery is rare, but it can occur.

Herpetic whitlow is a painful infection caused by the herpes virus.

The symptoms of whitlow primarily affect a single finger, but they can occur on more than one finger at a time.

Whitlow usually causes symptoms on your fingers, including:

• blisters or sores
• redness or other forms of skin discoloration
• swelling
• pain

Infection with HSV may cause symptoms in other parts of your body, including:

• blisters or sores around the mouth or genitals
• enlarged lymph nodes
• fever
• body aches

HSV can also be asymptomatic.

Rarely, whitlow leads to a serious infection that doctors need to evaluate in an emergency setting.

Without treatment, symptoms typically resolve in 2–4 weeks. If you start treatment promptly, your symptoms will likely resolve more quickly.

Doctors will first evaluate your symptoms and history to diagnose whitlow. If, after this, the cause is still unclear, the doctor may use one or more of the following tests to confirm the diagnosis:

• viral culture test
• polymerase chain reaction test
• serology test
• direct fluorescent antibody test
• Tzanck test

These tests involve collecting fluid from the lesions on your skin for analysis or drawing blood to look for antibodies to HSV.

Although no treatment will eliminate HSV from your body, your doctor may prescribe medications to improve the symptoms of the infection.

Antiviral medications are among the most effective treatments for HSV infections. These medications include:

• acyclovir (Zovirax)
• famciclovir (Famvir)
• valacyclovir (Valtrex)

To reduce pain and fever, you can use over-the-counter medications such as ibuprofen (Advil) and acetaminophen (Tylenol). Doctors may also prescribe antibiotics to treat any secondary infections.

There are things you can do at home to help keep the infection from spreading, including the following:

• Keep the affected finger clean and covered.
• Do not touch other people or yourself with the affected finger.
• Use glasses instead of contact lenses to avoid infecting your eye.

You should not try to drain the fluid from the infected finger. Doing so could cause the infection to spread.

You can help minimize your risk of serious complications by following your healthcare professional’s treatment plan.

Possible complications of whitlow include:

• numbness
• scarring
• bacterial infections
• severe and recurring infections
• herpes encephalitis

You may be able to lower your risk of whitlow or prevent the spread of HSV by:

• avoiding direct contact with open herpes lesions, including cold sores and genital lesions
• avoiding sharing objects that have been in contact with saliva, such as cutlery
• practicing safe sex by using a barrier method such as a condom
• not having sex while symptomatic

Several factors can increase the risk of developing whitlow, including:

• having a career in a healthcare profession that involves frequent exposure to people with infections, such as dentistry or nursing
• having HIV
• having a broken skin surface
• nail biting or thumb sucking
• engaging in any sexual activity that brings you into close contact with bodily fluids from a person with HSV

Talk with your doctor if you are experiencing a high fever or feel like the infection is getting worse.

The following are some additional questions that people often ask about whitlow.

Whitlow is commonly mistaken for paronychia, which is an infection in the nail folds of your fingers or toes. It can also be mistaken for a bacterial felon, which is an infection in the pad of your fingertip.

You should never drain a finger affected by whitlow due to the risk of spreading the infection or causing a bacterial superinfection.

It is best to follow the treatment plan developed by your care team, which will most likely include taking antiviral medications and keeping the affected finger clean and covered.

Whitlow is a highly contagious infection caused by HSV. When whitlow occurs, your fingers may become discolored and swollen with painful blisters.

To treat whitlow, your doctor may prescribe antiviral medications or antibiotics. It is also important to keep the affected finger covered and avoid touching anyone else with it to prevent the infection from spreading.

Talk with your doctor if your symptoms are worsening or causing you concern.