Herpetic whitlow, also known as whitlow finger, is a highly contagious infection of the finger caused by the herpes simplex virus. The herpes simplex virus has two main types, both of which can lead to the development of herpetic whitlow. Type one most commonly affects the areas around the mouth and frequently produces cold sores, and type two mostly affects the genital area and manifests as genital herpes.
Herpetic whitlow can develop when an individual uses their fingers to touch cold sores or other lesions infected with herpes. The virus can enter the body through cuts and minor breaks in the skin, including paper cuts. Patients who have herpetic whitlow will usually notice initial symptoms such as redness and swelling of the infected finger. Approximately one to two weeks after exposure, blisters may form at the site of infection. Some patients may have only a single blister, and other patients may develop a cluster of small blisters. The blisters may become infected and form a painful abscess. Some patients with the condition develop a fever and chills. Doctors can diagnose herpetic whitlow with blood tests and a swab of the infected area.
Although whitlow finger generally resolves on its own after a few weeks, the measures outlined in this article help speed recovery, manage symptoms and control the infection.
Antiviral medication can shorten the duration of herpetic whitlow, allowing blisters and abscesses to heal faster. Antivirals also help by reducing a patient's risk of getting a secondary bacterial infection and reducing the chance the herpes simplex virus will spread to other parts of the body. These strong medications must be prescribed by a doctor and are most effective in the early days of the illness. In fact, if herpetic whitlow is suspected, it is important to see a healthcare provider within the first forty-eight hours after symptoms begin. Generally, antiviral medications are not effective after this period, and the majority of doctors will only issue them if patients present themselves within two days of symptom onset.
Since the first episode of whitlow finger typically has the most severe symptoms, topical antivirals applied to the skin are often recommended. Patients who experience repeated episodes of herpetic whitlow may need to take oral antivirals for long periods, sometimes for years. Acyclovir can be used both topically and orally and is one of the most common antiviral drugs for this condition. Side effects of this medication include nausea, muscle and joint pain, headaches, dizziness, diarrhea, and fatigue.
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The use of topical creams in the treatment of herpetic whitlow is generally limited. Most often, the only topical treatments used for this condition are cream or gel formulations of acyclovir and other antiviral medicines. When acyclovir is used topically, it is typically applied as a five percent solution over the affected area. Topical applications deliver medication directly to the specific area affected by herpetic whitlow and have fewer side effects than the same medications taken orally. Valacyclovir and famciclovir are in the same drug category and can provide the same benefits as acyclovir.
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Covering The Infection
Due to the highly contagious nature of herpetic whitlow and the weeping blisters it may produce, it is especially important that the affected area is covered with a clean dressing at all times. Most wounds heal more quickly when covered. The wound should be cleaned daily with gentle soap or alcohol swabs. Gauze dressings are ideal, and a new dressing should be placed on the wound at least once a day or more often if there is drainage from the wound. Dressings should be changed as soon as possible after using public transportation or restrooms or otherwise coming into contact with potentially infectious material to maximize the effectiveness and speed of healing. Depending on the severity of the wound, covering the infection with several layers of gauze dressing may be advisable. Additional layers can be added to provide cushioning, and the dressing should be secured with medical tape.
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Following Proper Hygiene
Practicing proper hand hygiene is especially important when managing herpetic whitlow. Following proper hygiene can prevent the development of herpetic whitlow and can help prevent a future episode in patients who have previously had the condition. In addition to washing hands with soap and water or using hand sanitizer frequently, following proper hygiene includes being mindful of how one uses the hands and fingers on a daily basis. Patients should take care to avoid touching their mouth, nose, and eyes when they have herpetic whitlow, as doing so can spread the infection to other parts of the body. In particular, patients should not wear contact lenses when they are suffering from herpetic whitlow due to the ease with which the herpes simplex virus can spread from the fingers to the eyes. Patients should also never attempt to drain any fluid that may be present in blisters at the infected site, as this can easily spread the virus to other areas.
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Preventing The Spread
The herpes simplex virus is very easy to transmit, and preventing the spread can be difficult, including when it comes to herpetic whitlow. Infection control measures should be followed closely to prevent the spread of herpetic whitlow to other areas of the body and other individuals. During an episode, patients should try to use their unaffected hand for eating and other daily tasks, and avoid shaking hands with their affected hand as well. If possible, patients should only touch their infected finger when changing the dressing and wash their hands thoroughly afterward. To prevent spreading the virus to others, including family members, patients must refrain from touching others with their infected finger, and not let anyone else touch the infected site or assist with dressing changes unless they are wearing medical gloves.