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