Whitlow

Summary panaritium (paronychia)

Panaritium (or paronychia) is an acute infection that usually occurs in a finger and sometimes a toe.
The cause of whitlow is most often bacterial, certain factors such as a wound or a splinter can favor its development.
Whiplash can be very painful and often requires medical intervention to remove the pus. Some medical sources classify panaritium into three stages (1st, 2nd and 3rd) and others classify it into two types: superficial paronychia and deep paronychia.

In some cases, especially in advanced stages, whitlow can lead to complications and pose a risk of sepsis.

The treatment will depend on the stage of the panaritium, it can vary from a simple topical disinfection, a more generalized treatment (taking antibiotics), to a minor surgery to remove the pus.

The main prevention tips are to avoid biting your nails and to disinfect your manicure tools very well.

Definition

A paronychia, also popularly known as a whitlow, is an acute inflammation usually caused by a staphylococcus (especially golden) or streptococcus bacteria around a hand or, more rarely, a toe.

Whisker often occurs when the skin is wet (high humidity) or also when biting the nails. Whiplash is a form of abscess, pus usually forms under the nail.

The panaritium (in Latin: panaricium), also known as the white evil.

Causes

Whiplash is usually caused by an infection of the fingers or toes with bacteria such as staph (usually Staphylococcus aureus ) or streptococcus.

Some conditions, such as a humid environment, can promote the development of this bacteria.

Bacterial Entry, Contamination: 
Means of bacterial entry into the finger and particularly the area around the nail can be facilitated by a minor wound (including a nail that has been cut too short), a sting, a splinter, a bite or a wound. Manipulating the skin around a nail or applying an artificial nail can also promote the entry of bacteria around the nail.
An ingrown toenail, often caused by a nail that has been cut too short, is another cause of acne. In an ingrown toenail, as the name suggests, the nail grows into the surrounding flesh.

The stage before the appearance of a whitlow can be an ingrown toenail, usually caused by cutting too short. In an ingrown toenail, as it grows, the nail penetrates the flesh that surrounds it.

Symptoms

Panaritium can be classified into different stages, from 1 to 3:

Stage 1 : This is an inflammation with three classic signs: redness, heat and swelling.

At this stage, the patient does not suffer from fever. There is especially pain when touched, it is a pain that does not interfere with sleep, because it is not continuous.

This step is reversible, but it can also progress to stage 2.

Stage 2 : In this more severe stage, also known as the “subacute stage”, the symptoms are the same as in stage 1, which are the signs of inflammation, but with more pronounced symptoms. There is an intense pain and pulsating sensation (like the rhythm of the heartbeat), it feels like “hammering in the finger”, these are true painful twinges. The pain is also nocturnal, which can lead to sleep disturbances.

Other symptoms may appear such as swollen glands and fever.

At this stage, we can also see the accumulation of pus around the nail. It will be important to treat whitlow, in general, through a minor surgical operation to remove the pus. This will prevent complications and the transition to the third stage, with much greater health risks.

Stage 3 – Whiplash complication: In this severe stage, the inflammation develops in other parts of the body, usually in the areas close to the area affected by the Whiplash and develops in depth, but also in other regions. It can be observed, for example, that the bacteria can spread in the joints, with a risk of arthritis, or at the level of the tendons and bone level (risk of osteitis), etc.

In severe cases, germs (bacteria) can reach the bloodstream, this is called septicemia (sepsis), bouts of fever can be a sign that the infection is widespread.

In stages 2 and 3, always consult a doctor.

Some medical sources distinguish panaritium into 2 phases, superficial and deep panaritium.

In cases of superficial panaritium, as the name suggests, only the edge of the nail is affected. Represented by stages 1 and 2 described above.

In cases of deep panaritium, which are normally characterized by stage 3 above, the affected areas are mainly the bones, joints and tendons.

