The whitlow is a infection which is located in 2/3 of cases on the periphery or on the underside of the nail. However, it can also be located 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 germ responsible for whitlow is Staphylococcus aureus, but it can also be streptococcus, enterococcus, etc. The whitlow must therefore be treated quickly because it is an infection with pyogenic germs (= causing pus) of a fragile part of the body, likely to reach the tendon sheaths, bones and joints of the hands, and generate serious sequelae, such as loss of mobility and / or sensitivity of the hand.

Symptoms of the disease

The whitlow develops in three stages¹:

• The inoculation stage. The whitlow is caused by an injury that is a kind of entry point for the germ
• Bacteria enter or under the skin through the wound. This injury can go unnoticed because it is most of the time linked to a micro-cut, to small skin torn off around the nail, commonly called “cravings”, to bitten nails, to a manicure and to the repression of the cuticles, these small areas of the nail. skin that covers the nail at its base, a bite, a splinter or a thorn. For 2 to 5 days after the occurrence of this injury, no symptoms are still felt (no pain, redness, etc.)
• The inflammatory stage ou catarrhal. Inflammatory signs appear near the area of ​​inoculation, such as swelling, redness, and a feeling of heat and pain. These symptoms subside at night. There are no lymph nodes (= painful lump in the armpit, a sign that the infection is starting to affect the lymphatic drainage system). This stage is often reversible with local treatment (see section: Treatment of whitlow).
• The collection stage ou abcédé. The pain becomes permanent, throbbing (the finger “beats”) and often prevents sleep. The inflammatory signs are more marked than in the previous stage and it is common to see a purulent yellow pocket appear. A painful lymph node may be felt in the armpit (indicating spread of the infection) and a moderate fever (39 ° C) may occur. This stage requires a urgent surgical treatment because it exposes to complications related to the spread of the infection:

– either on the surface with the appearance of other yellow purulent dots, called fistulas (= ramifications of the infection in the surrounding skin), or a black plaque of necrosis (= the skin is dead at this place and an excision surgical treatment of the dead zone will be necessary)

– either in depth towards the bones (= osteitis), the tendons (= phlegmon of the tendon sheaths which surround the tendons or the joints (= septic arthritis). access for antibiotics and requiring flattening and surgical excision of infected structures.