What is herpetic whitlow?

Herpetic whitlow is a viral infection that usually causes a red, blistering rash to appear on one finger. It is possible for multiple fingers to be affected, but this is rare. If complications occur, herpetic whitlow can also cause scarring, nail damage, numbness, and skin hypersensitivity.

What causes a blister to form?

Blisters, also known as vesicles or vesicular lesions, are formed when fluid becomes trapped beneath the outermost layer of the skin (epidermis) which causes a small bubble to appear. Causes can range from allergic reactions and minor trauma to herpes or chickenpox.

Herpes Pictures and Cold Sores Pictures

There are two types of herpes virus infections: type 1 (HSV-1) and type 2 (HSV-2). You might be surprised that both types are common. In fact, 85% of people in the world have been infected with at least one type.

In the past, HSV-1 infections only occurred in the mouth. HSV-2 infections were only in the genital area. Now both of these herpes types can appear throughout the body, often on the finger or in one or both eyes.

The gallery below shows several pictures of herpes lesions, including cold sores and genital herpes. There are also images of conditions that look similar to or are confused with a herpes infection, like chickenpox or canker sores.

Note: Some of the following images are of genital areas.

Early Lesions (Close-Up)

Herpes rash early — Apple2000 / Getty Images

This photo shows an example of the early stages of the herpes rash. In herpes, the vesicles, or blisters, look like they are clustered in one red patch. This is different from chickenpox (see next picture), where each blister has its own red base.

Chickenpox Rash

Compare this picture of a typical chickenpox rash to the previous picture of a herpes rash. Note that each blister in this photo has its own red base and is not clustered together in a group.

Herpes Lesions on Leg

Herpes on leg — Getty Images / Amphawan Chanunpha

There are three stages of a herpes rash. The initial stage is a cluster of blisters on a red base. These fluid-filled blisters are delicate and open easily, creating an ulcer, or open sore. Eventually, the sore will stop oozing and crust over.

There is usually no scarring when the crust falls off. This is also different from the chickenpox virus, which may leave a scar after it heals.

Cold Sore

Cold sores and fever blisters, also called oral herpes, are caused by the herpes simplex virus. Cold sores are more often caused by herpes simplex type 1 (HSV 1) than herpes simplex type 2 (HSV 2).

Cold sores start with blisters on the mouth that turn into open sores. They crust and then heal without a scar. The stages are similar to genital herpes.

Oral herpes infection often involve sores around and throughout the mouth, including on the tongue or face. However, the sores can appear anywhere on the skin.

The sores can be quite painful. Especially during the first outbreak, people may develop flu-like symptoms, including:

Fever
Fatigue
Swollen lymph nodes

Herpes simplex virus is chronic and can be difficult to treat. The virus can hide away for months or years in the nerve cells before coming out and causing an infection. While there is no cure, there are therapies to help ease symptoms and shorten the duration of an outbreak.

Options include an antiviral cream or ointment (for example, Zovirax) applied directly to the sore or an antiviral medication taken by mouth, such as:

Zovirax (acyclovir)
Famvir (famciclovir)
Valtrex (valacyclovir)

Early Cold Sore

This is another picture of an early cold sore on the lip. Note that there is not much redness yet. Recurrent oral herpes infections occur on the lip, not inside the mouth. They also tend to become less severe after the first outbreak.

For people with recurrent infections, a prescription antiviral medication like Valtrex can be taken daily to reduce the number of cold sore outbreaks. Medication can also be used to reduce the severity when an outbreak does occur.

Aphthous Ulcers

This is a picture of aphthous ulcers, which are often confused with cold sores. Aphthous ulcers can occur anywhere in the mouth, but do not involve the outside of the lip. They are not caused by the herpes virus.

Aphthous ulcers can be caused by the following.

Coxsackievirus: One of the viruses that causes colds and hand, foot, and mouth disease
Autoimmune diseases: Crohn's disease, ulcerative colitis, and Behcet's syndrome
Contact dermatitis: Exposure to aspirin, strong mouthwashes, spicy foods, citrus
Chemotherapy medications: Used to treat cancer

Typical Herpes Lesions on Penis

This picture shows typical herpes lesions on the penis, including blisters and open sores. Because the number of lesions in this photo is extensive, this is likely a picture of a first outbreak of genital herpes.

Typically, the first herpes outbreak is worse than later outbreaks. Your immune system builds up antibodies that fight against the herpes simplex virus. With time, outbreaks tend to occur less often and they become milder.

Healing Lesions on Penis

This picture shows herpes lesions in a later stage. The sores are starting to fill in. Since the genital area is warm and moist, crusting may not develop as the lesions heal.

Like oral herpes, genital herpes can be treated with the same antiviral medications taken by mouth.

One of these medications may also be taken daily to prevent further outbreaks. If you take the medication during an outbreak, it will not stop the outbreak, but it can make it shorter and less severe.

Atypical Lesions on Penis

Because the genital area is warm and moist, sometimes herpes can have an atypical appearance. In this picture, the lesions look more like erosions (where only part of the top layer of skin is damaged). If you look closely, however, you can see that each red area has a cluster of small sores.

