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CARBUNCLES, FURUNCLES, BOILS

Discussion

Folliculitis, carbuncles and furuncles are all types of localized (superficial) skin infections that fall under the category of boilsBecause a limb (arm or leg) is considered an immunodeficient limb, lymphedema patients may be more prone to these types of cutaneous skin infections 

Presents as a red, usually round spot (localized erythema). Composed of a core of dead tissue, is usually filled with pus, and is tender or painful.

For lymphedema patients it is important to remember, these should not be squeezed or "picked-at." Doing this can cause the infection of the localized boil to spread.  Complications then can include cellulitis, lymphangitis, erysipelas.

As long as the boil is small and firm, opening the area and draining the boil is not helpful, even if the area is painful. However, once the boil becomes soft or "forms a head" (that is, a small pustule is noted in the boil), it can be ready to drain. Once drained, pain relief can be dramatic. Most small boils, such as those that form around hairs, drain on their own with soaking. On occasion, and especially with larger boils, the larger boil will need to be drained or "lanced" by a health-care practitioner. Frequently, these larger boils contain several pockets of pus that must be opened and drained. (1)

The key is prevention of boils through proper skin care. If the skin is allowed to become dry and brittle, the skin is more susceptible to cracking, developing small fissures and or small openings. We need to pay good attention to hygiene and when we wash we should use antibacterial soaps and/or antiseptic washes.

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Carbuncles
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Boils and Carbuncles

What Is It?

Boils and carbuncles are localized skin infections usually caused by Staphylococcus aureus bacteria (staph). These staph infections form pockets of pus in the skin that are filled with bacteria, dead skin cells and infection-fighting white blood cells. Whether the pocket of pus is called a boil or a carbuncle depends on the location and size of the skin infection:

Symptoms

A boil looks like a red, swollen, painful bump under the skin. As the infection progresses, a whitish tip, also called a point or head, can appear at the center of the boil. This tip is usually the area where the boil's pus will drain. A carbuncle looks like a cluster of interconnected boils.

Whenever you have a boil or a carbuncle, you also can have a fever and feel generally sick. A fever is more likely with a carbuncle than with a single boil.

Diagnosis

Your doctor can diagnose a boil or carbuncle by examining your skin. If you have frequent recurrences of boils within a short period of time, your doctor may do blood tests to check for diabetes or other medical conditions that can increase your risk of repeated infections.

Expected Duration

In many otherwise healthy patients, a small boil will form a white tip (come to a head) and drain within five to seven days. However, carbuncles or very large boils can last longer and may not drain on their own. These may require antibiotics and drainage by a physician.

Prevention

If you have an area of skin that is prone to boils or carbuncles, keep the area clean and dry, and avoid wearing tight clothing that doesn't allow the skin to breathe. Washing daily with an antibacterial soap also can help. At the earliest sign of irritation or a bump at a hair follicle, use warm compresses to open up the blocked pore and drain any early infection. If you develop signs of inflammation or infection at a hair follicle (folliculitis) as a result of shaving, you should avoid shaving in that area to prevent bacteria from being spread from this area to other parts of the skin.

Treatment

Small boils can be treated with moist heat (usually a warm, wet washcloth) applied for 20 to 30 minutes, three or four times a day. This will help the boil drain on its own. Once the boil drains, cover it with a clean bandage to protect the skin and absorb draining pus. Wash the affected area daily with antibacterial soap to prevent the infection from spreading. Anyone who helps care for the infected area should also wash his or her hands thoroughly with antibacterial soap.

Carbuncles and large boils may be treated with antibiotics. In many cases, the doctor will drain the infected area through a small incision. This will relieve pain, speed recovery and limit scar formation. If the infection is completely drained, antibiotics may not be necessary. If the infection is deep, your doctor may cover it with a piece of sterile gauze to keep the incision open and allow pus to continue to drain. You may need to return to the doctor a few times to have the gauze and dressing changed and to make sure the infection drains completely.

When To Call A Professional

Call your doctor whenever you have a carbuncle, a large boil or a boil that doesn't improve after a week of home treatment as described above. If you have diabetes, you should call your doctor even if you develop a small boil because you are more prone to developing serious infections. Ask to be seen immediately if a boil of any size:

develops in an infant

Iis located on the face, rectum, groin or spine

Produces fever or severe pain

Interferes with movement of a body part

Causes swelling, red streaks or other discoloration in nearby skin

If you have had several episodes of boils within a short period of time, visit your doctor. Your doctor can check whether an undiagnosed medical illness is affecting your body's ability to fight infections.

Most small boils heal without leaving a scar. In general, the larger the boil or carbuncle, the greater the chance that it will leave a scar. Because of this, you should see a doctor if you have a boil on your face. Antibiotic treatment and surgical drainage can help limit scar formation. 

