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Finger infections

Last updated: October 4, 2019

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Common finger infections include paronychia, felon, and herpetic whitlow. A paronychia is an acute or chronic soft tissue infection around the nail body. Acute infections are typically bacterial in origin and usually occur after minor trauma. Chronic paronychia infections have a multifactorial etiology, often related to repeated exposure to moist environments and/or skin irritants, and may be accompanied by secondary fungal infection. The diagnosis of paronychia is based on clinical signs of inflammation. A bacterial culture or fungal stain can confirm the causative pathogen. Treatment of acute paronychia usually involves antibiotics, while chronic paronychia is treated with topical steroids and antifungal therapy. Complications include nail dystrophy or felon.

Felon is an infection of the distal pulp space of the fingertip. While the cause is often unknown, minor trauma most commonly precedes infection. It is a clinical diagnosis based on the presence of local pain, swelling, induration, and erythema. Early stages of felon may be managed conservatively with analgesics and antibiotics. Later stages require incision and drainage. Complications include fingertip soft tissue necrosis and osteomyelitis.

Herpetic whitlow is discussed in herpes simplex virus infections.

Acute Chronic
Etiology
  • Multifactorial: chronic exposure to moist environments or skin irritants (e.g., household chemicals) eczematous inflammatory reaction → possible secondary fungal infection
Clinical features
  • Chronic or episodic history > 6 weeks of inflamed nail folds without fluctuance
  • May progress to thick, discolored nail plates → separation of cuticles/nail folds from the nail plate
Diagnosis
Treatment
Complications

References:[1][2][3][4]

References:[5][6]

References:[7]

  1. Fox J. Felon. Felon. New York, NY: WebMD. http://emedicine.medscape.com/article/782537-treatment#showall. Updated: February 29, 2016. Accessed: February 14, 2017.
  2. Sebastin S, Chung KC, Ono S. Overview of hand infections. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/overview-of-hand-infections?source=search_result&search=Felon&selectedTitle=1~4.Last updated: February 8, 2016. Accessed: February 28, 2017.
  3. Rich P. Overview of nail disorders. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/overview-of-nail-disorders.Last updated: August 29, 2017. Accessed: February 24, 2018.
  4. Relhan V, Goel K, Bansal S, Garg VK. Management of chronic paronychia. Indian J Dermatol. 2014; 59 (1): p.15-20. doi: 10.4103/0019-5154.123482 . | Open in Read by QxMD
  5. Goldstein BG, Goldstein AO. Paronychia and ingrown toenails. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/paronychia-and-ingrown-toenails.Last updated: December 8, 2016. Accessed: February 14, 2017.
  6. Billingsley EM. Paronychia. Paronychia. New York, NY: WebMD. http://emedicine.medscape.com/article/1106062-overview. Updated: June 6, 2016. Accessed: February 28, 2017.
  7. Rockwell PG. Acute and Chronic Paronychia. Am Fam Physician. 2001; 63 (6): p.1113-1117.
  8. Phillips BZ. Nail Anatomy. Nail Anatomy. New York, NY: WebMD. http://emedicine.medscape.com/article/1948841-overview. Updated: September 12, 2013. Accessed: February 28, 2017.