The term herpes is commonly associated with an infection of the genital area.
However, once the virus has invaded the body, the accompanying sores and discomfort can develop anywhere on the skin.
The painful lesions are difficult enough to deal with, but when they appear on the fingers or other areas where they can’t be hidden under clothing, it becomes an embarrassing, awkward ordeal.
It’s important to know the facts about all the variations of the herpes simplex virus, both to lessen the social stigma of the condition and to keep it from spreading.
What is Herpetic Whitlow?
A whitlow (also called a felon), in general, refers to an infection of the fingers.
When the infection is caused by the herpes virus, the resulting blister and painful lesion is called a herpetic whitlow.
The areas most often affected are the thick, fleshy pads at the tips of fingers and thumbs. The virus can also infect the toes, though this is not as common.
The term originated in 1959, when an outbreak of 54 cases swept through the nursing staff of a new hand clinic at St. George’s Hospital in London.(1)
Causes
There are two versions of the herpes virus: simplex I and simplex II.
Herpes simplex II attacks the skin around the genitals, while herpes simplex I causes “cold sores” around the mouth and nose.
Either version is capable of causing herpetic whitlow on the fingers.
When someone touches a herpes sore with bare hands (especially if an open wound is already present), the virus is easily transferred to the fingers.
Considering how often a person comes in contact with other people and common objects in one day, there is a high risk of spreading this infection to many other people over the duration of an outbreak.
Herpetic whitlow is often mistaken for lesser infections, so many sufferers don’t take it as seriously as they should.
Even if there are no obvious lesions, the virus is present in saliva and mucous membranes, and can be transmitted via touch or other contact with bodily fluids.
Young children and people with compromised immune systems face the most risk of contracting this virus, along with nurses, physicians, and dentists.
A herpetic whitlow outbreak at Roswell Park Memorial Institute in the early 1980s affected so many nurses that the institute had to change their policy to require protective gloves for any situation involving direct contact with patients presenting any type of lesion at all, whether it had been diagnosed as herpetic or not.(2)
Herpes infections are naturally recurrent, but Jon Johnson of Medical News Today tells us that certain experiences can trigger an outbreak as well.(3)
These triggers include emotional trauma and stress, a fever or other severe illness, hormonal imbalance, surgery, or even overexposure to sunlight.
Interestingly, a study by Dr. John Kreisel seems to suggest that the frequency of cold sores is a genetic trait. It is not known whether there is a connection to other types of herpes outbreaks.(4)
Herpes simplex may be far more widespread than commonly thought.
According to health24, some researchers have suggested that most people over 20 who live in or around cities are carriers.(5)
Luckily, most of them do not develop symptoms or spread the disease. Further, the article states that the virus is most contagious during the appearance of the first outbreak.
Subsequent outbreaks are less likely to spread the virus, especially if the patient receives treatment promptly each time.
Symptoms
The most obvious symptoms include painful blisters and sores on the ends of the fingers or thumb.
Outbreaks usually recur periodically in the same region as the original infection every few weeks or months.
Most patients will receive a series of warning signs before the actual outbreak occurs.
In a 1977 study conducted by Richard Glogau, some patients reported headaches, swelling of the lymph nodes, muscle pain, or other general discomfort before the lesions appeared or during their development.
Additionally, most of the patients also experienced dysesthesia (odd sensations like itching, tingling, or burning) in their fingers a few hours before the actual outbreak.(1)
Many studies since then have confirmed that these pre-symptoms are quite common.
As the infection progresses, the finger becomes inflamed and red. Small, painful blisters rise (either singly or in groups), filling with clear or cloudy liquid.
Occasionally satellite blisters will form around the original cluster.
Note that not all whitlows are caused by the herpes virus. A melanotic whitlow (or Subungual melanoma) is a kind of tumor that appears as discoloration adjacent to or beneath a fingernail.
A red, swollen area at the base of the fingernail, near the cuticle, is often caused by paronychia, a bacterial infection.
Laboratory tests may be necessary to ensure an accurate diagnosis.
