Furunculosis (Boils)

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Introduction

  • Infection of a hair follicle by staphylococcal organisms, that leads to an inflammatory nodule, with a pustular centre
  • A carbuncle is two or more confluent furuncles, with separate heads
  • Recalcitrant cases may occur with a background of immune suppression, alcoholism, malnutrition, blood dyscrasias, disorders of neutrophil function, diabetes, AIDS
  • May occur in patients with atopic dermatitis
  • May be iatrogenic

Clinical features

  • Can be found on all body sites where hairs are present. Starts with a small, yellow creamy pustule that rapidly evolves into a red nodule, often with a central yellow plug
  • As the lesion expands, it becomes: Painful and tense
  • Associated with local oedema, lymphangitis, regional lymphadenopathy and fever
    • Eventually, the central part of the nodule becomes soft and drains spontaneously
  • Healing occurs after about 1 - 2 weeks with scar formation

Differential diagnoses

  • Folliculitis
  • Cutaneous myiasis
  • Acne inversa in the axilla or groin

Complications

  • Cellulitis
  • Septicaemia
  • Carvenous sinus thrombosis when the lesions are on the head and neck

Investigations

  • Wound swab for bacteriology and sensitivity
  • Full Blood Count with differentials
  • Fasting blood glucose
  • HIV  screening
  • Urinalysis

Treatment goals

  • Treat infection
  • Correct predisposing factors
  • Prevent complications

Drug treatment

Topical antibiotics

  • Gentamicin 0.3% cream

Resistance may set in with prolonged use of Systemic antibiotics

Usually unnecessary except for head and neck lesions, or when the boil is accompanied by fever, chills, regional lymphadenopathy, or a feeling of being unwell

Co-trimoxazole

Adult: 960 mg orally every 12 hours for 5 - 10 days

Child: 6 weeks - 5 months: 120 mg;

6 months - 5 years: 240 mg;

6 - 12 years: 480 mg taken orally every 12 hours for 5 - 10 days

Erythromycin

Adult and child over 8 years: 250 - 500 mg orally every 6 hours or 1g 12 hourly for 5-10 days

Child: up to 2 years: 125 mg orally every 6 hours;

2 – 8 years: 250 mg every 6 hours for 5 - 10days

Surgical treatment

  • A small puncture wound often gives less of a scar than allowing spontaneous rupture; it also reduces the pain
  • Should be under antibiotic cover to prevent septicemia