Furuncles
Carbuncles
Furuncles and carbuncles references
Furuncles
A furuncle is a tender, erythematous, firm or fluctuant mass
of walled-off purulent material, arising from the hair follicle.
It is a more extensive infection of the hair follicle than
folliculitis and occurs as a result of the spread of the bacterial
infection deeper into the tissues of the follicles, beneath
the infundibulum.
These furuncle lesions may occur anywhere on the body, but
are most likely to be found in areas exposed to friction.
Furuncles rarely occur before puberty.
Furuncles are more commonly found in young adults, predominantly the male
sex, and the most likely sites are the face, back of the neck, breasts,
axillae, perineum, buttocks and thighs. This suggests
that androgens may be involved
in susceptibility to furuncles, but the association has not been researched
in any detail. Other predisposing factors for the development of furunculosis
include chronic Staphylococcal carriers, Diabetes Mellitus, malnutrition
and HIV infection.
Staphylococci are the most common causative agent in the
development of furuncles, particularly S.epidermidis.
Pathogenic Streptococci and Coliform
bacteria
have also been implicated as a cause of furuncles.
Most often, the furuncle develops into a wave-like mass
and eventually opens to the skin surface, allowing the
pus-like contents to drain. This
drainage
may occur as the furuncle ruptures, or following incision of the furuncle
(lancing).
Clinical Features
A furuncle begins as a tender, hot, red nodule that becomes
pustular (blister with pus). The lesion often ruptures
after a few days, discharging
pus,
blood and necrotic tissue, leaving a permanent scar. Furuncles tend
to occur in
the neck area, the face, on breasts and buttocks. Sometimes treatment
by a doctor will include lancing the furuncles (boils) as well as
a treatment to
kill the pathogens.
Differential Diagnosis
The diagnosis of furuncles is mostly a clinical one, and
the symptoms and the history allow the physician to come
to the diagnosis with
high accuracy.
Pathology
Pathologically, furuncles are seen as perifollicular abscesses
followed by necrosis and destruction of the follicle.
Treatment
Furuncles may burst, drain, and then heal on their own without
treatment. If the furuncle does not rupture on its own,
incision and drainage
may be necessary. Such intervention is indicated when
lesions are fluctuant
or
boggy with a thin, shiny appearance of the overlying skin.
It is important not to
incise deeper than the pseudo capsule that has been built
at the site of infection.
After incision, the wound can be packed with iodoform
gauze to encourage further drainage. In severe cases,
parenteral
antibiotics such as
cloxacillin or a
first-generation cephalosporin such as cefazolin may
be administered by intravenous or intramuscular injection.
Carbuncles are an aggregate of infected hair follicles that
form broad, swollen, erythematous, deep, and painful masses
that usually open and drain through
multiple tracts. Essentially, furuncles join together in the subcutaneous
area to form carbuncles and show multiple openings on the surface of the
skin. Suppuration (pus formation) is more deeply seated
than in the case of furuncles.
Necrosis (death) of the intervening skin occurs, and a nodule with a central
crater may be seen. Carbuncles show predilection for the back of the neck.
Clinical Features
The lesions manifest with painful erythema (redness), which
later on localize and accumulate pus, discharging the content
on the skin surface. Sloughing
or the separating out of dead tissue from surrounding living tissue
leaves an irregular
punched-out ulcer, which heals with scarring.
Differential Diagnosis
Constitutional symptoms, including fever and malaise, are
commonly associated with these lesions but are rarely found
with furuncles.
Pathology
Pathologically, carbuncles show involvement of a group of
follicles and the inflammatory changes extend deep into
the dermis and even the
subcutaneous
tissue. The process tends to spread laterally and then extend
to the surface.
Treatment
Carbuncles merit the same line of treatment as furuncles.
In cases of deep bacterial folliculitis, a culture needs
to be carried out
and oral
antibacterial
agents
administered according to the results of the culture.
In a nutshell, the term folliculitis is used to describe a
superficial inflammation of the hair follicle. However,
when the infection
spreads and involves the
tissue around the hair follicle as well, it is known as
a furuncle. Carbuncles form
when several furuncles connect subcutaneously with a number
of sinuses opening to the surface.
Furuncles,
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