Mushrooms are not the only cause of whitlow. There are also infectious forms related to staphylococcus. First, the paronychia superficial, which touches the fingertip and sometimes reaches the edge of the nail. It causes swelling of the finger, which becomes red, hot and painful. Subsequently, it can be complicated by a deep paronychia (which may appear immediately treated with fresh fingers) and thus reach the joint, or even a tendon. In this case, the inflammation is much more intense and prevents any movement of the finger.
These paronychia (fresh fingers uk) must absolutely be treated with antibiotics, because they can spread and cause a significant regional infection, or even a generalized infection (sepsis). The paronychia attached to a fungus almost always reaches the edge of the nail. Pain, inflammation and swelling are less important. The treatment, only local, then uses antiseptics and antimycotics. But the diagnosis is not always so obvious. It is therefore preferable, in case of doubt, to start immediately antibiotic treatment to avoid any further concern. Finally, when the paronychia is very evolved, an incision with the knife is sometimes necessary to evacuate the pus. This is always the case when the paronychia is deep.
The paronychia is an infection that is in 2/3 of the cases on the circumference or on the underside of the nail. However, it can also be at the level of the pulp, on the side or on the back of a finger, or even on the palm of the hand. In 60% of cases, the causative organism of the paronychia is Staphylococcus aureus, but it can also be a streptococcus, an enterococcus, etc. The paronychia (fresh fingers) must be treated quickly because it is an infection with pyogenic germs (= causing pus) of a fragile part of the body, likely to reach the tendinous sheaths, the bones and the articulations of the hands, and Severe sequelae, such as loss of mobility and / or hand sensitivity.
The paronychia evolves in three stages:
- The stage of inoculation . The paronychia is caused by an injury that is a sort of gateway to the germ
- Bacteria enter or under the skin via the wound. This injury can go unnoticed because it is mostly related to a micro-cut, small skin torn around the nail, commonly called “cravings”, nails gnawed, manicure and the removal of cuticles, these small areas of skin that covers the nail at its base, a sting, splinter or thorn. For 2 to 5 days after the onset of this injury, no symptoms are still felt (no pain, redness, etc.)
- The phlegmatic stage or catarrhal . Inflammatory signs appear near the area of inoculation, such as swelling, redness and a feeling of warmth and pain. These symptoms subside at night. There are no lymph nodes (= painful ball in the armpit, a sign that the infection begins to ring on the lymphatic drainage system). This stage is often reversible with local treatment (see Part: Treatment of parsnip worm) .
- The stage of collection. The pain becomes permanent, pulsatile (the finger “beats”) and often prevents sleep. Inflammatory signs are more marked than in the previous stage and it is common to see a purulent yellow pocket. A painful ganglion may be felt in the armpit (signaling spread of infection) and moderate fever (39 ° C) may occur. This stage requires urgent surgical treatment as it exposes to complications related to the spread of infection:
either on the surface with the appearance of other purulent yellow spots, called fistulas (= branches of infection in the surrounding skin), or a black necrotic plaque (= the skin is dead at this location and excision surgical dead zone will be required).
either deep down to the bones (= osteitis), tendons (= phlegmon of the tendinous sheaths that surround the tendons or joints (= septic arthritis) .This is in this case infections, closed structures, difficult to access for antibiotics requiring flattening and surgical excision of infected structures.