furuncles and carbuncles

8/7/2019 Furuncles and Carbuncles

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Furuncles and CarbunclesFuruncles and Carbuncles

IntroductionIntroduction

Skin infections are very common occurrencesSkin infections are very common occurrencesthroughout life. Some infections are self throughout life. Some infections are self--

limiting and resolve on their own, but manylimiting and resolve on their own, but manyothers require medical attention.others require medical attention. BacterialBacterial

skin infectionsskin infections technically have specifictechnically have specificnames based on their origin and extent, butnames based on their origin and extent, but

even in the medical community we often lumpeven in the medical community we often lump

these technical terms into the common termthese technical terms into the common term"boil" or "abscess"."boil" or "abscess".



Subsequent to folliculitis, an inflammatorySubsequent to folliculitis, an inflammatory

skin infection called furunculosis mayskin infection called furunculosis mayappear at the site of hair follicles.appear at the site of hair follicles.Carbuncles are series of abscesses in theCarbuncles are series of abscesses in thesubcutaneous tissue that drain via hair subcutaneous tissue that drain via hair

follicles and are a complication of follicles and are a complication of furunculosis. Frequently developing on thefurunculosis. Frequently developing on theback of the neck, face, axillae andback of the neck, face, axillae andbuttocks, furuncles and carbuncles arebuttocks, furuncles and carbuncles arecaused by perspiration, friction andcaused by perspiration, friction andbacteria.bacteria.



People who are obese, on corticosteroidPeople who are obese, on corticosteroid

therapy, or those with defective whitetherapy, or those with defective whiteblood cell function may be predisposed toblood cell function may be predisposed tofuruncles and carbuncles. Being in closefuruncles and carbuncles. Being in closecontact with others who havecontact with others who have

furunculosisfurunculosis²²such as members of asuch as members of afamily, military personnel, team athletes,family, military personnel, team athletes,and prison inmatesand prison inmates²²may increase themay increase thelikelihood of infection; furuncle outbreakslikelihood of infection; furuncle outbreaks

have been reported in thesehave been reported in thesesettings.settings. Staphylococcus aureusStaphylococcus aureus is mostis mostcommonly associated with both infections.commonly associated with both infections.



FolliculitisFolliculitis



FolliculitisFolliculitis

is an infection that is localized tois an infection that is localized to

thethe hair folliclehair follicle. A folliculitis looks like small,. A folliculitis looks like small,yellowyellow pustulespustules that are confined to thethat are confined to the

hair follicle.hair follicle.



Factors that can leadFactors that can lead

to the development of a folliculitis include:to the development of a folliculitis include:

TraumaTrauma

Chronic frictionChronic friction

Occlusive clothingOcclusive clothing

Occlusive chemicalsOcclusive chemicals Excessive sweatingExcessive sweating

Exposure to water Exposure to water

Folliculitis, decalvans causes scarring with hair lossFolliculitis, decalvans causes scarring with hair loss(alopecia).(alopecia). There areThere are

areas of "corn stalking" (grouped hairs arising within theareas of "corn stalking" (grouped hairs arising within theareaarea of alopecia), rednessof alopecia), redness(erythema), crusting, and pustules.(erythema), crusting, and pustules. Due to severe scarring,Due to severe scarring,permanent hair loss occurs in the involved sites.permanent hair loss occurs in the involved sites.



Hot Tub FolliculitisHot Tub Folliculitis

A special case of folliculitis that is notA special case of folliculitis that is not

caused bycaused by S. aureusS. aureus isis hot tub folliculitishot tub folliculitis..

