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Boils, carbuncles, folliculitis, paronychia and staphylococcal whitlow - Management
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Definition
- Staphylococcal whitlow is an abscess of the fleshy area of the palmar aspect of the fingertip.
For someone with a suspected boil, carbuncle, folliculitis, acute paronychia or staphylococcal whitlow, what assessment do I need to make?
- Size and position of the lesion.
- Presence of pus or fluctuance (wave-like feeling on palpating skin overlying a fluid-filled cavity with nonrigid walls).
- Symptoms suggesting systemic spread of infection.
- Whether a swab is required.
In depth
Do I need to take a swab (boils, carbuncles, folliculitis, paronychia, staphylococcal whitlow)?
- Swabs are not routinely required for initial management.
- Swabs are indicated if the lesion is getting worse over 48 hours despite antibiotic treatment, or there is no response to empirical antibiotic treatment within 5–7 days.
In depth
How do I manage staphylococcal whitlow without fluctuance?
- Advise the person to:
- Elevate the finger.
- Use warm soaks three to four times a day.
- In addition, treat empirically with oral antibiotics.
- Referral for IV antibiotics should be considered if oral antibiotics fail, the person is unwell, or proximal lymphangitis or cellulitis is present.
- Urgently discuss management with a specialist if complications (e.g. osteomyelitis, skin necrosis, sinus tract formation, septic joint, tenosynovitis, compartment syndrome) are suspected.
- Offer analgesia (paracetamol or ibuprofen) if needed.
In depth
How do I manage staphylococcal whitlow with fluctuance?
- Refer for incision and drainage; only attempt in primary care if skilled in incising and draining staphylococcal whitlows.
- In addition, treat empirically with oral antibiotics.
- Referral for IV antibiotics should be considered if oral antibiotics fail, the person is unwell, or proximal lymphangitis or cellulitis is present.
- Urgently discuss management with a specialist if complications (e.g. osteomyelitis, skin necrosis, sinus tract formation, septic joint, tenosynovitis, compartment syndrome) are suspected.
- Offer analgesia (paracetamol or ibuprofen) if needed.
In depth
Which antibiotic should I prescribe (if indicated)? (boils, carbuncles, folliculitis, paronychia, staphylococcal whitlow)
- Oral flucloxacillin is recommended for empirical treatment.
- Oral erythromycin (or clarithromycin if erythromycin is not tolerated) is an alternative for people with penicillin allergy.
In depth
How long should I prescribe antibiotics for? (boils, carbuncles, folliculitis, paronychia, staphylococcal whitlow)
- A 7-day course of empirical antibiotic treatment is recommended.
In depth
What should I do if there is no response to treatment (staphylococcal whitlow)?
- Urgently discuss further management with a specialist, for example general-, plastic-, or orthopaedic surgeon, depending on local policy.
In depth
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