Whitlow is a purulent infection at the end of a finger or toe in the area surrounding the nail. A pus filled abscess or boil is seen on the tip of the finger next to the nail. Virus or bacteria primarily causes whitlow that enters the human body via cut. People who work in water are likely to suffer from this disease more. Briefly, whitlow can be stated as “Finger tip soft pad infection”.
Some of the symptoms of Whitlow include, Fingertip infection, swollen fingertip, Painful fingertip, Fever, Tender elbow lymph nodes, swollen elbow lymph nodes, Tender armpit lymph nodes & swollen armpit lymph nodes.
In a fingertip abscess, most often initial symptoms are pain and burning. This usually is followed by erythema, edema, and the development of 1- to 3-mm grouped vesicles on an erythematous base over the next 7-10 days. These vesicles may ulcerate or rupture and usually contain clear fluid, although the fluid may appear cloudy or bloody. Lymphangitis and epitrochlear and axillary lymphadenopathy are not uncommon. After 10-14 days, symptoms usually improve significantly and lesions crust over and heal. Viral shedding is believed to resolve at this point. Complete resolution occurs over subsequent 5-7 days.
Whitlow or the nail disease paronychia is of two types. They are acute paronychia and chronic paronychia. Whitlow is often a tender bacterial or fungal infection where the nail and skin meet at the side or the base of a finger or toenail. The infection starts suddenly in acute paronychia and gradually in chronic paronychia. The cuticle acts as a protective seal, but if it is damaged in any way then bacteria are able to enter the skin and cause infection. Despite the small area affected these infections can be extremely painful as the skin becomes inflamed, hot, red, and throbs continually. Pus is usually present, along with gradual thickening and browning discoloration of the nail plate. If a large amount of pus has collected then it may be necessary to make a little cut in the skin under local anesthetics to release it. Prosector’s paronychia is a primary inoculation of tuberculosis of the skin and nails, named after its association with prosectors, who prepare specimens for dissection. Paronychia around the entire nail is sometimes referred to as runaround aronychia.When the infection comes on quickly it is usually caused by bacteria. Most often it is trauma to the cuticle that allows infection in.
Herpetic whitlow is an intense painful infection of the hand involving 1 or more fingers that typically affects the terminal phalanx. Herpes simplex virus 1 (HSV-1) is the cause in approximately 60% of cases of herpetic whitlow, and herpes simplex virus 2 (HSV-2) is the cause in the remaining 40%.Herpetic whitlow is initiated by viral inoculation of the host through exposure to infected body fluids via a break in the skin, most commonly a torn cuticle. The virus then invades the cells of the dermis and subcutaneous tissue, and clinical infection ensues within a matter of days.
In children, HSV-1 is the most likely causative agent. Infection involving the finger usually is due to autoinoculation from primary oropharyngeal lesions as a result of finger-sucking or thumb-sucking behavior in patients with herpes labialis or herpetic gingivostomatitis. Similarly, in health care workers, infection with HSV-1 is more common and usually is secondary to unprotected exposure to infected oropharyngeal secretions of patients. This easily can be prevented by use of gloves and by scrupulous observation of universal fluid precautions.
The diagnosis varies according to the severity of the disease. Diagnosis of herpetic whitlow usually is clinical, based on presentation of the affected digit with characteristic lesions and a typical history. In children, observation of concurrent gingivostomatitis is almost pathognomonic. In adults, the presence of occupational risk factors or finding of concurrent oral or genital herpes lesions should strongly suggest the diagnosis. Definitive diagnostic testing includes the Tzanck test, viral cultures, serum antibody titers, fluorescent antibody testing, or DNA hybridization.
Herpetic whitlow is a self-limited disease. Treatment most often is directed toward symptomatic relief. Acyclovir may be beneficial to shorten the duration of symptoms and viral shedding during the primary infection. Oral acyclovir may prevent recurrence. Antibiotic treatment can be used only in cases complicated by bacterial super infection. Tense vesicles may be unroofed to help ameliorate symptoms, and wedge resection of the fingernail may be used for the same purpose in cases involving the subungual space.Deep surgical incision is contraindicated, since this may lead to delayed resolution, bacterial super infection or systemic spread, and complications such as herpes encephalitis.
Biting or picking at the cuticle, damage through work and overenthusiastic manicuring are the usual culprits. Individuals who work with their hands in water, such as health care workers and food processors, are quite prone to this type of infection.
Excess water weakens the seal and soaps or detergents will remove the protective skin oils, leaving the skin dry and more liable to split.
To prevent from this painful disease, Health care workers should use gloves, practice strict hand washing, and scrupulously observe universal fluid precautions In general it is important to moisturize the skin well after having the hands in any water and not to go digging around the cuticle when manicuring the nails. Studies have demonstrated herpes virus in 2.5% of asymptomatic patients and in 6.5% of hospitalized patients with tracheostomies. Caution patients with oral, labial, or genital lesions and the parents and caregivers of children with lesions against digital contact with lesions.
The remedies for whitlow which can be done at home are stated below.
*Make a hole in a lemon fruit and thrust the infected finger inside it for 30 minutes in a day for fast relief.
* Apply a poultice out of rice flour and linseed and apply it on affected finger for quick relief.
Hepar sulphur is the great homoeopathic remedy for suppurations where the pus is not decomposed. It suits especially lymphatic, phlegmatic individuals. Excessive sensitiveness of the parts is a leading indication. It is further indicated by these symptoms: chilly sensations, throbbing in the parts or sharp, sticking pains which are worse at night .If given low in threatening suppuration it will favor the formation of pus. The suppurative process will often be aborted by Hepar if given in the higher potencies. Such abscesses as felon or whitlow generally do well under Hepar. If there be a bruised pain present, sometimes Arnica may do well.
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