Furunculosis

Furunculosis also called boils, is a deep form of bacterial folliculitis (deep infection of a hair follicle). Boils (furuncles) are painful pus-filled bumps on your skin that is usually caused by a type of bacteria called Staphylococcus aureus (“staph”). Many people are “carriers” of the staph germ, meaning that it normally lives on their skin or in their nose without doing them any harm. Tiny breaks in the surface of the skin (such as those caused by friction or scratching), however, can help the germ gain entry into and infect the hair follicle, resulting in a boil. A carbuncle is the name used when a focus of infection involves several follicles and has multiple draining sinuses. Recovery leaves a scar.

Furuncles (boils) are most common in teenagers and young adults.

People that are particularly prone to developing furuncles include:

• Athletes participating in contact sports or using shared equipment.
• Individuals with a weakened immune system, such as persons with HIV, diabetics, and those taking certain medications such as the types of medications used to prevent rejection of a transplanted organ or to treat cancer (chemotherapy).
• Individuals with another skin condition that may lead to scratching or other injury to the skin (eczema, scabies).
• Staph carriers (staphylococcal carrier state).
• People who are obese.
• Individuals with poor nutrition.
• People living in close quarters with others (military barracks, prison, homeless shelters).

Furuncles or boils may resolve with simple self-care measures, but the infected fluid (pus) needs to drain in order for them to heal completely. Many boils drain of their own accord, or they can be lanced by a health care professional. Antibiotics may also be prescribed. Untreated boils can enlarge or grow together to form a giant multi-headed boil (carbuncle). Rarely, the infection in the skin can get into the bloodstream, leading to serious illness.

Furuncles causes

Most people with furuncles are otherwise healthy and have good personal hygiene. They do however carry Staphylococcus aureus on the surface of their skin (staphylococcal carrier state). Why this occurs is usually not known, but it is estimated that 10–20% of the population are staphylococcal carriers.

Staphylococcus aureus is most commonly carried in the nostrils, armpits, between the legs and in the cleft between the buttocks. It may be transferred to other sites from the nostrils via the finger nails.

Tiny nicks or grazes or something rubbing against the skin can innoculate the bacteria into the wall of a hair follicle which is a weak point in the skin’s defences. Once innoculated, the bacteria cause a boil which goes on to run its usual course of about 10 days.

Although most people with furuncles are otherwise healthy, furuncles are sometimes related to immune deficiency, anemia, diabetes, smoking or iron deficiency.

Furuncles prevention

• Consult your doctor about your general health.
• If you are overweight, try to reduce your weight; take regular exercise.
• Follow a balanced healthy diet with meat, plenty of fruit and vegetables.
• Avoid smoking.
• Wash your whole body once a day with soap or cleanser and water. Wash your hands several times daily or use antiseptic hand rubs.
• Don’t share your flannel or towel with other family members.
• Maintain a clean handkerchief and don’t pick your nose!
• Change your underclothes and night attire regularly.
• Consider modifying leisure activities that cause sweating and friction from clothing, such as squash and jogging.
• If you are iron deficient, a course of iron tablets may help reduce infection.
• 1000 mg of vitamin C each day has also been advocated to improve deficient neutrophil function.
• Keep skin clean and if dry, well moisturized.
• Minimize shaving and waxing. When shaving, use a new blade each time and moisturise the skin afterwards.
• Do not wear tight-fitting clothes.
• Ensure adequate sterilisation of hot tubs.
• In case of repeated episodes of staphylococcal folliculitis, apply mupirocin ointment to the nostrils to eliminate S. aureus carrier state.

Furuncles symptoms

Furuncles present as red-to-purple, tender spots, lumps or pustules on an area of the skin that also has hair. The most common areas for furuncles to occur are places where there is friction and/or places that tend to be sweaty, such as the buttocks, armpits, groin, neck, shoulders, and face. The skin surrounding the lump may look swollen and red. The center of the lump eventually becomes filled with yellow or white pus that you will be able to see (called “coming to a head”). The pus is a mixture of bacteria and infection-fighting white blood cells.

Careful inspection reveals that the boil is centerd on a hair follicle. A boil is a deep form of bacterial folliculitis; superficial folliculitis is sometimes present at the same time. Staphylococcus aureus can be cultured from the skin lesions.

If there are multiple heads, the lesion is called a carbuncle. Large furuncles form abscesses, defined as an accumulation of pus within a cavity. Cellulitis may also occur, ie, infection of the surrounding tissues, and this may cause fever and illness.

