Herpes simplex virus, type 1 or type 2, causes viral-mediated cellular death and associated inflammatory response. A herpes whitlow is a painful herpetic infection of a finger, fingers, and/or fingertips. It can be caused by any of the herpes strains. A whitlow causes pain, itching, redness, blister formation, and swelling. Herpetic whitlow can be recurrent, causing multiple painful outbreaks every year over the course of several years or even be lifelong.
It is well-established that the incubation time for herpes infections (the time between initial contact with the virus and the onset of symptoms) ranges most often from 1 day to 12 days. However, incubation times may be several weeks. Typically, herpes virus infections are acquired by direct contact with skin or mucous membranes that are infected with the virus, however, the herpes virus can survive on inanimate objects and remain infectious for hours. When a nail bed suffers microtrauma from the action of a nail file, nail clipper, or a chemical solution—things commonly utilized in nail salons as in this case—the skin’s normal defense mechanisms become injured and impaired, potentially allowing for entry of herpes virus into the cells. With sufficient injury and sufficient viral exposure, a herpes infection will occur. In short, trauma-induced skin injury during a manicure can weaken the protection normally afforded by the skin and allow herpes virus to enter. That infection will be lifelong. It should also be noted that if a nail technician has a herpes infection, particularly of the hand, it can be the source of transmission to the finger of the manicure recipient. This can certainly occur even without an active lesion; that is because the herpes virus is often shed asymptomatically from the skin.