The treatment of felons and paronychias.

Infections of the distal finger have a varied presentation, course, and treatment. As in other hand infections, initial treatment should always include elevation of the extremity and the avoidance of snug clothing or constricting jewelry. Immunosuppressive states and systemic diseases such as diabetes must be considered, for they will alter the action of the causative organisms as well as the intensity of treatment that a patient will require. Appropriate, specific antibiotic treatment can be part of the initial treatment of acute felons and paronychias, but it should never replace adequate incision and drainage. Finally, "minor" finger infections are only minor when diagnosed and treated properly. If mistreated, their consequences can have long-term implications for both the individual and for society. It is important to understand the natural history, bacteriology, and anatomy of the distal finger if we are to return patients to their jobs with expedience and minimal long-term sequelae.