Felon or Whitlow on the Finger: Causes, Symptoms, Diagnosis, Treatment and Prevention

Felon or Whitlow on the Finger: Causes, Symptoms, Diagnosis, Treatment and Prevention

A felon, also known as a whitlow, is an infection of the fingertip, usually around the nail. It is a common condition that can affect anyone but is more frequent in people who work with their hands frequently. Felons often start as red, swollen and painful lumps on the fingertip and can progress to form abscesses with pus if left untreated. While felons are not life-threatening, they can be quite painful and lead to temporary disability of the affected finger. Prompt treatment is recommended to relieve symptoms and prevent complications.

Causes The most common causes of felons include:

  • Bacterial infections – Staphylococcus aureus is the bacteria most often responsible. It can enter the fingertip through tiny cuts or cracks in the skin. People with nail biting habits or hangnails are at higher risk.
  • Fungal infections – Yeasts and molds can also infect the fingernail bed and cause swelling and pain. This is more common in people with weakened immune systems.
  • Viral infections – Viruses like the herpes simplex virus can sometimes infect the fingertip and result in a painful sore known as a herpetic whitlow.
  • Foreign bodies – Splinters, thorns or other foreign material lodged under the nail can introduce bacteria and lead to a felon.
  • Occupational exposures – Felons frequently affect people in occupations that involve repetitive use of the hands and exposure to bacteria, fungi or irritants. Examples include cooks, gardeners, carpenters, mechanics, janitors etc.

Symptoms The signs and symptoms of felons typically develop over a few days and include:

  • Redness, warmth and swelling at the tip of the finger, usually around the nail
  • Tenderness and throbbing pain, often severe, in the affected area
  • Pus drainage if an abscess forms
  • Loss of the fingernail in severe cases
  • Difficulty moving the finger due to pain and swelling
  • Red streaks extending from the infection site up the arm in some cases

Diagnosis Felons are usually diagnosed based on the characteristic symptoms and a physical examination of the affected finger. Investigations may include:

  • Blood tests to check for signs of infection such as elevated white cell count
  • Culture of drainage from the area to identify the causative bacteria or fungus
  • Imaging tests like x-rays or ultrasound to look for a foreign body or abscess under the nail
  • Biopsy of the nail fold to examine tissue samples under a microscope

Treatment Treatment aims to eliminate the source of infection, drain any abscesses and prevent further complications. Options may include:

  • Antibiotics – Oral or intravenous antibiotics effective against Staph bacteria are usually prescribed. Some examples are cephalexin, dicloxacillin and clindamycin.
  • Antifungals – Oral antifungal medications like fluconazole may be used if a fungal felon is suspected.
  • Incision and drainage – A small surgical procedure may be done to open and drain any abscesses under local anesthesia. This immediately relieves pain and pressure.
  • Removal of nail – If the nail is damaged extensively, it may need to be partially or completely removed to allow drainage and healing.
  • Splinting and immobilization – Splints or finger guards may be used to immobilize the finger and allow rest and healing.
  • Warm compresses – Applying warm, moist compresses to the affected finger can help improve blood flow and hasten drainage.
  • Pain medications- Over-the-counter or prescription pain relievers can help relieve throbbing pain and discomfort.
  • Elevation – Keeping the hand elevated above the level of the heart can minimize swelling and tenderness.

Prevention Some preventive measures to reduce the risk of developing felons include:

  • Maintain good hand hygiene – Wash hands frequently and keep fingernails trimmed and clean.
  • Avoid nail biting and picking – This can introduce bacteria under nails.
  • Wear gloves – Use protective gloves while performing tasks that pose a risk of cuts or puncture wounds to fingers.
  • Treat hangnails – Carefully trim or moisturize hangnails instead of tearing them off to avoid open wounds.
  • Disinfect minor cuts – Promptly wash out and apply antiseptic to any cuts or scratches on the fingers or hands.
  • Seek treatment for infections – Have any red, swollen, tender fingers evaluated quickly to prevent progression to an abscess.
  • Consider protective gear – Those with high occupational exposure may benefit from finger guards or thimbles.
  • Manage chronic illnesses – Control underlying conditions like diabetes that increase infection risk.


Felons are common fingertip infections that require prompt medical treatment for best outcomes. Preventing minor skin injuries to the hands and nails and seeking care at first signs of infection can help reduce the incidence of this painful condition. Maintaining good hand health is important for everyone, especially those whose work involves extensive hand use and exposure to bacteria or irritants.


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