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Whitlow (Advise patient (Take paracetamol or ibuprofen as required for…
Whitlow
Advise patient
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Ensure that the infected finger is covered with a clean, dry dressing to prevent transmission.
Avoid touching other parts of their body with the affected finger, especially the eyes. They should avoid wearing contact lenses (instead wear glasses) until the infection has healed.
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Inform the person that recurrence is common, but the initial infection is usually the most severe.
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Advise patient:
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Reduce the risk of recurrence by avoiding risk factors, such as injuries to the finger tips.
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Swelling and pain become worse, or the whitlow becomes fluctuant (incision and drainage may be necessary).
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Differentials
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A finger-tip injury, such as a subungual haematoma from blunt or crush injuries, avulsion of the nail root, or fracture of the terminal phalanx.
Differentials
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Paronychia. For more information, see the CKS topic on Paronychia - acute.
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Infective endocarditis with Osler's nodes, which are painful, swollen, purplish nodules in the pulp of the fingers.
Treatment
Wear protective gloves when touching a person with active symptoms of herpes, such as an open, fluid-filled blister.
Consider prescribing an antiviral drug if the person presents soon after the onset of symptoms (for example within 48 hours). Aciclovir is recommended first line..
Antiviral drugs can be used to treat recurrent episodes if they are initiated within 48 hours of onset of symptoms.
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Staphylococcal whitlow (also known as a felon) is a closed-space infection of the distal finger pulp.
Herpetic whitlow is a herpes simplex infection that typically appears on the distal phalanx of the finger
Consider arranging for same-day incision and drainage for people with a whitlow that is tense (even when a frank abscess has not developed) or fluctuant (the lesion feels 'boggy', and the overlying skin has a shiny appearance).