Herpetic whitlow and dyshidrotic eczema are relatively common rashes that can have a similar appearance. But they have different causes, symptoms, and treatments.

Your hands are one of the most common areas of the body where skin rashes can flare.

For example, both dyshidrotic eczema and herpetic whitlow typically begin on your fingers as crops of tiny blister-like lesions. But they are distinctly different skin conditions.

Dyshidrotic eczema is a subtype of eczematous or atopic dermatitis. Eczema is a widespread chronic condition affecting up to 10% of adults and 30% of children in the United States.

In contrast, herpetic whitlow is relatively uncommon, with an estimated 2.4 cases per 100,000 people annually. It’s due to a contagious viral skin infection.

It can be easy to confuse dyshidrotic eczema and herpetic whitlow since they both cause blisters on your fingers. However, they require very different treatment strategies.

While herpetic whitlow and dyshidrotic eczema may look similar, the experience of symptoms may be quite different.

Herpetic whitlow

Burning or tingling pain is the most frequent symptom in people with herpetic whitlow. You might feel these symptoms in the affected digit even before a rash appears.

Next, you’ll notice discoloration, swelling, and the eruption of small blisters, often around the nailbed. The fluid inside blisters is often clear or clearish-yellow, though it can turn milky or crusty. Sometimes, you could also have a fever or swollen lymph nodes.

Because herpetic whitlow is a local infection, it typically starts in a single finger. However, the infection can spread if you touch the infected area.

Dyshidrotic eczema

In contrast, the main symptom of dyshidrotic eczema is usually severe itching. Sometimes, the itching is present even before the blisters are obvious. Stinging or burning can also occur.

Multiple crops of deep, tiny, and scaled blisters will often appear on the sides of your fingers. The blisters are intensely itchy.

Dyshidrotic eczema can affect multiple digits. It may also appear in other locations, such as your palms or feet.

The herpes simplex virus (HSV) (type 1 or 2) causes herpetic whitlow. This is the same virus that causes other common skin conditions like cold sores. When you come in contact with HSV, the virus can penetrate microscopic breaks in your skin barrier, leading to herpetic whitlow finger infection.

Dyshidrotic eczema is an allergic or atopic condition with a wide array of triggers. Allergies and irritants, like fragranced skin products, sweat, or certain metals, can provoke flares.

Are herpetic whitlow and dyshidrotic eczema contagious?

Herpetic whitlow results from infection by the herpes simplex virus (HSV). This contagious virus spreads easily via skin-to-skin contact with sores. People with HSV infections shed the virus periodically, even when no symptoms are present.

Dyshidrotic eczema is not an infectious or contagious condition.

According to the National Eczema Association, dyshidrotic eczema tends to affect young adults ages 20 to 40 years. Like other atopic conditions, such as allergies or asthma, dyshidrotic eczema also tends to run in families, suggesting it has a genetic element.

Additional risk factors include:

Herpetic whitlow can occur at any age, but it’s most common in:

  • young children who suck their thumbs
  • healthcare workers frequently exposed to soft tissue inside the mouth, such as dental hygienists or respiratory therapists
  • athletes with frequent skin contact, such as wrestlers

Often, a doctor can arrive at a diagnosis after simply talking with you and examining your skin.

Sometimes, if they suspect an infection, a doctor may gently break open a blister and use a cotton swab to take a fluid sample. They can send this sample to a lab for testing for HSV or bacteria.

To treat herpetic whitlow, a doctor may recommend:

  • oral antiviral medication, especially if symptoms began very recently (within 48 hours)
  • pain medications like ibuprofen and acetaminophen
  • a cool compress

Since herpetic whitlow is a viral (not bacterial) infection, antibiotics won’t help. Still, you’ll want to keep any HSV lesions covered and avoid picking at them. During an active outbreak, the virus can spread to other parts of your body through skin contact.

To treat dyshidrotic eczema, a doctor may recommend:

Blistering skin conditions, like herpetic whitlow and dyshidrotic eczema, disrupt the skin barrier. This allows bacteria to enter wounds and cause a secondary infection more easily. If a doctor suspects a secondary bacterial infection, they may prescribe antibiotics.

In healthy people, herpetic whitlow will usually heal on its own within 2 to 4 weeks. Early oral antiviral medication can help reduce the period of active symptoms and viral shedding.

As in other forms of HSV infection, there is a 30% to 50% chance of a recurrence. But recurrences are usually milder and short-lived. You can use prophylactic antiviral medication to reduce the frequency of recurrences if needed.

Dyshidrotic eczema tends to be a chronic, recurrent problem. Triggers can be difficult to control, and flares may arise every few weeks for months at a time. This can sometimes lead to thickened, discolored, or peeling skin in affected areas.

However, you can manage eczema symptoms, and dyshidrotic eczema tends to improve with increasing age.

Dyshidrotic eczema and herpetic whitlow are two of many potential causes of blistering eruptions of the hands and fingers.

While both can cause tiny blisters that may later coalesce, distinguishing the two conditions is important. If you suspect you or your child may have herpetic whitlow or dyshidrotic eczema, you should reach out to a doctor.

Herpetic whitlow is contagious. Taking proper precautions can help prevent its spread. Although it often self-resolves, oral antiviral medication may also be helpful if doctors identify the HSV infection early.

Similarly, prescription topical medications can help relieve the intense itching and other symptoms associated with dyshidrotic eczema. Adopting preventive care advice can also help reduce flares of this chronic condition.

Herpetic whitlowDyshidrotic eczema
Appearance? single digit, often near nailbed
? fluid-filled blisters
? skin discoloration to red or purple, depending on skin tone
? swelling
? one or more digits, often sides of fingers, palms, or soles
? small deep blisters that may coalesce into larger bullae
? scaling or peeling
Other symptoms? tingling or burning sensation
? pain
? occasional fever or swollen lymph nodes
? intense itch
? stinging or burning sensation
Duration? 2 to 4 weeks? weeks to months of recurrent flares
Affected groups? young children and young adults
? healthcare workers and those in frequent contact with skin or open mouths
? young adults
? personal or family history of eczema or atopy
Cause? herpes simplex virus (HSV) infection? allergies and irritants
? sweating
Contagious?? yes? no
Treatment? oral antivirals
? pain medication
? topical emollients
? topical corticosteroids or calcineurin inhibitors