Herpes simplex infections can have an atypical appearance or mimic other skin conditions, so it's best to see your healthcare provider for a proper diagnosis.

Crusting Lesions on Penis

This is another example of herpes lesions in the later stages of healing. In this case, there is crusting. A rash in this stage might be confused with scabies. Scabies is caused by a mite that infests the skin.

It's important to note that many people with a genital herpes infection don't realize they have it because they have no symptoms. They can then transmit it to their partners unknowingly.

This is more common in genital herpes than oral herpes. It is called asymptomatic viral shedding. The use of male latex condoms can help prevent transmission but it is not 100% effective.

Herpes Lesion on Vulva

This picture shows an ulcer on the vulva that is caused by herpes. The vulva is the external part of the female genitalia.

Women are four times more likely to get a herpes simplex type 2 infection than men. In addition, women may have genital symptoms that are caused by a herpes infection but are not recognized as herpes.

For instance, a woman may feel pelvic pain if the genital herpes rash is located inside the vagina or on the cervix. This pain could lead to a misdiagnosis of pelvic inflammatory disease.

Also, many women experience burning with urination during a genital herpes outbreak. The burning may be misdiagnosed as a urinary tract infection.

Lesions Around the Eye

The herpes virus can cause a rash anywhere on the skin—not just in the mouth or genital area.

This picture shows herpetic keratitis, a herpes infection that involves the cornea, or the outside covering of the eye. Note the blisters around the eyelid and ulcerations on the eyelid.

Symptoms of herpetic keratitis may include:

Eye pain
Sensitivity to light
Watery discharge
Blurry vision

Herpes around the eye is serious. Don't wait to see an ophthalmologist for evaluation and treatment. If left untreated, herpetic keratitis can cause scarring of the cornea.

Early Herpes Infection on Finger

The finger is a common place to get a herpes infection. In fact, it's common enough that it has its own name—herpetic whitlow.

This picture shows the early stage of the infection. Since the skin on the fingers is thicker, the blisters aren't as fragile and may not spread quickly.

Typical Lesions on Finger

Herpes on finger — James Heilman, MD , CC BY-SA 3.0 / Wikimedia Commons

This picture shows a herpetic whitlow, or herpes infection of the finger, that has blisters and sores. Herpetic whitlow will go away on its own, although often Zovirax (topical acyclovir) is given for treatment.

Oral antivirals are generally not needed unless the infection is severe or a person has a weak immune system.

Summary

HSV-1 was formerly known as oral herpes and HSV-2 as genital herpes, but both types can occur anywhere on the body. In fact, herpes virus infections are common on the finger and in one or both eyes.

Though their appearance can vary, they usually cause a red patch with fluid-filled blisters. The blisters will pop and ooze, turning into sores that eventually crust over.

Especially during the first outbreak, sores can be painful and even be accompanied by flu-like symptoms. Herpes simplex infections can mimic other skin conditions and some people have no symptoms at all.

A Word From Verywell

Herpes virus infections are common. While they cannot be cured, they can be managed and prevented with medication. If you are concerned you have been infected with the herpes virus, see your healthcare provider for an evaluation. Your healthcare provider may take a sample of the sore to confirm the diagnosis.

Frequently Asked Questions

What is herpetic whitlow?

Herpetic whitlow is a viral infection that usually causes a red, blistering rash to appear on one finger. It is possible for multiple fingers to be affected, but this is rare. If complications occur, herpetic whitlow can also cause scarring, nail damage, numbness, and skin hypersensitivity.
What causes a blister to form?

Blisters, also known as vesicles or vesicular lesions, are formed when fluid becomes trapped beneath the outermost layer of the skin (epidermis) which causes a small bubble to appear. Causes can range from allergic reactions and minor trauma to herpes or chickenpox.

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4 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Edgar NR, Saleh D, Miller RA. Recurrent aphthous stomatitis: A Review. J Clin Aesthet Dermatol. 2017;10(3):26-36.
Modi S, Van L, Gewirtzman A, et al. Single-day treatment for orolabial and genital herpes: a brief review of pathogenesis and pharmacology. Ther Clin Risk Manag. 2008;4(2):409-17.
Sauerbrei A. Herpes genitalis: Diagnosis, treatment and prevention. Geburtshilfe Frauenheilkd. 2016;76(12):1310-1317. doi:10.1055/s-0042-116494
Wu IB, Schwartz RA. Herpetic whitlow. Cutis. 2007;79(3):193-6.

Additional Reading

American Academy of Dermatology. Herpes simplex: Signs and symptoms.
Bernstein DI, Bellamy AR, Hook EW, et al. Epidemiology, clinical presentation, and antibody response to primary infection with herpes simplex virus type 1 and type 2 in young women. Clinical Infectious Diseases. 2013;56(3):344-351. doi:10.1093/cid/cis891
Centers for Disease Control and Prevention. Genital HSV infections. Updated January 25, 2021.

What Does a Herpes Rash Look Like?