National Demographic and Treatment Patterns of Finger Cellulitis, Paronychias, and Felons

Finger cellulitis, felon, and paronychia may be treated nonoperatively if diagnosed in a timely manner. Delayed or improper treatment may result in progression to more serious conditions, which necessitate intervention by a hand surgeon. This investigation sought to evaluate national demographics and treatment patterns in finger infections.

The PearlDiver Mariner database, an insurance claims database with 151 million unique patients within the United States, was used to identify patients with finger cellulitis, felon, and paronychia from 2010 to 2015. Billing events were organized by insurance plan, treatment location, and regional geography. Antibiotics prescribed and respective course duration were also analyzed.

A total of 1,937,102 coded events for finger infections, including 1,452,724 cases of cellulitis (7596), 448,548 paronychias (23%), and 35,830 felons (2%), occurred during the 5-year study period. The plurality (38%) of infections occurred in the Southern United States. Ninety- six percent of events occurred in an outpatient setting, most commonly treated by family medicine physicians, and 4% were associated with hospital admission. Seventy-two percent of claims were processed through commercial insurance, 13% through Medicaid, 12% through Medicare, and the remainder through government insurance plans or self-pay. Cephalexin was the most commonly prescribed antibiotic for finger cellulitis and paronychias, with a mean treatment duration of 8.6 and 8.8 days, respectively. Sulfamethoxazole-trimethoprim was prescribed more frequently than cephalexin for felons (32% vs. 30%; Ρ < 0.01 ),with a mean treatment duration of 8.8 days.

Acute finger cellulitis, paronychias, and felons are common infections managed by a diverse group of providers in a variety of healthcare settings. Regional, insurance, and treatment differences exist. Further research is warranted to evaluate the impact of these variations and potentially refine management strategies for finger infections.