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Dr. Andrew Rynne
Dr. Andrew Rynne

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Do pimple on the finger and cold sores suggest herpetic whitlow?

Answered by
Dr. Asmeet Kaur Sawhney


Practicing since :2007

Answered : 4231 Questions

Posted on Fri, 16 Sep 2016 in Skin Hair and Nails
Question: Hi,
I've had cold sores for 6 years. On average I get one or two a year and sometimes nothing in a whole year. The other day I noticed a tiny pimple on my index finger towards the side of my finger tip with some swelling and some pain if I pressed on it. I freaked out because I've heard of herpes whitlow so I took valtrex immediately. I couldn't risk and wait to see if indeed that's what it was. The pimple kinda looked like maybe it was turning into a blister. I'm a nursing mom and I am still breastfeeding after 9 months. The day before I saw the pimple on my finger the outside part of my breasts were tender and I thought it was mastitis since I've gotten that before from having milk engorged breast. And with mastitis I also would get a low grade fever which I did get too. So now I'm wondering if I was not having mastitis but that my Axillary nodes were tender from a primary infection to my index finger that my outside breast area became tender. Also at the base of my index figure I've developed what appears to be a black and blue bruise. Since I took valtrex 3 days ago it appears that the pimple is disappearing although I can still see it and it has a tiny black spec in the middle, it does not hurt when pressed on. The slight swelling is also gone. The bruise at the base of my finger is still there but not as dark. I haven't experienced any cold sores in months so I don't know if when I was flossing I was asymptomatic and transferred it. Or maybe I was symptomatic when I tasted with my finger cake batter when I was baking. I don't usually put my fingers in my mouth unless I'm going to floss (I wash my hands after flossing) and I never bite my nails. I also don't have any cuts or abrasions prior to discovering this pimple on my finger. I'm a relatively healthy person and take a multivitamin and eat mostly organic and clean, mostly a paleo diet. I'm also really careful when I have a cold sore never to touch it. I'm wondering now if I did some how give myself whitlow herpes but bc I took the antiviral I stopped it. How likely is it that I gave it to myself while not having a cold sore?
Answered by Dr. Asmeet Kaur Sawhney 1 hour later
Brief Answer:
Herpetic whitlow less likely, seems to be bacterial infection

Detailed Answer:
Thanks for being at healthcaremagic
I am Dr Asmeet Kaur Sawhney, a dermatologist.
I have gone through your entire complaints and chances of that pimple being herpetic whitlow is less likely.
Herpetic whitlow usually occurs after direct inoculation of the virus into an abrasion or into normal skin.
Since you didn't have active infection for few months there are less chances of it being herpetic infection .
Moreover it is charactersised by painful deep vesicles which coalesce to give honeycombed appearance or to form a large bulla.
A single pimple is a against the diagnosis of herpetic whitlow.
You might have developed simple bacterial infection of the skin which is now resolving and tender breasts might be associated with it.
Dr Asmeet
Above answer was peer-reviewed by : Dr. Veerisetty Shyamkumar
Follow up: Dr. Asmeet Kaur Sawhney 32 minutes later
Dr Asmeet XXXXXXX Sawhney, thank you for your answer. What do you mean by normal skin? Wouldn't my index finger be described as having "normal skin"? Normal skin for direct inoculation?
Also when you said "Moreover it is charactersised by painful deep vesicles which coalesce to give honeycombed appearance or to form a large bulla." Since I took valtrex at the first sight of a tiny bump wouldn't that have prevented it from forming into painful deep vesicles?
Also is the black and blue bruise at the base of my index finger the same as the red streaks that are seen in heretic whitlow infection?
I'm really paranoid and I have been wearing a bandaid just in case.
Answered by Dr. Asmeet Kaur Sawhney 1 hour later
Brief Answer:
Direct inoculation from an active sore into normal or abraded skin

Detailed Answer:
I meant to say direct inoculation of the virus from an active sore already present ( lips in your case ) into either the normal skin or an abraded skin.
You were not having any sore prior to the appearance of this pimple.
It's very presentation as a pimple is against Herpetic whitlow as in herpes tiny blisters are formed from the very beginning.
Black bruise can be formed in any infection whether viral or bacterial.
Looking at a single pimple it is very difficult to confirm whether it is bacterial or viral in origin.
Both herpes and bacterial infection are close differential diagnosis.
If it recurs in future I would recommend you to go for Tzanck smear examination of the blister fluid and gram stain examination to find out whether it is herpes or bacterial infection.
Also it is seen that herpetic whitlow is usually associated with genital herpes as compared to herpes of the lips.
Above answer was peer-reviewed by : Dr. Veerisetty Shyamkumar

The User accepted the expert's answer

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