Symptom appearance: 
Whiskers appears a few days (2-5 days) after the traumatic or contaminating event (e.g. injury, perforation, ingrown toenail, manipulation of the skin around the nail)1.

Treatments

The treatment of whitlow will vary depending on the stage of whitlow, graded from 1 to 3, read whitlow symptoms for more information.

Stage 1 treatment:

At this early stage, it is preferable to carry out a local treatment, in the form of antiseptics. The aim is to prevent progression to stage 2.
Regular finger washing with soap and water is very important.

Dakin or hot water
– The patient can, for example, apply a Dakin bath (finger bath). Ask your pharmacist for information on how to perform the Dakin bath. In Dakin there is a chlorinated derivative (hypochlorite) that acts as a disinfectant. The treatment proposed by the doctor normally varies between 3 to 5 baths of 10 minutes a day (during which the finger is soaked).
– There are also disinfectant baths, ideal for toenail pain (in Switzerland, Hibiscrub®, Lubex®, Der-Med®). The toe should soak for about ten minutes.
– Some sources, such as the French magazine Prescrire2 , known for its independence from the pharmaceutical industry, advises to dip your finger in a warm water bath for 10 to 15 minutes 3 to 4 times a day. For this journal, there is no demonstrated benefit in replacing water with other liquids, such as saline or antiseptic, nor in locally applying an antistylococcal antibiotic (eg, fusidic acid).

Creams or ointments: 
Between baths, you can also use an ointment or salve based on ammonium sulphobituminate. Apply this ointment to the rash, wrap it with a bandage and renew it every day.

Stage 2 treatment:

In addition to continuing the local treatment indicated for stage 1. In the second stage of the panaritium, it is possible to use anti-inflammatory drugs against pain and fever. However, it is usually recommended to go to the doctor to perform a minor surgery to remove the pus.
Doctors sometimes prescribe oral antibiotics, especially in patients at increased risk of infectious complications (in people with diabetes or immunosuppression). Cloxacillin, a penicillin, is the first-choice antibiotic3 , to be taken normally for 7 days. Floxacillin, a penicillin-resistant penicillin, is also a first-choice treatment when there is a risk of infectious complications. The combination of amoxicillin and clavulanic acid is used as a second choice. In case of allergy to penicillins, the doctor may prescribe macrolides such as azithromycin or spiramycin.

After this treatment, the whitish usually disappears within a few days.

Stage 3 treatment:

At this advanced and potentially serious stage, the doctor will suggest the appropriate treatment, a surgical operation and systemic antibiotics are often indicated.

Analgesics:
For the pain caused by the panaritium, paracetamol may be sufficient. Due to a possible worsening of the infection, anti-inflammatory drugs (steroidal or not) such as ibuprofen should be avoided.

Tips

– It is advisable to regularly try to lift the skin bordering the fingernail, because it often gets under the skin and this can cause infection and sometimes lead to whitlow.

– Do not cut your nails too short.

– Avoid biting the skin around the nails and the nails themselves, because this is how often infection mediated by microorganisms (bacteria) from saliva is introduced.

– Cover the wound caused by the whitlow well to avoid superinfection and therefore complications.

– Disinfect all manicure tools (with 70° alcohol, for example).

– If you suffer from panaritium, avoid cooking to avoid spreading the germs to other people (your guests).

– Do not hesitate to wear gloves for certain activities that may affect the skin (bites, injuries) such as gardening.

– As with all injuries, it is advisable to monitor your tetanus vaccination status .

– In the case of pimples, pedicure sessions can be useful.

– In the case of whitlow, wear open shoes (eg sandals) if possible.

– In case of a sore foot, pedicure sessions can be useful.

– In case of foot pain, whenever possible, wear open shoes (eg sandals).

Jeanne Kenney
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I’m a stylist trainer, a content creator, and an entrepreneur passion. Virgo sign and Pisces ascendant, I move easily between my dreams, the crazy world I want, and my feet on the ground to carry out my projects.

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