This self This self--limited infection is causedlimited infection is caused

byby Pseudomonas aeruginosaPseudomonas aeruginosacontractedcontracted

from hot tubs, whirlpools, and pools withfrom hot tubs, whirlpools, and pools with

inadequate chlorine leinadequate chlorine le



FuruncleFuruncle



FuruncleFuruncle

an infection of thean infection of the pilosebaceous unitpilosebaceous unit

is more extensive than a folliculitisis more extensive than a folliculitisbecause the infection also involves thebecause the infection also involves thesebaceous glandsebaceous gland

frequently occurs on the neck, face,frequently occurs on the neck, face,

armpits, and buttocksarmpits, and buttocks begins as a small, tender, redbegins as a small, tender, red nodulenodule thatthat

becomes painful andbecomes painful and fluctuantfluctuant



Factors that contributeFactors that contribute

to the development of furuncles include:to the development of furuncles include:

ObesityObesity Blood disordersBlood disorders

Taking oral steroid medicationsTaking oral steroid medications

DiabetesDiabetes



CarbuncleCarbuncle



a multiple furuncles grouped together a multiple furuncles grouped together

is a collection of multiple infectedis a collection of multiple infected hair hair folliclesfollicles

usually involves the deeper usually involves the deeper layers of thelayers of theskinskin -- the subcutaneous fatthe subcutaneous fat

It looks like a large, red nodule that is hotIt looks like a large, red nodule that is hotand may have visible layers of pus justand may have visible layers of pus justbeneath the surface of the skinbeneath the surface of the skin

It is anIt is an abscessabscess, just like a, just like a furunclefuruncle is anis anabscess but a carbuncle is a much moreabscess but a carbuncle is a much moreserious infection.serious infection.



AppearanceAppearance

usually extends into the deeper usually extends into the deeper layers of layers of

the skinthe skin --the subcutaneous fatthe subcutaneous fat

forms into a broad, red, hot, painful noduleforms into a broad, red, hot, painful nodule

that often drains pus through multiplethat often drains pus through multipleopenings of the skinopenings of the skin

someone likely will feel sick and have asomeone likely will feel sick and have a

fever and fatiguefever and fatigue occur in areas with thicker skin like theoccur in areas with thicker skin like the

nape of the neck, the back, or the thighsnape of the neck, the back, or the thighs



DiagnosisDiagnosis

based on their typical appearancebased on their typical appearance ( but( butsometimes they can be confusedsometimes they can be confused

withwith rupturedruptured epidermoid cyst).epidermoid cyst).



There aren't any tests that are performed toThere aren't any tests that are performed to

decide if an infection is a carbuncle, but oftendecide if an infection is a carbuncle, but often

the pus inside the carbuncle is tested withthe pus inside the carbuncle is tested withaa gram staingram stain or or bacterial culturebacterial culture to determineto determine

if the bacteria causing the infection is aif the bacteria causing the infection is a

typicaltypical Staphylococcus aureusStaphylococcus aureus or one that isor one that is

resistant to the usual penicillinresistant to the usual penicillin--type antibiotics.type antibiotics.



CauseCause

Methacillin ResistantMethacillin Resistant StaphylococcusStaphylococcus

AureusAureus (MRSA)(MRSA)



These infections often occur These infections often occur spontaneously in thespontaneously in the groin, buttock, and groin, buttock, and

upper thigh regionupper thigh region. Currently, there are. Currently, there are

antibiotics that do treat this resistant strain.antibiotics that do treat this resistant strain.The antibiotic of choice for MRSAThe antibiotic of choice for MRSA

infections that were not acquired from ainfections that were not acquired from a

hospital or longhospital or long--term care facility areterm care facility are

isistrimethoprimtrimethoprim--sulfamethoxazole (Septrasulfamethoxazole (Septraor Bactrim)or Bactrim)..



Treatment of Folliculitis, Furuncles,Treatment of Folliculitis, Furuncles,

and Carbunclesand Carbuncles good hygiene and wound caregood hygiene and wound care

Mild cases of folliculitis and small furuncles may heal on their Mild cases of folliculitis and small furuncles may heal on their own with.own with.

dicloxacillindicloxacillin or or cephalexincephalexin

More extensive furuncles and all carbuncles need to be treatedMore extensive furuncles and all carbuncles need to be treatedwith antibiotics.with antibiotics.

incision and drainage (I&D)incision and drainage (I&D)

If pus or induration are present, in addition to antibiotics, thisIf pus or induration are present, in addition to antibiotics, thisprocedureprocedure should be performed to drain the pus and allow the lesionshould be performed to drain the pus and allow the lesionto heal from the inside out.to heal from the inside out.



Thank you !Thank you !

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furuncles and carbuncles

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