Furunculosis treatment

Warm compresses applied to the area for 20 minutes at least 3–4 times a day may ease the discomfort and help encourage the boil to drain. If the boil starts to drain, wash the area with antibacterial soap and apply some triple antibiotic ointment and a loose bandage. Repeat this process of cleansing and bandaging the area 2–3 times a day until the skin is healed.

Boils can be very contagious. Do not share clothing, towels, bedding, or sporting equipment with others while you have a boil. Wash your hands frequently with antibacterial hand soap to avoid spreading the infection to others.

Use an antibacterial soap on boil-prone areas when showering, and dry your skin thoroughly after bathing. Avoid tight-fitting clothing and activities that cause a great deal of sweating.

The pus inside of a boil needs to be drained thoroughly before the body can completely clear the infection. Do not pop the boil yourself with a pin or needle. Doing so may make the infection worse.

If the boil does not drain itself, your doctor may wish to perform a simple procedure. In this procedure, a sterile needle or small blade is used to “nick” the skin over the top of the boil, and the pus is allowed to drain out. The area will then be cleaned and bandaged, and you will be sent home with instructions to wash, apply antibacterial ointment, and re-bandage the area several times daily as discussed above. You may also be prescribed a course of antibiotics to be taken by mouth.

Your physician may choose to collect a swab of the pus for laboratory analysis and swabs from other areas of the body (nose, armpits, and/or anus and genital area) to determine if you are a carrier of staph. If you are a carrier, your doctor may prescribe a topical medication applied to the inside of the nose and/or oral antibiotics for several days. These measures can help prevent a recurrence of the boil(s) and decrease the possibility that you may unknowingly spread the germ to others. If your doctor prescribes antibiotics, be sure to take the full course of treatment to avoid the development of bacterial resistance to the antibiotic.

Medical treatment of furuncles

Treatment of furuncles depends on their severity. Your doctor may give you specific advice and medical treatment, some are listed below:

• Antiseptic or antibacterial soap in your daily bath or shower for a week then twice weekly for several weeks. The cleanser may cause a little dryness.
• Use a hand sanitizer regularly to reduce the chance of reinfecting yourself or others with contaminated hands.
• Antiseptic or antibiotic ointment or gel to apply to the inside of the nostrils.
• Wipe the entire skin surface daily for a week with 70% isopropyl alcohol in water (this will make the skin dry).
• Apply a topical antiseptic such as povidone iodine or chlorhexidine cream to the furuncles and cover with a square of gauze.
• Your doctor may prescribe an oral antibiotic (usually the penicillin antibiotic flucloxacillin), sometimes for several weeks.
• Other members of the family with furuncles should also follow a skin cleansing regime. Your doctor may also advise the family to apply topical antibiotic to their nostrils in case they are Staphylococcus aureus carriers as well.
• If the furuncles fail to clear up, a swab should be taken for microbiological culture, in case of methicillin resistant Staphylococcus aureus (MRSA).
• Sometimes, special antibiotics may be prescribed on the recommendation of a specialist, including fusidic acid, clindamycin, rifampicin and cephalosporins.

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is a strain of staph bacteria resistant to antibiotics in the penicillin family, which have been the cornerstone of antibiotic therapy for staph and skin infections for decades. Community-associated methicillin-resistant Staphylococcus aureus previously infected only small segments of the population, such as health care workers and persons using injection drugs. However, CA-MRSA is now a common cause of skin infections in the general population. While CA-MRSA bacteria are resistant to penicillin and penicillin-related antibiotics, most staph infections with CA-MRSA can be easily treated by health care practitioners using local skin care and commonly available non-penicillin-family antibiotics. Rarely, CA-MRSA can cause serious skin and soft tissue (deeper) infections. Staph infections typically start as small red bumps or pus-filled bumps, which can rapidly turn into deep, painful sores. If you see a red bump or pus-filled bump on the skin that is worsening or showing any signs of infection (ie, the area becomes increasingly painful, red, or swollen), see your doctor right away. Many people believe incorrectly that these bumps are the result of a spider bite. Your doctor may need to test (culture) infected skin for MRSA before starting antibiotics. If you have a skin problem that resembles a CA-MRSA infection or a culture that is positive for MRSA, your doctor may need to provide local skin care and prescribe oral antibiotics. To prevent spread of infection to others, infected wounds, hands, and other exposed body areas should be kept clean, and wounds should be covered during therapy.