Treatment
There is no cure for the herpes virus. This is a highly contagious condition, and should be carefully monitored and controlled.
It’s difficult to predict how often an outbreak will recur, and there are no absolute guidelines for treating herpetic whitlow.
We do know that the longer a patient waits, the less effective any remedies will be.
For the most accurate diagnosis, cultures should be taken from the finger and analyzed by a laboratory within the first 24 to 48 hours of the first symptoms.
Some antibiotics, if taken within the first 48 hours, can help control the symptoms, reduce the duration of the infection, and prevent the virus from spreading to other parts of the body.
Doctors commonly prescribe topical and oral antiviral medicines such as valacyclovir and famciclovir, and analgesics for pain.
The infections usually run their course in one to three weeks.
For those hoping to supplement prescription drugs with other remedies, the British Medical Journal advises that the area should be kept dry and coated with proflavine or spirit of camphor, and that soaking the skin in a solution of hot saline and a few drops of permanganate of potash.(6)
In young children, herpetic whitlow is often accompanied by gingivostomatitis aphthosa, or orolabial herpes, an infection of the gums and tissues in the mouth.
In these cases, Dr. Ran D. Goldman recommends increasing fluid intake in addition to the any other prescribed herpes medications, since the oral infection can cause dehydration.(7)
Prevention
While it’s impossible to avoid touching people and objects in daily life, there are some ways to reduce the danger of contracting or spreading the virus.
Hands should be washed frequently after touching common public surfaces, like doorknobs or computer keyboards. Avoid touching cold sores with bare fingers.
During an outbreak, keep the infected area covered: wear latex gloves or wrap the affected area with a bandage to keep the virus contained.
If you wear contacts, consider switching to glasses during an outbreak, to avoid spreading the virus to your eyes.
The pre-outbreak symptoms mentioned above can give patients an advantage, as well.
They act as a warning, giving patients time to check their medications and plan for extra caution in daily social interactions before the outbreak to keep the virus under control.
Finally, just because there are no outward symptoms of infection does not mean that a carrier of herpetic whitlow cannot spread the virus.
Herpes goes through phases of dormancy between outbreaks, giving the carrier a respite from the symptoms, but the virus is always present.
Be sure to inform your health care professionals and anyone with whom you regularly have close contact so that they can take measures to protect themselves.
Summary
Herpetic whitlow is a recurring infection of the fingers caused by the herpes virus.
While not life-threatening, the blisters and lesions are annoying, painful, and contagious.
There is no cure, but there are steps one can take to ease the symptoms and protect others from infection:
- Pay attention to any pre-outbreak symptoms.
- Avoid touching other people, common surfaces, or sharing food without first covering the infection.
- See a doctor as soon as possible at the beginning of every outbreak.
References
1.Glogau, Richard, et al. Herpetic Whitlow as Part of Genital Virus Infection. The Journal of Infectious Diseases. 1977;136-5:689-692.
2.Baroni, Mary and Joyce Lucey. Herpetic Whitlow. The American Journal of Nursing. 1984;1:60-61.
3.Johnson, Jon. Herpetic whitlow: Symptoms, causes, and treatment. Medical News Today. https://www.medicalnewstoday.com/articles/317701.php. Updated 31 May 2017. Accessed 19 December 2017.
4.Kriesel, John D., et al. C21orf91 Genotypes Correlate With Herpes Simplex Labialis (Cold Sore) Frequency: Description of a Cold Sore Susceptibility Gene. The Journal of Infectious Diseases. https://academic.oup.com/jid/article/204/11/1654/850031 1 December, 2011. Accessed 20 December, 2017.
5.Herpetic whitlow. health24. http://www.health24.com/Medical/Diseases/Herpetic-whitlow-Client-20120721. Updated 22 May 2015. Accessed 20 December 2017.
6.Herpetic Whitlow. The British Medical Journal. 1961;2-5253:696-697.
7.Goldman, Ran D. Acyclovir for herpetic gingivostomatitis in children. NCBI. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4865337/. Updated May 2016. Accessed 20 December 2017.
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