Most people think of herpes as something that shows up on the mouth or genitals. But it can also appear on the fingers and hands, a condition called herpetic whitlow. It’s less common, but it’s the same virus. Here’s what you need to know.
What is herpetic whitlow?
Herpetic whitlow is a herpes simplex virus (HSV) infection of the fingers, thumbs, or occasionally the toes. It’s caused by the same virus that causes cold sores (typically HSV-1) and genital herpes (typically HSV-2). About 60% of herpetic whitlow cases are caused by HSV-1, and 40% by HSV-2.
It’s the same virus, just in a different location. And like herpes anywhere else on the body, it’s manageable, treatable, and (while uncomfortable) not dangerous for most people.
How do you get herpetic whitlow?
The virus enters the finger through a break in the skin, a tiny cut, a torn cuticle, a hangnail, cracked skin, or even a small abrasion you don’t notice. The most common routes of infection are:
- Autoinoculation (self-transfer): This is the most common cause in the general population. If you touch an active herpes sore on your mouth or genitals and then touch a break in the skin on your finger, you can transfer the virus to your hand. In children, herpetic whitlow often develops from thumb-sucking during an oral herpes (cold sore) outbreak.
- Occupational exposure: Before universal glove use, herpetic whitlow was common among dentists, dental hygienists, respiratory therapists, and other healthcare workers who came into contact with oral or respiratory secretions from patients with active herpes infections. It still occurs occasionally, usually when gloves are torn or not worn.
- Direct contact: Less commonly, the virus can be transmitted from another person’s active herpes lesion directly to your finger through skin-to-skin contact, such as during intimate contact.
An important note about autoinoculation: The risk of transferring herpes to a new body site is highest during a primary (first) herpes infection, before your body has built up antibodies. Once your immune system has developed antibodies (typically within a few weeks to months of your initial infection), the risk of autoinoculation drops significantly. So if you’ve had herpes for a while, accidentally touching an outbreak and then your finger is very unlikely to cause herpetic whitlow.
What does herpetic whitlow look and feel like?
Herpetic whitlow follows a similar pattern to herpes outbreaks elsewhere on the body:
Prodrome (early warning signs):
- Pain, tingling, or burning sensation in the affected finger, often before any visible signs appear
- This prodromal phase typically lasts a few hours to 1-2 days
Active outbreak:
- Small, fluid-filled blisters (vesicles) appear, usually on the fingertip, the pad of the finger, or along the sides near the nail
- The blisters may merge together into a larger cluster
- The area becomes red, swollen, and tender
- The pain can be quite intense, many people describe it as throbbing
- You may notice swollen lymph nodes in your arm or armpit
- Some people develop a low-grade fever during the first episode
Healing:
- The blisters gradually crust over and heal within 2-4 weeks
- First episodes tend to last longer and be more painful than recurrences
How is it different from other finger conditions?
Herpetic whitlow can be mistaken for other conditions, which is why getting a proper diagnosis matters:
- Bacterial paronychia (infected nail fold): Both cause redness and swelling near the nail, but bacterial infections produce thick, creamy pus and respond to antibiotics. Herpetic whitlow blisters contain clear fluid and don’t respond to antibiotics.
- Felon (deep fingertip abscess): A felon causes intense throbbing pain and swelling in the fingertip pad, similar to whitlow. However, felons are bacterial and typically need drainage, which should never be done with herpetic whitlow (it can spread the virus and delay healing).
- Contact dermatitis: Allergic skin reactions can cause blistering on the fingers, but the blisters are usually itchy rather than painful and don’t follow the typical herpes pattern of clusters.
- Dyshidrotic eczema: Causes small, itchy blisters on the fingers and palms. Usually affects multiple fingers at once and is itchy rather than painful.
Getting the right diagnosis matters because treatment is different for each condition. If you suspect herpetic whitlow, your doctor can confirm it with a viral swab test (PCR) of the blister fluid.
Treatment
Herpetic whitlow is treated with the same antiviral medications used for herpes elsewhere on the body:
- Acyclovir, valacyclovir (Valtrex), or famciclovir, started as early as possible, ideally within 48 hours of symptom onset
- Starting antiviral treatment early can shorten the outbreak by up to 4 days and reduce viral shedding
- Even without treatment, herpetic whitlow is self-limiting and resolves in 2-4 weeks
What NOT to do:
- Do not lance, drain, or pop the blisters. This can introduce bacteria (causing a secondary infection), spread the virus to surrounding skin, and delay healing.
- Do not use antibiotics unless a secondary bacterial infection is confirmed. Antibiotics don’t work against viruses.
For comfort during an outbreak:
- Keep the area clean and dry
- Cover the affected finger with a light, breathable bandage to prevent spreading the virus
- Over-the-counter pain relief (ibuprofen, acetaminophen) for pain management
- A cool compress can help with swelling
Can it come back?
Yes. Like herpes in any location, herpetic whitlow can recur. After the initial infection, the virus retreats into the nerve ganglia in the arm and can reactivate later. Recurrences happen in an estimated 20-50% of cases.
The good news: recurrent episodes are typically milder, shorter, and less painful than the first outbreak. If recurrences are frequent or disruptive, daily suppressive antiviral therapy can reduce their frequency, the same approach used for frequent genital or oral herpes outbreaks.
Prevention
The best ways to prevent herpetic whitlow:
- Avoid touching active herpes sores (on yourself or others) with bare hands, especially if you have cuts, hangnails, or broken skin on your fingers.
- Wash your hands thoroughly after touching any area of your body during an outbreak.
- Healthcare workers: Always wear gloves when examining patients’ mouths or genitals. Double-gloving provides extra protection.
- If your child has cold sores, discourage thumb-sucking and finger-sucking during active outbreaks.
- Keep the skin on your hands healthy. Moisturize to prevent cracking, treat hangnails promptly, and avoid biting your nails, intact skin is your best defense.
The connection to oral and genital herpes
Herpetic whitlow is the same virus as oral and genital herpes, just in a different spot. Having herpes on your finger doesn’t mean you have a different "kind" of herpes. It’s HSV-1 or HSV-2, the same two types that cause cold sores and genital herpes.
If you already have oral or genital herpes and develop herpetic whitlow, it’s almost certainly from autoinoculation (transferring the virus from one part of your body to another). This is most likely during a primary infection. Once you’ve had herpes for a while and your immune system has developed robust antibodies, spreading it to new areas of your own body becomes very uncommon.
The bottom line
Herpetic whitlow is uncommon but manageable. It’s caused by the same virus that causes cold sores and genital herpes, it responds to the same antiviral medications, and it follows the same general pattern: an initial outbreak that heals, the possibility of recurrences that tend to be milder, and effective treatment options to manage it.
If you think you might have herpetic whitlow, see your doctor for a proper diagnosis. The most important thing is getting the right diagnosis so you get the right treatment, and knowing not to drain the blisters. ;) It's the same herpes you already know about, just in a less typical spot. Nothing to panic about. You've got this.
