Boils

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A boil or furuncle is a deep bacterial infection of the hair follicles. A more superficial infection is termed folliculitis. Several boils grouped in an area and discharging pus from several points is termed a carbuncle. Patients with recurrent boils or carbuncles should be screened for diabetes mellitus and skin disorders such as scabies, pediculosis or eczema while patients with repeated folliculitis in the shaving areas, e.g. face and armpits should be educated on shaving techniques.

Cause

  • Staphylococcus aureus

Symptoms

  • Single or multiple painful swellings on the skin which may discharge pus
  • Fever

Signs

  • Swellings - purulent, warm, fluctuant and/or tender (in single or multiple areas of skin) 

Investigations

  • FBC
  • Fasting blood glucose (if diabetes suspected)
  • Swabs for culture and sensitivity in persistent or recurrent infection

TreatmentTreatment Objectives

  • To treat infection
  • To relieve pain
  • To identify and treat any predisposing condition
  • To prevent scars and keloids

Non-pharmacological treatment

  • Incision and drainage - if boil becomes fluctuant and large
  • Wound dressing

Pharmacological treatment 

1st Line Treatment

Evidence Rating: [B]

For boils or furunculosis in patients without penicillin allergy

  • Flucloxacillin, oral,

Adults

250-500 mg 6 hourly for 7 days

Children

5-12 years;  250 mg 6 hourly for 7 days 

1-5 years; 125 mg 6 hourly for 7 days

<1 year;  62.5 mg 6 hourly for 7 days

For boils or furunculosis in patients with penicillin allergy

  • Erythromycin, oral,

Adults

500 mg 6 hourly for 7 days    

Children

6-12 years; 250 mg 6 hourly for 7 days

1-5 years; 125 mg 6 hourly for 7 days

< 1 year; 62.5 mg 6 hourly for 7 days

And  

  • Paracetamol, oral, 

Adults

500 mg -1 g 6 to 8 hourly for 3-5 days

Children

6-12 years; 250-500 mg 6 to 8 hourly for 3-5 days

1-5 years; 120-250 mg 6 to 8 hourly for 3-5 days

3 months-1 year; 60-120 mg 6 to 8 hourly for 3-5 days

For Folliculitis

  • Mupirocin ointment, topical,

Adults and children

12 hourly for 7 days 

Referral Criteria

  • Refer to a specialist if the underlying condition requires further management