Imagine having painful blisters on your hands or fingers that just won’t go away. This can happen with two skin conditions — herpetic whitlow and dyshidrotic eczema. At first glance, these conditions may seem similar, but they require different treatments, so getting the right diagnosis is important for healing and relief.

Continue reading to learn about the similarities and differences between herpetic whitlow and dyshidrotic eczema. This article covers how common these conditions are, what causes them, their symptoms, how they’re diagnosed, and how they’re treated.

How Common Are Herpetic Whitlow and Dyshidrotic Eczema?

Dyshidrotic eczema is more common than herpetic whitlow. Dyshidrotic eczema causes between 5 percent and 20 percent of all cases of hand dermatitis (irritated, inflamed skin on the hands).

In comparison, herpetic whitlow affects about 2.4 people per 100,000 each year in the United States — far less than 1 percent of the population.

What Causes Herpetic Whitlow and Dyshidrotic Eczema?

Even though herpetic whitlow and dyshidrotic eczema share some similar symptoms, they have very different causes and treatments.

Herpetic Whitlow Causes

Herpetic whitlow is caused by the herpes simplex virus (HSV). This is the same virus that causes cold sores (oral herpes) or genital herpes. If the virus infects the skin on your fingers or hands, it can cause a painful, blistering rash.

Herpetic whitlow is most common in people who come into contact with saliva or other body fluids that carry the herpes virus, such as:

• Children who suck their thumbs
• Healthcare professionals, such as dental hygienists or respiratory therapists
• People exposed to genital herpes
• Athletes who have close physical contact, such as wrestlers

You may be more likely to have an outbreak of herpetic whitlow if you have a weakened immune system. This can be caused by having a medical condition or from taking certain medications.

Dyshidrotic Eczema Causes

Dyshidrotic eczema is a type of eczema that causes itchy, blistering rashes on the hands, fingers, or feet. It’s also known as dyshidrosis, acute palmoplantar eczema, vesiculobullous dermatitis, or pompholyx. It’s a common type of foot and hand eczema.

The exact cause of dyshidrotic eczema isn’t known, but it’s more common in certain groups of people, according to Cleveland Clinic, including:

• People between the ages of 20 and 40
• Females
• People with a family history of eczema
• People with a family history of contact dermatitis (a rash caused by touching an allergen or irritant)
• People receiving immunoglobulin infusions to treat immune system problems

About half of dyshidrotic eczema flare-ups happen in people who have a history of allergic reactions to things they’ve touched. Common triggers include:

• Metals like cobalt or nickel
• Laundry detergents
• Frequently wet hands from sweating or hand-washing
• Smoking
• Certain medications, such as birth control pills or aspirin

A MyEczemaTeam member shared a personal trigger for their dyshidrotic eczema: “Anyone with dyshidrotic eczema notice that heat/sweat triggers it? Especially for the soles of the feet?”

Hot, humid weather and sweating can trigger a dyshidrotic eczema flare. As with other types of eczema, stress and allergies to food or seasonal pollen can also cause flare-ups.

When you come in contact with a trigger, your immune system overreacts. This results in inflammation that causes many of the symptoms of dyshidrotic eczema.

Is Eczema a Form of Herpes?

Eczema isn’t a type of herpes. Unlike herpetic whitlow, eczema is unrelated to the herpes virus and can’t be transmitted from one person to another.

What Are the Symptoms of Herpetic Whitlow and Dyshidrotic Eczema?

Herpetic whitlow and dyshidrotic eczema have several symptoms in common.

Both conditions cause painful blisters to form on the hands or fingers. However, the main difference is where the blisters appear.

Herpetic Whitlow Symptoms

If you have herpetic whitlow, the blisters usually form close to your fingernail. Most people have symptoms on only one finger, but the infection can sometimes spread to nearby fingers.

How Do You Know You Have Herpetic Whitlow?

Before blisters appear, you may feel pain, tingling, or burning in the area. Shortly afterward, small blisters or fluid-filled bumps may form near a fingernail. The skin around the affected area may become sensitive to touch.

You might also notice that the finger is swollen and discolored, often appearing darker than the surrounding skin.

The blisters usually start to heal within a few days, forming a crust where the blisters were. Symptoms usually last about two weeks. However, they may last longer if you don’t treat them.

Dyshidrotic Eczema Symptoms

If you have dyshidrotic eczema, blisters — also called vesicles — form on the skin of your palms, the sides of your fingers, or the soles of your feet. The blisters are usually small (about 1 to 2 millimeters across), but they can sometimes merge into larger blisters.

Most people develop rashes on both sides of the body — for example, on both hands or feet. As the rash develops, it may feel itchy and painful.

