Q. Recently my left big toe swelled up, formed something like small blisters and itched and burned. I knew this wasn’t normal, so I went to the doctor.
The physicians’ assistant diagnosed the problem as “herpetic whitlow.” She prescribed acyclovir to speed recovery. I couldn’t afford it and when I learned it wouldn’t cure the problem, I went without. I took diphenhydramine to help me sleep through the itch. It seemed to reduce the swelling a bit as well.
I’ve never heard of herpetic whitlow before. What can you tell me about it?

A. Most people have seen cold sores and fever blisters on or near the mouth, caused by herpes simplex virus. The herpes virus can also get into small cuts or abrasions on the fingers or toes and cause painful swelling, blisters and itching. The medical term for this type of sore is “herpetic whitlow.”
Acyclovir or other anti-herpes drugs such as valacyclovir or famciclovir can help ease symptoms of whitlow, but they should go away on their own.
Here is a link to a picture and more complete discussion of this skin condition:

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  1. Dolores

    Could this be similar to an outbreak of shingles but in a different place? Sounds and looks like it.

  2. Gail

    Mystery solved! I have had the blister occurrence maybe once a year more or less for over thirty years not knowing what it was until now! I would feel a few days of malaise and then the painful blisters, lateral side, middle finger, right hand. I thought it was a type of shingles!

  3. Millard H. Zisser, M.D.

    Herpetic whitlow is very rare. On the toe it would be extremely unusual. The herpes virus is a contact virus requiring contact with an existing lesion. Whitlow by definition involves the nail or digit and, when it does occur, it is overwhelmingly most common on the finger. An insect bite or dyshidrotic eczema would also be a similar causes of the same clinical findings. It’s always best to confirm the diagnosis by taking blister fluid for viral culture.

  4. dsufreu

    Unfortunately, STD rates soar worldwide and most people with STDs don’t even know that they have them. The government should grant more money for STD education to lower the rates of STD transmission.

  5. J.B.

    I wonder what dead sea salts might do for this? After treating a common viral skin infection called mulloskum for a year with tea tree oil with no success, and then aloe vera, and coconut oil with good but slow success, we completely eradicated the infection in less then 2 weeks using dead sea salts in a bath. We added enough salt to the water until it tasted pretty darn bad, then soaked for 30 minutes. By the 7th bath, it was gone. Someone speculated that maybe it was the zinc in the salts, though I haven’t researched whether or how much zinc is in dead sea salt. Maybe it would have a similar effect on other viruses.

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