Herpetic whitlow, or distal digital herpes simplex virus (HSV), is an uncommon infection occurring on the fingers or periungually, either from HSV1 or HSV2. Herpetic whitlow from HSV1 usually affects children and dental and medical personnel who do not regularly wear gloves. Toe involvement has been reported in infants from toe sucking. Digital-to-genital contact of HSV2 is also a mode of transmission.

After an incubation period of 3-7 days, during which there may be local erythema and edema as well as tenderness, a group of vesicles appears around the perionychium and on the volar digital skin. Vesicles may progress to erosions or may become pustular first and simulate a felon. Lesions may involve the distal-free edge of the nail and extend into the nail bed, which often results in hemorrhage. Swelling of the hand with lymphatic streaking may also occur.

Recurrences of herpetic whitlow may be seen, especially in immunosuppressed individuals.