A paronychia

This is a paronychia—an infection that stays around the fingernail. It’s not as dangerous as a felon (another type of finger infection), but it still needs proper treatment so it doesn’t get worse.

by James Hubbard, M.D., M.P.H.

If you’ve ever had a hangnail that got a little infected, you discovered you have a lot of nerve endings in your fingers. And you found out you use your hands for just about everything. Hands you’ll especially need during disasters.

Fortunately, most infected hangnails heal well as long as you keep the area dry and clean. (Gloves? Band-Aids?) But sometimes, rarely, an infected finger can get serious.

The infection can run up the finger, into your hand’s tendons, and you have a dangerous mess on your hands—literally. Or the fingertip can become so swollen that it starts cutting of the circulation, putting you in danger of losing that finger. This type of infection is called, perhaps appropriately, a felon.

Here are some tips to help you kinda know what you’re dealing with and what to do.


Paronychia: An Infection Around the Fingernail

Unless there’s a cut or scratch, most infections spring up around the cuticle, where the bacteria worked its way in. If the infection stays there—around the fingernail—it’s called a paronychia (pa-ruh-NIK-ee-uh). Who knows why? To treat a paronychia if you can’t get to a doctor:

  1. Use warm soaks on it. You can dip it in warm water or use warm, wet cloths. Do this often, for ten to twenty minutes at a time.
  2. If you’re bumping it, cover it with a adhesive bandage. Wear gloves. Splint it with a stick if you need the extra protection.
  3. Within a day of heat, it’ll either heal or come to a head, meaning the redness will localize in one corner around the nail, and a small white spot will form.
  4. Sterilize a sharp object, such as a safety pin, by holding the tip under a flame until it’s red. Or at least dip the tip in alcohol.
  5. Lightly prick the white spot. It shouldn’t hurt because you don’t stick the needle deep, just enough to let the pus out. There’s no need to stick it if there’s not that white spot. You’ll only get blood—and a risk for more infection.
  6. Apply antibiotic ointment or honey (not for babies) and an adhesive bandage.  It should be healed in another day.
  7. If this doesn’t do it, start oral antibiotics, if available.

Pretty easy stuff.


Felon: A Serious Infection in the Fingertip Pad

Rarer is the more serious felon. No, not the criminal type. This is when infection gets deep into the fingertip pad. The fingertip swells and throbs. The circulation could cut off and you could lose a finger, or the infection could spread into the hand.

To treat a felon:

  1. Get to a health-care provider if you can. Many times a felon has to be surgically opened up. The fingertip pad must be cut open to relieve the pressure. A pin’s not going to do it here.
  2. Until you can get expert treatment, start oral antibiotics.
  3. Elevate the finger about at your heart level.
  4. Warm soaks are worth a try.

Something similar to a felon is a herpetic whitlow. It’s caused by the herpes virus. As with a fever blister and genital herpes, a whitlow is recurrent and tends to cause pain and blisters, run its course, and go away. The finger pad is usually not as swollen as it is with a felon. If you catch a whitlow early, prescription antiviral medications may shorten the course.

Unless you’ve had a whitlow before, it’s going to be hard to tell the difference between that and felon. If you couldn’t get to a doctor, I’d treat it like a felon.

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Photo by Chris Craig.