OVERVIEW

What is felon?

Felon is a type of bacterial infection in the hand, typically characterized by redness, swelling, and significant pain in the fingertip pulp. It usually requires surgical incision for pus drainage and antibiotic treatment. Generally, it leaves no sequelae.

Felon is also known as pulp space infection.

Is felon common?

Literature reports indicate that felon accounts for 15-20% of all hand infections.

Is felon the same as paronychia?

No. Felon occurs in the fingertip pulp, while paronychia affects the skin surrounding the nail. Paronychia is slightly more common than felon.

SYMPTOMS

What are the common manifestations of felon (pulp abscess)?

• Pain in the fingertip pulp: This is the most common and earliest symptom of felon, mainly due to the rich nerve endings in the fingertip.

• Redness and swelling of the fingertip pulp: As the felon progresses, localized redness and swelling of the skin occurs, often accompanied by significant tenderness.

• Pus formation in the fingertip pulp: In moderate to advanced stages, pus accumulates beneath the skin, causing severe pain. A visible white purulent material can often be seen under the skin.
  Typically, the pus remains localized to the distal fingertip and rarely spreads beyond the distal interphalangeal joint toward the proximal area.

CAUSES

What is the cause of felon (pyogenic finger infection)?

The most common cause is minor trauma to the finger skin causing skin breakage, allowing bacteria to invade and lead to finger inflammation. Sometimes the injury may be so minor that patients may not have clear awareness or memory of it.

What are the common bacteria causing felon?

It is mainly Staphylococcus aureus, so doctors typically choose anti-staphylococcal antibiotics for empirical treatment. However, in recent years, methicillin-resistant Staphylococcus aureus (MRSA) has become increasingly prevalent.

DIAGNOSIS

How to Determine if You Have Felon (Pulp Infection)

Generally, redness, swelling, and pain in the fingertip pulp, along with a localized high-tension purulent point, are sufficient to diagnose felon without additional tests. However, further evaluation may be needed in the following cases:

• To identify the causative bacteria, a bacterial culture and antibiotic sensitivity test may be required to guide treatment.

• If the infection extends beyond the distal interphalangeal joint, X-rays or MRI may be necessary to assess for osteomyelitis or infectious tenosynovitis.

• In cases of clear trauma, especially with skin lacerations from small foreign objects, imaging may be needed to evaluate for retained debris.

• If systemic symptoms (e.g., fever, chills) are severe, blood tests may be required to assess inflammation levels, and blood cultures may help identify the causative bacteria.

TREATMENT

Which department should I visit for felon (finger abscess)?

This varies by hospital. Generally, the initial department is orthopedics, while some hospitals may direct patients to general surgery, depending on their departmental setup.

Can felon heal on its own?

With proper early treatment, mild cases may resolve spontaneously. However, most cases require surgical intervention.

How is felon treated?

Most cases require surgical management, though a small number may heal with regular disinfection and oral antibiotics. Immediate surgical treatment is needed if:

• A visible pus pocket forms with high skin tension and obvious fluctuance.
• The infected area extends beyond the fingertip, surpassing the distal interphalangeal joint.
• Imaging (X-ray, MRI) shows infection spreading to bone or other structures.
• Infection persists or worsens despite antibiotic therapy.

What does surgical treatment for felon involve?

The primary procedure is abscess incision and drainage. A skin incision is made at the point of highest tension to drain pus, which is sent for bacterial culture.

Empirical antibiotics are initially prescribed, followed by targeted therapy once culture results are available.

How long does felon treatment take?

Recovery depends on severity and bone involvement. With prompt treatment, complete healing typically occurs within 3–4 weeks.

Does felon cause long-term complications?

Significant sequelae are rare. However:

Scarring may occur at the incision site, with possible localized tenderness or hypersensitivity lasting 6–12 months or permanently.

Recurrent infections may develop, often due to incomplete debridement. Rarely, chronic infections may necessitate finger amputation.

DIET & LIFESTYLE

Are there any lifestyle precautions for patients with felon (purulent finger inflammation)?

No special precautions are needed. Maintain a balanced diet and engage in physical exercise to strengthen the body's resistance. You can refer to the following health recommendations for dietary and lifestyle arrangements:

• No specific dietary restrictions—just maintain a healthy, balanced diet.

  • When cooking, use less salt, less oil, and fewer high-sodium seasonings. Avoid pickled vegetables, meats, etc.;
  • Avoid relying solely on refined rice and flour for staple foods. Replace some with whole grains, legumes, potatoes, or pumpkin;
  • Balance meat and vegetables. Prioritize white meats like chicken, duck, and fish, and limit fatty meats. Eggs and milk are important sources of protein and other nutrients;
  • If vegetarian, consume more beans and soy products for protein. Eat plenty of fruits and vegetables. Avoid alcohol as much as possible.

• No special lifestyle precautions—just maintain a healthy routine.

  • Avoid smoking;
  • Exercise regularly, avoid prolonged sitting, and prevent overweight or obesity;
  • Exercise 3–5 times a week, about 30 minutes per session, combining aerobic and strength training with moderate intensity;
  • Ensure sufficient sleep daily, regardless of bedtime;
  • Learn to manage stress and emotional tension.

PREVENTION

How to prevent felon?

Pay attention to avoiding injuries in daily life. If an injury occurs, especially when tiny fragments pierce the skin, promptly remove the foreign object and disinfect the wound.