A MyEczemaTeam member described their dyshidrotic eczema blisters as “aggravating and itchy.”

As with herpetic whitlow, you may notice itching and burning sensations in the area first. “I feel a tingly itching/burning sensation where I’m going to get eruptions,” shared a MyEczemaTeam member.

The itchy blisters caused by dyshidrotic eczema usually start to go away within three to four weeks. However, you might have some scaling (dry, flaky skin) in the area after the blisters heal.

If you have dyshidrotic eczema, your symptoms may come and go. A MyEczemaTeam member who experienced dyshidrotic eczema during high school said, “I used to scratch the blisters, and after they would pop, they would go away only to return later.”

Are Herpetic Whitlow and Dyshidrotic Eczema Contagious?

Herpetic whitlow is contagious. The infection can spread to another person through direct physical contact. It’s most contagious when there are active blisters, as the virus can spread through the fluid inside them.

Once the blisters start to form a crust, the risk of spreading the virus drops significantly. If you have herpetic whitlow, it’s a good idea to cover the blisters with a bandage to help protect others until the skin has fully healed.

Dyshidrotic eczema isn’t contagious. Just like other forms of eczema, you can’t spread dyshidrotic eczema to other people, even when you have blisters on your skin.

However, scratching the skin can cause breaks or open sores, which can become infected with bacteria. Keeping the skin clean and using treatments as prescribed can help lower the risk of infection.

How Are Herpetic Whitlow and Dyshidrotic Eczema Diagnosed?

A dermatologist usually diagnoses herpetic whitlow or dyshidrotic eczema based on how the skin looks and your medical history. They may ask questions to learn whether you’ve had contact with possible triggers — like allergens, irritants, or saliva carrying the herpes virus.

To confirm your diagnosis or rule out other possible causes, you may have additional tests, such as:

• Skin biopsy — A procedure where a small sample of skin is removed and tested
• Allergy testing — A test to identify substances that trigger allergic reactions
• Blood tests — Tests that measure substances in your blood to help with diagnosis
• Culture test — A test that checks if the herpes simplex virus is causing an infection

It’s possible to have both conditions at the same time. In fact, a different type of eczema called eczema herpeticum can develop when a large area is infected by the herpes virus.

How Are Herpetic Whitlow and Dyshidrotic Eczema Treated?

The treatments for herpetic whitlow and dyshidrotic eczema aim to address the underlying cause of each condition. By treating the cause, these therapies not only ease symptoms but also help prevent future flare-ups and support better skin health.

Herpetic Whitlow Treatment

If you have herpetic whitlow, your doctor may prescribe antiviral medication to fight the viral infection. Antiviral medications can be taken orally (by mouth) or applied topically (to the skin). If you’re in pain, your doctor may also recommend an over-the-counter pain reliever, such as ibuprofen or acetaminophen.

Ask your doctor about the best way to care for your skin while it heals. Covering the rash may help protect the area and prevent spreading the infection to others.

Dyshidrotic Eczema Treatment

If you have dyshidrotic eczema, your treatment plan will be tailored to your symptoms. Many options focus on calming inflammation, such as:

• Topical corticosteroids — Ointments or creams that help reduce inflammation where they’re applied
• Oral corticosteroids — Pills like prednisone that lower inflammation throughout your body
• Phototherapy — A treatment that uses controlled beams of light to ease dyshidrotic eczema symptoms
• Topical calcineurin inhibitors (TCIs) — Creams or ointments that help manage severe symptoms, but are not usually used long term

Your doctor may recommend other remedies to help with the pain and itching associated with dyshidrotic eczema, including:

• Taking antihistamines — Medications like cetirizine or fexofenadine that can help relieve itching
• Soaking the affected area in cool water or applying cool compresses
• Applying moisturizers frequently to keep your skin hydrated

The Bottom Line

In summary, herpetic whitlow and dyshidrotic eczema may seem similar, but they are two different conditions.

• Herpetic whitlow is caused by the herpes simplex virus and is contagious.
• Dyshidrotic eczema isn’t contagious and is often related to allergies, irritants, or skin sensitivity.

Understanding the differences is key to getting the right treatment. If you think you might have either condition, talk to a healthcare provider as soon as possible to take the first steps toward feeling better.

Talk With Others Who Understand

MyEczemaTeam is the social network for people with eczema and their loved ones. On MyEczemaTeam, more than 55,000 members come together to ask questions, give advice, and share their stories with others who understand life with eczema.

Have you had blisters on your hands, fingers, or feet? Have you been diagnosed with herpetic whitlow or dyshidrotic eczema? Share your experience in the comments below, or start a conversation by posting on your Activities page.