Herpetic Whitlow Treatment & Management

Updated: Nov 11, 2022
  • Author: Michael S Omori, MD; Chief Editor: Steven C Dronen, MD, FAAEM  more...
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Emergency Department Care

Herpetic whitlow is a self-limited disease. Treatment most often is directed toward symptomatic relief.

Acyclovir may be beneficial. Studies of clinical efficacy are limited and treatment suggestions are extrapolated from data regarding response of other HSV infections. In primary infections, topical acyclovir 5% has been demonstrated to shorten the duration of symptoms and viral shedding. Oral acyclovir may prevent recurrence. Doses of 800 mg twice daily initiated during the prodrome may abort the recurrence. Alternative dosing regimens may also be effective. [7]

Famciclovir or valacyclovir may shorten the clinical manifestations of acute occurrence.

Use antibiotic treatment only in cases complicated by bacterial superinfection.

Tense vesicles may be unroofed to help ameliorate symptoms, and wedge resection of the fingernail may be used for the same purpose in cases involving the subungual space.

Deep surgical incision is contraindicated, since this may lead to delayed resolution, bacterial superinfection or systemic spread, and complications such as herpes encephalitis.


Medical Care

Antiviral agents may be prescribed as noted above.

Appropriate analgesic medications should be prescribed if indicated.


Surgical Care

Do not attempt to incise and drain lesions as this may lead to worsening scarring or possible dissemination of the virus.



Virions are shed by open lesions and patients may inadvertently spread the infection to other anatomic locations, including ocular, genital or oral and rarely the infection may progress to herpetic encephalitis. 

Inappropriate attempts to incise and drain lesions may lead to subsequent scarring.



None indicated under most circumstances, but if the diagnosis is in question, consultation to Infectious Disease physician or Dermatologist may be appropriate.



Health care workers should wear gloves while providing medical and/or dental care to prevent inadvertent exposure and subsequent infection.