Mānuka

CASE STUDY: Mānuka

SUBMITTED BY: Katie Donnelly

CLIENT: Male, 21 years old

INITIAL PRESENTATION:

Male presenting with paronychia of the hallux, after experiencing nail trauma. Toe is swollen, red, painful, and warm to the touch. Some yellowing is evident under the skin. Mild pressure on the toe from the client, using a cotton bud, has drained some of the pus. However, he advised that the next morning, it was the same again. No yellowed crusting present.

Client is otherwise in good health. There is no fever present. The redness is isolated to the big toe and does not show signs of spreading further at present. It has begun to seep clear fluid, which is worse during the day when he wears shoes and socks for work, creating a moist environment. This fluid often dries and sticks to his sock. When he removes the sock, this peels away the layer and causes notable pain and some raw skin exposure.

The client has not experienced any other skin conditions or previous infections. He has no known allergies and is not taking any supplementation. He has advised that he will go to the doctor for an assessment if required for antibiotic ointment. Essential oils were not appropriate for this client.

HERBAL TREATMENT – Topical antimicrobial/antiseptic blend

Leptospermum scoparium Mānuka 10% 1:2

Thymus vulgaris Thyme 5% 1:2

Macropiper excelsum Kawakawa 5% 1:2

Total 20%

Application

54864. to 50mg base cream. Apply 3-4 times per day after washing the toe. Use a spatula or popsicle stick to get the cream out and do not ‘double dip’.

TREATMENT RECOMMENDATIONS

• Fresh ribwort leaves have been supplied to gently crush, warm, and apply as a poultice in the evening after work, to draw out infection. Keep this wrapped around the toe for as long as possible, but a minimum of 15 minutes at a time. Rise the toe afterwards and apply cream.
• Alternate poultice application with soaking the foot in warm, salted water.
• After cleaning your toe in the morning, dry and then apply the cream. Loosely wrap a dry bandage around the toe prior to applying socks.
• Allow for air exposure as frequently as possible by keeping the toe uncovered.

FOLLOW-UP – ONE WEEK LATER:

The client kept in touch over the week to ensure the infection did not develop further, and to ensure there was no signs of redness spreading or symptoms worsening.

Visual improvements noted. Redness has reduced, but still noticeably pink and swollen. Pus has subsided significantly.

He has advised that there were phases where pain was gone, but then redness and infection returned when he re-stubbed the same toe.

Although the client had been applying the cream, he had not been soaking the toe or cleaning the wound adequately.

• Soaking and cleaning the wound is crucial for healing.
• Continue to apply the cream liberally after gentle washing, 34 times per day. It is important to be vigilant with this.=
• Introduce plenty of antioxidant rich foods to support overall wellbeing or commit to a vitamin c supplement.
• Ensure you use a fresh piece of bandage each time you need to wrap your toe prior to wearing socks. Keep your feet out of shoes and socks wherever possible, including breaks at work. Clean your toe during this time (with clean hands) and reapply cream.

FOLLOW-UP – TWO WEEKS LATER:

The client has been following guidelines more carefully and the wound has cleared. No signs of pus, swelling, or infection, and no pain. He is very pleased with his personal progress and with how well his wound has healed.