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
    • Mupirocin cream or fusidic acid cream or ointment
  • 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