Medicines for Herpetic whitlow

What it is

A herpetic whitlow is an infection of a finger (or, occasionally, a thumb or toe) caused by the herpes simplex virus — the same virus that causes cold sores and genital herpes. It occurs when the virus infects the skin of a finger, usually entering through a small break in the skin. This can happen, for example, by touching a cold sore or other herpes lesion (transferring the virus to the finger), or through contact with the virus in other ways; it can also occur in people who have herpes elsewhere. It was historically an occupational infection in some healthcare and dental workers (from contact with the virus in patients’ mouths) before routine glove use. A herpetic whitlow causes a painful infection of the affected finger, and the symptoms typically include: pain, tingling, or itching in the finger (which may come before the visible signs); redness and swelling of the finger; and the development of small, fluid-filled blisters (vesicles), often grouped together, which can be quite painful and may weep or crust; there may also be swelling, and sometimes swollen glands nearby or a mild feverish feeling, particularly with a first infection. The condition can be quite painful, but it is usually not serious, and, like other herpes simplex infections, it typically heals on its own over a couple of weeks (often around two to three weeks) as the blisters dry up and the skin heals. Because it is caused by the herpes simplex virus, which stays in the body after the first infection, a herpetic whitlow can occasionally recur in the same area (usually more mildly), like cold sores. Herpetic whitlow is contagious (the fluid in the blisters contains the virus), so care is needed to avoid spreading the virus to other parts of one’s own body (particularly the eyes) or to other people. Treatment is often not needed, as it heals by itself, but antiviral medicine can help, particularly if started early or for severe or recurrent cases, and simple measures relieve the symptoms. It is important not to burst the blisters, and to keep the area covered. The key messages are that a herpetic whitlow is a painful herpes virus infection of a finger causing blisters and swelling, that it usually heals on its own over a couple of weeks, and that antiviral treatment and simple measures can help, along with care to avoid spreading the virus.

How it is treated

A herpetic whitlow usually heals on its own over a couple of weeks, with antiviral treatment and simple measures to help and care to avoid spreading the virus; it is important not to confuse it with a bacterial infection (which would be treated differently). Diagnosis is usually based on the appearance (a painful finger with grouped blisters) and the history, sometimes with a swab to confirm the herpes simplex virus if needed; it is important to distinguish a herpetic whitlow from a bacterial finger infection (such as a paronychia or a pus-filled infection), because a herpetic whitlow should generally not be cut open or drained (as would be done for a bacterial abscess), since this does not help and can worsen it or spread the infection — so correct diagnosis matters. For the typical case, care includes: simple measures to relieve the pain (such as pain relief, and keeping the finger comfortable); keeping the affected area clean and covered with a dressing, which protects it, reduces the risk of spreading the virus, and helps prevent bacterial infection of the broken skin; and, importantly, not bursting or picking the blisters (as the fluid contains the virus and this can spread it and worsen the infection). The infection usually heals over a couple of weeks. Antiviral medicine (the same type used for cold sores and other herpes simplex infections) can help, particularly if started early in the infection, or for severe, extensive, or recurrent cases, and may be prescribed by a doctor. Because a herpetic whitlow is contagious, care to avoid spreading the virus is important: keeping the lesion covered, good hand hygiene, avoiding touching the lesion and then other parts of the body (particularly the eyes, as herpes can cause a serious eye infection) or other people, and not sharing items that contact the lesion. If a bacterial infection develops on top (increasing pain, spreading redness, pus, or feeling unwell), or if the infection is severe, not healing, or there are concerns, medical advice is needed; and people with a weakened immune system, or if the eye may be affected, should seek advice. The reassuring messages are that a herpetic whitlow is usually not serious and heals on its own over a couple of weeks, that antiviral medicine and simple measures help, that it should not be cut or drained like a bacterial abscess (so correct diagnosis matters), and that keeping it covered and good hygiene prevent spread; so simple care, avoiding bursting the blisters, and, where helpful, antiviral treatment are the keys to managing it.