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| Miscellaneous Disorders of the Hand & Upper Extremity > Fingertip Infections What are Fingertip Infections? There are several kinds of fingertip infections, typically occurring in the following locations: Felons are infections in the top portion of the finger, in the pad of skin above the first joint, the DIP or distal interphalangeal joint controlling the fingertip. They most often affect the thumb and index finger. Paronychia infection is the most common type of hand infection. It occurs in the soft tissue surrounding the fingernail. Herpetic Whitlow is a herpes simplex virus (HSV) infection in the pad of skin in the fingertip. Causes of Fingertip Infections? Fingertip infections are caused by bacterial or viral agents that penetrate the skin by means of a wound. Staphylococcus aureus is the most common bacterial organism of felons and paronychia. Sometimes these infections are caused by streptococci. A felon is commonly the result of a puncture wound, although it may also arise when untreated paronychia spreads infection into the pad of the fingertip. Paronychia, an infection of the tissue around the fingernail, may be spread by means of a manicure, an ingrown nail, a hangnail, or dishwashing. When seen in children, it is usually the result of thumb or finger sucking. Herpetic whitlow results from the direct inoculation of either type I or type II herpes simplex virus into the broken skin of the fingertip. It used to be more common among healthcare workers, such as dental hygienists and respiratory therapists, who are exposed to human saliva. Using universal body substance precautions, such as latex gloves, limits exposure to herpes simplex (HSV). Symptoms of Fingertip Infections? Felons are characterized by severe pain. The entire pad of the fingertip is tense, red, swollen, and very tender. There may be a visible puncture wound. The infection is contained above the DIP joint in a closed fibrous compartment, helping prevent the spread of bacteria to lower portions of the finger. The felon exerts pressure within this compartment, often impairing the flow of blood to the fingertip. Sometimes the infection invades the fingertip bone, leading to a condition called osteomyelitis. Paronychia infection does not usually produce the intense pain of a felon. Nevertheless, the area alongside and at the base of the fingernail is swollen, red, and bothersome. If paronychia spreads completely around the edge of the nail, it is referred to as a "run-around abscess." Herpetic whitlow also produces localized intense pain and swelling in the fingertip. It is normally limited to one finger. Close examination reveals clear vesicles (tiny sacs or cysts) specific to this condition. In later stages, the vesicles may form an ulcer. If the fluid in the vesicles is cloudy, there may be a superimposed infection. The pulp of the finger pad remains soft, distinguishing it from the tense fingertip surface of a felon. Treatment of Fingertip Infections? If you develop an infection in a fingertip, have it examined promptly. Emergency medical physicians are trained to treat fingertip infections, as are most doctors. Do not try to drain an abscess yourself, as this could result in the spread of infection into the adjacent flexor tendon sheath or other sensitive finger or thumb tissue. Proper treatment of fingertip infections prevents such complications as scarring, sensory loss, damage to the finger pad, and unnecessary pain. Your doctor will examine your hand and ask about any contributing factors, such as a puncture wound or other traumatic injury. If necessary, your tetanus booster status will be updated. Sometimes x-rays are used to rule out the possibility of a fracture, a foreign body within the injury, or damage to the bone indicating osteomyelitis. X-rays help identify any gas formation that may be present in the wound as well. You will be asked to passively flex and extend your finger to see if motion increases the pain. Increased pain is suggestive of a deep infection in the sheath of the flexor tendon; this condition usually requires specialized care. The pad of the finger will be inspected for the small vesicles of herpetic whitlow. A diagnosis of herpes simplex can be confirmed with a Tzanck test, a laboratory test using cells scraped from the base of a vesicle. The diagnosis of felons and paronychia usually require no lab work. Sometimes your doctor will recommend frequent hot soaks and a short course of antibiotics, hoping that these will clear up the problem. In most cases, particularly when the fingertip is abscessed, incision and drainage are the preferred treatment for these infections. Using a digital nerve block to numb any pain, your doctor makes the particular incisions required by each condition, normally using a small wick to allow for the continued drainage of pus. In the case of a felon, the incision should not extend into the crease of the DIP joint. Paronychia sometimes requires the removal of a section of the adjacent fingernail. If the infection has produced a large abscess beneath the nail plate, causing it to "float," the entire nail may require removal. The site of the incision is irrigated and loosely packed with gauze dressing. An overlying splint may be applied as well. Follow-up treatment for felons and paronychia involves soaking the finger three to five times daily, according to your doctor°s instructions. If antibiotics are prescribed, continue taking them for as long as recommended, usually 3 to 7 days. Schedule a follow-up exam for 48 hours after the initial incision; at this point the wound is re-evaluated, the packing removed, and the injury irrigated. In cases of continued drainage, another follow-up exam should be scheduled for 24 hours later. If there is no further drainage, you will probably be instructed to wash the wound twice daily in warm soapy water and then cover it with clean gauze dressing. If herpetic whitlow is diagnosed, you will be told how to keep the infected area clean and covered with a dry dressing. This helps contain further spread of the virus. Oral acyclovir is sometimes prescribed, especially for immunocompromised patients or for those who suffer from recurring herpes infections. After treatment, felons normally take one or two weeks to heal. Paronychia may resolve in two to four days. Cases of herpetic whitlow usually clear up within two to four weeks, although recurrance is not uncommon if the virus remains dormant in the neural ganglia of the fingertip. As in the case of any infection, watch the wound and promptly report any worsening condition to your doctor. The information provided herein is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting a licensed physician. ©2000 DynoMed.com, LLC, Indianapolis, IN |