GPAtlas🧭 When to suspect
A felon is an acute infection of the closed pulp space of the distal phalanx (the fingertip pad). The pulp is divided by tough fibrous septa into many small compartments, so infection raises pressure rapidly inside an unyielding space – producing intense, throbbing pain and risking ischaemic necrosis of the pad and osteomyelitis of the underlying bone. The usual organism is Staphylococcus aureus, and most follow a minor penetrating injury (splinter, thorn, needle, or a diabetic capillary glucose finger-prick).
The two clinical priorities are simple: recognise and decompress a tense felon (antibiotics alone are often insufficient once pus has formed), and do not mistake it for the two conditions it most resembles – acute paronychia (a nail-fold infection) and herpetic whitlow (a viral, vesicular infection that must never be incised).
| Condition | Typical features | Key management difference |
|---|---|---|
| Felon (pulp space) | Tense, shiny, exquisitely tender fingertip pad; closed-space throbbing pain | Antibiotics plus incision & drainage if tense or fluctuant |
| Acute paronychia (nail fold) | Red, swollen, tender nail fold ± pus; pulp not primarily involved | Antibiotics ± drainage of nail-fold pus |
| Herpetic whitlow (HSV) | Grouped non-purulent vesicles; prodromal tingling; pulp typically not tensely swollen | Self-limiting; aciclovir if early – never incise |
Source: NICE · DermNet
🔒 Sign up free to read the full topic
You're viewing a free preview. Create a free account to unlock the rest.
Sign up free →Sample topics are open to everyone in the Free Sample Bundle.