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Whitlow - Coggle Diagram
Whitlow
Diagnosis
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Sometimes an initial tight feeling, or a pricking pain.
A rapid onset of very severe, throbbing pain.
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An abrupt onset of oedema, redness, and localized tenderness of the infected finger (severe pain which is usually out of proportion to physical findings).
A previous history — up to half of people with herpetic whitlow will experience recurrent infections.
Examine the affected finger, looking for evidence of an abscess, or vesicles suggesting herpetic infection
Take a history, including asking about any preceding injury, onset of symptoms, and previous episodes.
any part of end of finger may be affected, and more than one, most common index finger and thumb
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No vesicles are present, but pointing of an abscess may be present.
Vesicles are present. Fluid within the vesicles is usually clear, but may appear cloudy or bloody.
Management
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Swab -recurrent, increased risk of infection, no response to Rx after 2-3 days, Hx of MRSA, doubt about diagnosis
Self care advice- elevate finger, moist heat 3-4 times daily to alleviate pain, and hasten drainage of pus, Paracetamol or NSAIDS for pain, avoid injury to finger, worsening advice
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Self Care Advice- Paracetamol or NSAID for pain. Avoid touching area. Wear dressing to protect from further infection.
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Complications
Tenosynovitis — may result from spread of infection due to accidental nicking of the flexor tendon sheath with a scalpel during incision and drainage.
Tissue necrosis — the pulp of the fingertip is divided into many small compartments by vertical septa, and the increase in pressure (due to the presence of pus) in these small compartments may cause tissue necrosis.
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Rarely, systemic infection.
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Increased sensitivity or numbness in between episodes of infection — reported in about 30–50% of people.
Lymphangitis and lymphadenitis, particularly with herpes simplex virus-2 infection
Rarely, lymphoedema of the hand and forearm.
Differential
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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.
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Infective endocarditis with Osler's nodes, which are painful, swollen, purplish nodules in the pulp of the fingers.
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Risk Factors
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Presence of other herpetic lesions, such as herpes labialis, herpetic gingivostomatitis, or genital herpes — infection can spread through autoinoculation
Immunocompromised people (such as people with HIV infection or people undergoing treatment with corticosteroids)
Definition .
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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 fingers