Furunculosis and Carbuncles

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A boil or furuncle is a deep-seated infection of the hair follicles with a walled-off collection of pus. A carbuncle is a cluster of interconnected furuncles.

Causes

  • Mostly caused by Staphylococcus aureus

Signs and symptoms

  • Purulent swellings on the skin in single or multiple areas of skin
  • Swellings may be warm and/or tender
  • Pain, swollen lymph nodes, fever

Differential diagnosis

  • Folliculitis
  • Cutaneous myiasis
  • Acne
  • Epidermal cyst

Investigations

  • No specific investigation is needed
  • Swab of exudate or discharge for gram stain, microscopy, culture, and sensitivity
  • If recurrent, screen for diabetes mellitus, HIV infection

Treatment objectives

  • Treat infection
  • Correct predisposing factors
  • Prevent complications

Non-pharmacological treatment

  • Consider incision and drainage
  • Intermittent hot compresses

Pharmacological treatment

For treatment of infection 

1st line treatment

Flucloxacillin

Adult: 

500 mg oral every 6 hours for 5-7 days

Child:

up to 2 years: 125mg every 6 hours

2-10 years: 250mg every 6 hours 

OR

Erythromycin oral

Adult:

500 mg four times a day for 5 – 7 days

Child:

up to 2 years: 125mg every 6 hours

 2 – 8 years: 250 mg every 6 hours

2nd line treatment:

Doxycycline oral

Adult:

100mg every 12 hours for 7 days

For pain relief:

Paracetamol oral 

Adult: 

1 g 3 – 4 times a day as required

Child:

 > 3 years:  250mg every 6-8 hours 

< 3 years: 125 mg every 6-8 hours

Prevention

  • Personal hygiene with the use of antiseptic soap

Referral

  • Refer all cases not resolving with the above treatment to a specialist