Herpetic whitlow
Herpetic whitlow is a herpes infection on a finger. It looks so much like an ordinary bacterial whitlow that it is regularly incised surgically — and that is…
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Medicines commonly prescribed for Herpetic whitlow
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 200mgActive substance: aciclovirManufacturer: Laboratorio Stada S.L.Prescription requiredDosage form: TABLET, 800 mgActive substance: aciclovirManufacturer: Mabo Farma S.A.Prescription required
Herpetic whitlow is a herpes infection on a finger. It looks so much like an ordinary bacterial whitlow that it is regularly incised surgically — and that is exactly what should not happen: an incision does not help and can spread the infection and invite a bacterial complication. The whole point here is recognising it correctly.
Symptoms
- at first burning, tingling and pain in the finger, sometimes a day or two before anything is visible;
- then small grouped blisters with clear fluid appear on a reddened base;
- the blisters sit in a cluster and often merge into one larger blister with a scalloped edge;
- marked pain, often throbbing and disturbing sleep;
- the finger swells and reddens, usually near the nail and at the tip;
- lymph nodes in the hand and near the elbow may enlarge, and there may be a fever;
- the blisters dry into crusts and heal in 2–3 weeks without scarring.
How to tell it from a bacterial whitlow
This is the key question, and the difference lies in a few details:
- herpetic: several small grouped blisters with clear contents; the fluid is not thick; tissue tension is moderate; there was often tingling before the rash; there have frequently been similar episodes on the same finger before;
- bacterial: a single focus with thick pus; the finger is tense and feels as if it will burst, with shiny skin; the pain builds steadily; there are no grouped blisters.
Getting it wrong is costly in both directions: a bacterial whitlow needs surgical drainage, while a herpetic one only worsens with an incision.
Who gets it
- children with herpetic gingivostomatitis — they transfer the virus to a finger by sucking it or biting their nails. This is the commonest route;
- healthcare workers — dentists, nurses, anaesthetists; hence the old name "nurse's finger". The risk is removed by wearing gloves;
- people with cold sores — the virus is carried to the finger by hand, particularly through a break in the skin or a bitten cuticle;
- people with atopic dermatitis and damaged skin on the hands;
- people with reduced immunity, in whom it runs a more severe course.
When to see a doctor
- grouped blisters and severe pain have appeared on a finger;
- you are not sure whether this is herpes or a purulent infection — a reason to have it looked at rather than wait;
- the finger is very swollen, the pain is increasing and thick pus has appeared;
- there is fever or red streaks on the hand or forearm;
- the rash is spreading beyond the finger;
- the area around an eye is affected or there is eye pain — this is an emergency;
- episodes keep recurring;
- your immunity is reduced;
- it is a child with lesions in the mouth.
How it is diagnosed
Usually by appearance and by the account of tingling beforehand. Where needed, a swab or fluid from a blister is sent for PCR, which reliably confirms the virus. If bacterial infection is in doubt, a culture is taken.
Treatment
- oral antivirals — aciclovir or valaciclovir; the effect is greatest if started within the first 48 hours;
- pain relief — paracetamol, non-steroidal anti-inflammatories;
- a clean dry dressing — which also protects other people from the infectious blister fluid;
- do not open or incise it — this is the main rule;
- antibiotics only if a bacterial infection is added;
- preventive antiviral treatment for frequent recurrences, prescribed by a doctor.
What you can do
- cover the finger with a dressing and change it when it becomes damp;
- wash your hands thoroughly; do not touch your eyes or wear contact lenses while lesions are present;
- do not bite the nail or pick off the crusts;
- do not kiss children or prepare food without a dressing during the acute phase;
- use your own towel;
- for a child: keep nails short and distract them from sucking the finger;
- healthcare workers: do not see patients without gloves and discuss the situation with your manager.
Common questions
Is it contagious? Yes, while there are blisters and moist erosions. Once crusts form the risk drops sharply.
Will it come back? It can: the virus remains in the nerve ganglion. Recurrences are usually milder than the first episode and occur at the same site.
Can I pierce the blister? No. It does not speed healing and increases the risk of spread.
Will a cream help? Topical antivirals on a finger are of limited use; tablets work far better.
Online consultation
In an online consultation the doctor uses photographs to help distinguish a herpetic whitlow from a bacterial one — sparing you an unnecessary incision — prescribes antiviral treatment while it still has maximum effect, and explains how to avoid passing the infection to those around you.
This material is for information only and does not replace a medical consultation.
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Reviewed on Jul 30, 2026
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