| A furuncle is a pocket of infection that occurs when the entire hair follicle and the underlying tissue become infected, usually from Staphylococcus aureus, and fill with pus. Often it is preceded by a superficial or deep infection and inflammation of hair follicles (folliculitis). Furuncles can be multiple and recurrent. They may occur anywhere where hair follicles are present, but they are most common in areas subject to friction, perspiration, and rubbing from clothing or athletic equipment (e.g., the neck, face, armpits, and buttocks).
The condition is more common in people who are overweight or obese, diabetic, do not practice good hygiene, or use intravenous drugs (West). Other predisposing factors include treatment with corticosteroids or cytotoxic agents (e.g., anticancer medications), immunodeficiency conditions, mite infestation (scabies), chronic nasal carriage of Staphylococcus aureus, dermatitis with scratches and cracks (excoriations), and malnutrition. Individuals with oily skin, dark complexion, acne, and dandruff (acne-seborrhea complex) or those undergoing hormonal changes (e.g., adolescents) are also at increased risk of developing furuncles.Risk: Men and women are equally affected. Incidence and Prevalence: Furuncles are very common; nearly everyone has one at some point. |
Source: Medical Disability Advisor
| History: The individual may complain of a hard, tender, red, enlarged, and painful nodule on the skin or itching in the area before the furuncle develops. The furuncle may be swollen with pus. If the furuncle has ruptured, the discharge of pus may lead to decreased swelling, redness, and pain. Fever, fatigue, or general discomfort may be present. The individual may have a history of folliculitis or previous furuncles. Physical exam: The exam may reveal a reddened nodule that may be hard, tender, warm, and painful to the touch. The boils may be swollen, and discharge may occur. Tests: Bacterial culture of the pus can determine the offending organism and its antibiotic sensitivities. A complete blood count (CBC) may be done in patients who have fever or are acutely ill. |
Source: Medical Disability Advisor
| Some furuncles may burst, drain, and resolve on their own. Warm, moist cloths can be applied to facilitate drainage. Deep or large furuncles may need to be lanced and drained (incision and drainage). If the infection has spread or the furuncle is on the face, oral antibiotics may be prescribed. General skin care should include use of antimicrobial soap solution, wearing a protective bandage, and avoidance of skin irritants (e.g., strong soaps, deodorants). Clothing should be loose, lightweight, and porous.
Immunocompromised or febrile individuals, or those who have furuncles with surrounding skin inflammation (cellulitis), may require intravenous (IV) antibiotics. |
Source: Medical Disability Advisor
| The outcome is very good in most cases but depends on the severity of the infection, response to treatment, and the individual's overall health and ability to resist infection. Furunculosis is often recurrent. Deep furuncles may result in scarring. |
Source: Medical Disability Advisor
| Complications may be local, such as skin inflammation (cellulitis), a walled-off focus of infection (abscess), or systemic, when the infection is spread via the bloodstream. A systemic infection is life-threatening because it may cause infection of the heart (endocarditis), inflammation of bone (osteomyelitis), or brain abscess. Squeezing of furuncles located about the lips, nose, or spine can spread the infection even more rapidly and lead to a brain or spinal abscess. Multiple furuncles can merge and form a mass of furuncles (carbuncle). |
Source: Medical Disability Advisor
| Individuals should wash their hands thoroughly after contact with the lesions. They should also avoid chemicals and oils and situations that might cause sweating. If individuals are required to wear uniforms, they should avoid pressure from tight clothing or belts. Depending on the location of the furuncle, excessive sitting or walking may need to be restricted, and the use of personal protective equipment (e.g., respirator) may be hindered. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Does individual complain of a hard, tender, red, enlarged, and painful nodule on the skin? Has the nodule ruptured?
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Does individual have a history of folliculitis?
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Has diagnosis of folliculitis been confirmed?
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Does individual have any predisposing factors for folliculitis such as obesity, diabetes mellitus, treatment with corticosteroids or cytotoxic agents (e.g., anticancer medications), immunodeficiency conditions, mite infestation (scabies), chronic nasal carriage of Staphylococcus aureus, dermatitis with scratches and cracks (excoriations), skin trauma caused by friction from clothing, poor hygiene, and malnutrition?
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Does individual have oily skin, dark complexion, acne, and dandruff (acne-seborrhea complex)? Is individual undergoing hormonal changes (e.g., adolescence)?
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Were conditions with similar symptoms ruled out?
Regarding treatment:
- Was culture and sensitivity done to identify the infectious organism and determine the most effective antibiotic to use?
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Do symptoms persist despite treatment?
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Were antibiotic-resistant organisms ruled out?
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Did incision and drainage relieve pain and help resolve the infection?
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Did individual comply with the skin care program?
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If cellulitis or fever developed, was individual treated with IV antibiotics? Has cellulitis resolved?
Regarding prognosis:
- Does individual have any comorbid conditions that may impact recovery such as diabetes, AIDS, organ transplantation, cancer, or obesity?
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Has individual experienced any complications, either local or systemic, associated with the furuncle? Have complications responded to treatment?
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Does individual suffer from recurrent furuncles?
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Can anything be done to prevent recurrences?
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Source: Medical Disability Advisor
| West, S. K. "Furuncle." Discoveryhealth.com. 2 Jul. 2001. Duke Orthopaedics. 9 Oct. 2004 <http://health.discovery.com/encyclopedias/110.html>. |
Source: Medical Disability Advisor
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