Herpetic whitlow
Symptoms, Treatment and Prevention

A herpetic whitlow is an infection on a finger or thumb and occasionally on a toe. It is usually caused by the herpes simplex virus 1 (HSV-1) and sometimes herpes simplex 2 (HSV-2).

This is probably the most painful herpes infection any unfortunate victim could be forced to endure. However, apart from unsupervised newly infected infants and children, the disease is fully preventable.


How is this Infection Transmitted?

1 - Autoinoculation:

Herpetic Whitlow

A Herpes whitlow is often caused by a process known as “autoinoculation”.

For example, this process can be observed in thumb-sucking children with a primary herpes lesion such as their first cold sore (herpes labialis).

Whether it's a child, teenager or adult, apart from sucking their thumb, the natural reaction to these new blisters is to gently touch and probe. The instant he or she does that, the HSV-1 virus jumps the gap and burrows itself under the cuticle. Once it has a foothold, it invades a suitable cell and turns it into a virus factory.

Here's another example: A person with primary genital herpes may touch an open lesion on their own pelvic area and thereby contract a herpetic whitlow via autoinoculation.

During this process, the "factory" spawns millions of new viruses, these then migrate to the surface of the thumb or finger, and develop into a purilent (puss filled) whitlow.

A day or so later, the victim is in agony.

Why “primary” herpes lesion?

As a result of the initial or “primary” infection, the body produces antibodies to the particular type of HSV involved, whether it's herpes simplex virus type 1 (HSV-1), or herpes simplex virus type 2 (HSV-2).

This process takes between 2 to 12 weeks, and it's known as "seroconversion".

After seroconversion does its job, the resultant antibodies developed by the immune system prevent a person transferring an additional form of their particular herpes virus to another part of their own body.

In other words, after seroconversion, autoinoculation is impossible. Therefore children or adults with a cold sore cannot develop a whitlow by sucking their thumb or probing a lesion on their own body.


Personal Contact

You could develop a herpetic whitlow by touching an active lesion or rash on another infected person’s body with your finger or thumb.


Who is at Risk?

Anyone coming into tactile contact with someone infected with the herpes virus, such as:

  • People engaging in sexual activity with a partner infected with genital herpes
  • Dentists
  • Doctors
  • Nurses
  • Paramedics
  • Beauty therapists
  • Masseurs
  • Anyone in the habit of biting their fingernails or sucking their thumb
  • Autoinoculation prior to seroconversion, as described above


What Are The Symptoms?

Symptoms can occur anywhere from 2 to 20 days following tactile exposure to the virus. Most commonly infected areas are the thumb and index finger. However, a whitlow can also occur on a toe. For example, a person with a foot fetish may touch an infected partner's genital area with his foot or big toe.

Prodromal (pre outbreak) symptoms such as a dull pain, tingling, itching, or numbness in the infected digit may occur a few hours to a couple of days before blisters form.

If a person contracts herpes for the first time, initial or “prime” symptoms can be rather severe; these may include fever, malaise and/or swollen lymph nodes.

Symptoms of herpetic whitlow include:

  • Swelling
  • Reddening
  • Tenderness

Followed by:

  • A rash
  • Formation of small grouped vesicles (water filled blisters)
  • Extreme ongoing pain
  • Eruption of vesicles followed by scabbing over
  • And then healing after 2 to 3 weeks

Note: Do not pick the scabs or try to loosen them; they will flake off naturally without leaving a scar when the lesion is fully healed.


Precautions and Treatment of Herpetic Whitlow

  • Do not agree to having the lesion lanced or surgically debrided. Doing so may cause a superinfection or encephalitis.
  • Never intentionally pop a whitlow blister. Doing so will intensify the infection, increase the chances of developing a superinfection, and add to the risk of transmitting the virus to someone else.
  • Painkillers help to a certain extent.
  • Ice packs reduce the swelling and pain during the initial stages.
  • If you detect prodromal symptoms, immediate prescribed oral antiviral treatment may abort painful eruptions if caught early enough; nevertheless the medication usually accelerates the healing process.
  • Apply a liberal coating of over the counter acyclovir based topical medication to the finger as soon as the blister bursts; the infection should start clearing up within 48 hours. To keep the salve in place, cover the lesion with a cotton finger boot for a full day, then remove the boot to air the lesion and to allow a protective scab to form. 

Note: If you're using an ice pack, wear a waterproof finger boot instead of cotton.

Home Remedies?

Alas, so far we haven't come across anything that works, other than paracetamol or low-dose codeine to ease the pain. See your doctor if you need something with more punch...



  • Always follow OSHA health care standards and if you're a health care worker, wear latex gloves during contact with HSV positive patients.
  • Avoid sharing towels, mugs, glassware, eating utensils or toothbrushes if you or another member of your family is infected. As an added precaution, soak all toothbrushes in hydrogen peroxide when not in use.
  • If you're a beauty therapists or masseur, avoid treating people infected with herpes. Touching a lesion or cold sore with your finger puts you at risk of developing a herpetic whitlow. 


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