Folliculitis, furuncles, and carbuncles
Folliculitis, furuncles, and carbuncles: Excerpt from Handbook of Diseases
A bacterial infection of the hair follicle, folliculitis causes the formation of a pustule of the hair follicle opening. The infection can be superficial (follicular impetigo or Bockhart’s impetigo) or deep (sycosis barbae).
Furuncles, commonly known as boils, are another form of deep folliculitis. Carbuncles are a group of interconnected furuncles. The prognosis depends on the severity of the infection and the patient’s physical condition and ability to resist infection.
Causes
The most common cause of folliculitis, furuncles, or carbuncles is coagulasepositive Staphylococcus aureus. Predisposing factors include an infected wound, moisture, obesity, diabetes mellitus, skin disease, poor hygiene, debilitation, tight clothes, friction, and immunosuppressive therapy.
Signs and symptoms
Folliculitis, furuncles, and carbuncles have different signs and symptoms.
❑ Folliculitis appears as a primary lesion in a small pustule located over a sebaceous orifice and may be perforated by a hair.
❑ Furuncles are hard, painful nodules that commonly develop on the neck, face, breasts, perineum, thighs, axillae, and buttocks. For several days, these nodules enlarge and then rupture, discharging pus and necrotic material. After the nodules rupture, pain subsides, but erythema and edema may persist for days or weeks.
❑ Carbuncles appear as multiple pustules or deep abscesses that drain through multiple openings onto the skin surface, usually around several hair follicles. Fever and malaise may accompany these lesions.
Diagnosis
The obvious skin lesion confirms folliculitis, furuncles, or carbuncles. Wound culture usually shows S. aureus. In carbuncles, patient history reveals preexistent furuncles. A complete blood count may show an elevated white blood cell count (leukocytosis).
Treatment
Appropriate treatment includes the following:
❑ Folliculitis is treated by cleaning the infected area thoroughly with antibacterial soap (such as Hibiclens) and water; applying warm, wet compresses to promote vasodilation and drainage from the lesions; applying topical antibiotics, such as mupirocin ointment, clindamycin or erythromycin solution; and, in extensive infection, administering systemic antibiotics (a cephalosporin or dicloxacillin) after culture and sensitivity results return.
❑ Furuncles may require incision and drainage of ripe lesions after application of warm, wet compresses and systemic antibiotics, as indicated by culture results, after drainage.
❑ Carbuncles require systemic antibiotic therapy as well as incision and drainage.
Special considerations
❑ Care for folliculitis, furuncles, and carbuncles is basically supportive and emphasizes teaching the patient scrupulous personal and family hygiene measures. Taking the necessary precautions to prevent spreading infection is also an important part of care.
❑ Caution the patient never to squeeze a boil because this may cause it to rupture into the surrounding area.
❑ To avoid spreading bacteria to family members, urge the patient not to share towels and washcloths and to wash items in hot water before they’re reused. The patient should change clothes and bedsheets daily, and they also should be washed in hot water. Encourage the patient to change dressings frequently and to discard them promptly in paper bags.
❑ Advise the patient with recurrent furuncles to have a physical examination because an underlying disease, such as diabetes, may be present.
Book Source Details
- Book Title: Handbook of Diseases
- Author(s): Springhouse
- Year of Publication: 2003
- Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Handbook of Diseases
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2003
ISBN: 1-58255-266-5
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