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Herpetic Whitlow - Causes, Symptoms, and Treatment

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Herpetic whitlow occurs when an open cut or sore finger comes in contact with the herpes simplex virus.

Written by

Dr. Geethika. B

Medically reviewed by

Dr. Shubadeep Debabrata Sinha

Published At August 17, 2022
Reviewed AtJune 5, 2024

What Is Herpetic Whitlow?

Herpetic whitlow is a condition caused by the herpes simplex virus (HSV), resulting in small, painful blisters on the fingers and fingertips. Adamson first described it in 1909 and 1959, and it was noted to be an occupational risk among healthcare workers. It often develops in childhood after direct physical contact with a contagious sore. The infection often occurs as a sequel to local trauma to the nail cuticle. The exposure to the herpes virus is through self (pre-existing infection in other parts of the body) or contact with infected individuals. The most common sites for herpetic whitlow include the thumb, index finger, other fingers, and toes. It usually occurs in a single finger but rarely in multiple digits.

What Is Herpes Simplex Virus?

Herpes simplex virus 1 (HSV-1) causes approximately 60 percent of cases of herpetic whitlow, whereas herpes simplex virus 2 (HSV-2) causes the remaining 40 percent of cases. The virus is highly contagious, and the two variants affect different areas, namely:

  • Herpes Simplex Virus Type 1: Areas around the mouth, lips, and face.

  • Herpes Simplex Virus Type 2: Genitals.

In rare cases, the virus spreads to the fingertips through an open wound and causes pain, swelling, erythema, and blisters known as herpetic whitlow.

The symptoms of an infection after exposure to the HSV virus may include:

  • Lesions (vesicles, blisters, sores) on the tongue, mouth, chin, cheeks, or nostrils.

  • Swelling of the lips.

  • Pain and difficulty swallowing.

  • A sore throat.

  • Swollen lymph nodes.

  • A high body temperature.

  • Headaches.

  • Dehydration.

  • Nausea.

What Are the Stages of Herpetic Whitlow?

The stages of herpetic whitlow are as follows:

  • Initial Stage: The initial stage lasts one to three days. Symptoms include redness, swelling, tenderness on the affected finger or thumb, and the appearance of small and painful blisters or vesicles.

  • Vesicular Stage: It lasts four to seven days. Symptoms include rupturing blisters and forming shallow ulcers. These ulcers are painful and have a greyish or yellow base.

  • Ulcerative Stage: It takes seven to 14 days. During this stage, the ulcers enlarge and become more painful.

  • Healing Stage: This stage lasts 14 to 28 days. During this stage, the ulcers begin to heal, and the skin may be sensitive with residual redness.

  • Resolution Stage: This stage starts after 28 days. The skin returns to normal, and no scars will form.

What Are the Symptoms of Herpetic Whitlow?

The symptoms often appear one to two weeks after exposure to the virus. The first noticeable symptoms are pain and the tingling sensation of the infected finger. The symptoms are followed by the most common sign— a blister (an area of skin covered by a raised, fluid-filled bubble) or a cluster of blisters accompanied by redness and swelling of the finger. It usually involves only a single finger. In patients with reduced immunity, ulcerations and necrosis can be seen. Fever and swelling of the lymph nodes may be present.

Who Is at Risk for Developing Herpetic Whitlow?

Individuals across all age groups and genders are equally prone to developing the infection. However, it is most common among children with thumb-sucking habits and healthcare workers (general physicians, dentists, dental hygienists, respiratory therapists) who come in contact with an infected patient's blisters or sores without adequate protection. Patients with a compromised immune system (e.g., patients undergoing chemotherapy, diabetes mellitus, acute immunodeficiency syndrome (AIDS), etc.) are also more prone to the disease. Herpetic whitlow has also been noted to spread quickly among athletes who wrestle, adolescents, and young adults following herpes exposure.

How Is Herpetic Whitlow Treated?

The treatment strategies are described below:

  • In patients with regular immune system functioning, the infection is self-limited, and the symptoms resolve within two to four weeks.

  • The treatment primarily aims to relieve symptoms and avoid secondary infections.

  • If antiviral drugs are administered within 48 hours of the onset of symptoms, they tend to shorten the duration of the symptoms.

  • In cases of secondary infections or pus formation, it is advised to consult a physician who might administer antibiotics.

What Are the Practices to Be Followed at Home if Affected With Herpetic Whitlow?

Things people do, if they have herpetic whitlow, are as follows:

  • Keep the infected area clean and cover the blister with a sterile dressing. Wearing gloves while cleaning the infected area and covering the infected vesicle will prevent the spread of the virus to other parts of the body and other individuals.

  • Applying a cold compress to reduce the swelling may aid in reducing it.

  • Take a painkiller like Acetaminophen or Ibuprofen, If the pain is intolerable and the fever persists.

  • In case of the absence of a sterile dressing, avoid touching other parts of the body with the infected finger. Avoid wearing contact lenses, which may spread the infection to the eye, causing herpetic keratoconjunctivitis (corneal infection caused by HSV).

  • Do not try to drain the blisters; this will spread the infection further and possibly cause a secondary bacterial infection with pus formation.

When to Seek Medical Care if Affected With Herpetic Whitlow?

It is advisable to visit a general physician when there is pus or if the body temperature is extremely high for an extended period. If diagnosed, inform the other healthcare providers about an active infection with herpes so that they can use the appropriate protective measures; this will also protect the healthcare providers and the other patients.

What Is the Prognosis of Herpetic Whitlow?

Herpetic whitlow usually shows spontaneous regression in two to four weeks. The pain reduces after this acute stage, and the blisters dry and crust. The pain regresses within two weeks, whereas the skin shows initial discoloration but heals eventually.

Does the HSV Virus Show Recurrence?

Once the initial outbreak regresses, the virus stays dormant in the body for years.

The following factors can trigger the recurrence of the herpes infection:

  • A fever.

  • Physical, emotional, or mental trauma.

  • Immunocompromised conditions.

  • A recurring illness.

  • Excessive stress.

  • Hormonal imbalances.

  • Increased exposure to the sun.

  • Surgery.

Recurrence of herpetic whitlow has been noted in 30 to 50 percent of the cases (due to latent sensory ganglion infection). Recurrent herpetic whitlow is treated by suppressive therapy with an antiviral agent. Since the body develops antibodies when infected for the first time, the recurrent outbreaks are usually less severe and heal faster.

What Other Conditions May Resemble Herpetic Whitlow?

The complications arise as herpetic whitlow is often misdiagnosed as a paronychia (a localized bacterial abscess in the nail fold) or bacterial felon (digital pulp abscess). The treatment for these conditions may result in procedures that increase the risk of secondary bacterial infection, systemic infection, and possibly developing herpes encephalitis (about the brain).

Other potential complications are:

  • Scarring.

  • Numbness.

  • Hypersensitivity.

  • Ocular spread.

Conclusion:

Overall, herpetic whitlow can be managed and treated if it is diagnosed early. It is best if the patient knows the do’s and don'ts. It is a manageable condition with proper treatment and preventive measures. Prompt medical attention is necessary if symptoms worsen or do not improve with home treatment. Discussing the symptoms with a healthcare professional and understanding the treatment options is also advisable.

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Dr. Shubadeep Debabrata Sinha
Dr. Shubadeep Debabrata Sinha

Infectious Diseases

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herpetic whitlowherpes simplex virus
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