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 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.
Symptoms of The whitlow
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”, nail gnawed, a 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 occurrence of this injury, no symptoms are still felt (no pain, redness, etc.)
- The phlegmasic 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 parsnipworm)
- The stage of collection or abcédé . 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.
People at risk for The whitlow
The paronychia is a pathology which concerns especially the manual workers , more at risk of having injuries to the fingers.
The people with paronychia should not cook because staph present in the paronychia can contaminate food and cause acute diarrhea in people who have consumed. People working in the food sector (cooks, butchers, bakers, etc …) must stop their activity until healing.
The risk factors for paronychia are:
- trauma (puncture, excoriation …) of the fingers and nails, even minimal;
- manicure care;
- diabetes, because it predisposes to infections;
- alcoholism and drug addiction;
- Immune deficiency, which may aggravate an infection: treatments with cortisone or other immunosuppressants, HIV / AIDS, etc.)
The prevention of paronychia involves reducing risk factors such as:
- avoid biting nails and small skins around;
- avoid pushing back the cuticles;
- Wear gloves for manual work.
- To treat the small wounds which constitute potential doors of entry for the germs? It is important to wash and disinfect them with an antiseptic, to put a bandage, and to remove thorns and splinters if necessary with a sterilized tweezers)
Medical treatments of The whitlow
The treatment of paronychia requires consulting a doctor because complications can arise in case of inappropriate treatment.
- In any case, you must check that your tetanus vaccines are up to date and report them to your doctor because re-vaccination is necessary if the last injection is more than ten years old.
- In the phlegmasic or catarrhal stage, the doctor prescribes oral antibiotics active on staphylococcus, such as penicillin (Orbénine) or macrolide (Pyostacine), local treatments such as Fucidine-type antibiotic dressings or Mupiderm, as well as finger baths in an antiseptic (Hexomedine). An improvement must imperatively be noted within 48 hours. Otherwise, you must consult your doctor again urgently.
- At the collection stage, surgical treatment involves excising all necrotic tissue and purulent areas under local or locoregional anesthesia. They will be cultured for bacteriological analysis to determine the germ involved and its sensitivity to antibiotics (antibiogram). An adapted antibiotic treatment can then be put in place.