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WHITLOW - Coggle Diagram
WHITLOW
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Diagnosis
Staphylococcal Whitlow - penetrating injury/untreated paronychia/tight feeling/pricking pain.
Rapid onset very severe/throbbing pain. Redness/swelling distal pulp of fingertip
Herpetic Whitlow - no history of injury. Current/recent oral or genital herpetic lesions. History of fever/malaise/prodrome of pain /paraesthesia of affected finger few days. Sudden onset of oedema/redness/localised tenderness infected finger. Previous history of herpetic whitlow.
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Management
staphylococcal whitlow
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If incision/drainage not indicated - consider oral antibiotics. Flucloxacillin first line. Erythromycin /clarithromycin if allergy to penicillin. Erythromycin for pregnant/breastfeeding women. Seek specialist advice if known MRSA infection
Consider taking swab - if whitlow is recurrent. If immunosuppressed/at risk of infection. If whitlow not responding to treatment 2-3 days. if hx of MRSA infection /contact/uncertainty of diagnosis.
Consider X-ray if hx of injury/foreign body. Consider need for Tetanus prophylaxis.
Advise person to elevate finger.
Apply most heat.
Take simple analgesia
Reduce risk of recurrence by avoiding risk factors. Advice seek medical advice if swelling/pain worse/fluctuant/systemically unwell.
Recurs.
Herpetic Whitlow
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Consider taking swab for - Virological culture if diagnosis uncertain/whitlow not resolved with treatment/recurrent /immunosuppressed. Bacterial culture if secondary infection suspected
Advise - Simple analgesia for pain relief. Avoid touching infected area. Ensure infected finger covered with clean/dry dressing to prevent transmission
Avoid touching other parts of body with infected finger. Avoid contacted lenses until infection healed
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Inform that recurrece is common. Offer HIV testing if lesion extensive. Manage underlying cause of herpetic whitlow.
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