Additional Information:

American Academy of Dermatology
930 E. Woodfield Rd.
Schaumburg, IL 60173-4927
Phone: (847) 330-0230
Toll-Free: (888) 462-3376
Fax: (847) 330-0050
http://www.aad.org/

National Institute of Arthritis and Musculoskeletal and Skin Diseases
Information Clearinghouse
1 AMS Circle
Bethesda, MD 20892-3675
Phone: (301) 495-4484
Toll-Free: (877) 226-4267
Fax: (301) 718-6366
TTY: (301) 565-2966
E-Mail: niamsinfo@mail.nih.gov
http://www.niams.nih.gov/


http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/9671.html

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Nosocomial outbreak of multidrug-resistant USA300 methicillin-resistant Staphylococcus aureus causing severe furuncles and carbuncles in Japan. Dec. 2011

Keywords:

http://onlinelibrary.wiley.com/doi/10.1111/j.1346-8138.2011.01284.x/abstract;jsessionid=544EB6918FBBAAF3AE1469201E5F64B6.d01t04

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Furuncles

Alternative names    

Infection - hair follicle; Hair follicle infection; Boils

Definition    

A furuncle is an infection of a hair follicle. (Also see carbunculosis.)

Causes, incidence, and risk factors    

A furuncle (boil) is a skin infection involving an entire hair follicle and the adjacent subcutaneous tissue.

Furuncles are very common. They are caused by staphylococcus bacteria, which are normally found on the skin surface. Damage to the hair follicle allows these bacteria to enter deeper into the tissues of the follicle and the subcutaneous tissue. Furuncles may occur in the hair follicles anywhere on the body, but they are most common on the face, neck, armpit, buttocks, and thighs.

Furuncles are generally caused by Staphylococcus aureus, but they may be caused by other bacteria or fungi. They may begin as a tender red subcutaneous nodule but ultimately become fluctuant (feel like a water-filled balloon). A furuncle may drain spontaneously, producing pus. More often the patient or someone else opens the furuncle.

Furuncles can be single or multiple. Some people have recurrent bouts with abscesses and little success at preventing them. Furuncles can be very painful if they occur in areas like the ear canal or nose. A health care provider should treat furuncles of the nose. Furuncles that develop close together may expand and join, causing a condition called carbunculosis.

Symptoms    

The lesions themselves are the primary symptoms:

Less common symptoms include the following:

Note: Itching (pruritus) of the skin may occur before the lesion develops.

Signs and tests    

Diagnosis is primarily based on the appearance of the skin. Skin or mucosal biopsy culture may show staphylococcus or other bacteria.

Treatment  

Furuncles may heal on their own after an initial period of itching and mild pain. More often, they progress to pustules that increase in discomfort as pus collects. They finally burst, drain, and then heal spontaneously.

Furuncles usually must drain before they will heal. This most often occurs in less than 2 weeks. Boils that persist longer than 2 weeks, recur, are located on the spine or the middle of the face, or that are accompanied by fever or other symptoms require treatment by a health care provider because of the risk of complications from the spread of infection.

Warm moist compresses encourage furuncles to drain, which speeds healing. Gently soak the area with a warm, moist cloth several times each day. Deep or large lesions may need to be drained surgically by the health care provider. Never squeeze a boil or attempt to lance it at home because this can spread the infection and make it worse.

Meticulous hygiene is vital to prevent the spread of infection. Draining lesions should be cleaned frequently. The hands should be washed thoroughly after touching a boil. Do not re-use or share washcloths or towels. Clothing, washcloths, towels, and sheets or other items that contact infected areas should be washed in very hot (preferably boiling) water. Dressings should be changed frequently and discarded in a manner that contains the drainage, such as by placing them in a bag that can be closed tightly before discarding.

Antibacterial soaps and topical antibiotics are of little benefit once a furuncle has formed. Systemic antibiotics may help to control infection.

Drainage is the definitive treatment.

Expectations (prognosis)    

Full recovery is expected. Some people may experience many repeated episodes.

Complications     Calling your health care provider    

Call for an appointment with your health care provider if furuncles (boils) develop and do not heal with home treatment within one week.

Call for an appointment with your health care provider if furuncles recur or are located on the face or spine.

Call for an appointment with your health care provider if boils are accompanied by fever, red streaks extending from the boil, large fluid collections around the boil, or other symptoms.

Prevention     Update Date: 12/29/2002

http://www.nlm.nih.gov/medlineplus/ency/article/001474.htm

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Boils

Medical Revising Editor: William C. Shiel Jr., MD, FACP, FACR

A boil, also referred to as a skin abscess, is a localized infection deep in the skin. A boil generally starts as a reddened, tender area. Over time, the area becomes firm and hard. Eventually, the center of the abscess softens and becomes filled with infection-fighting white blood cells that the body sends from the bloodstream to eradicate the infection. This collection of white blood cells, bacteria, and proteins is known as pus. Finally, the pus "forms a head," which can be surgically opened or spontaneously drain out through the surface of the skin.

There are several different types of boils. Among these are:

Why do boils occur?

There are many causes of boils. Some boils can be caused by an ingrown hair. Others can form as the result of a splinter or other foreign material that has become lodged in the skin. Others boils, such as those of acne, are caused by plugged sweat glands that become infected.

The skin is an essential part of our immune defense against materials and microbes that are foreign to our body. Any break in the skin, such as a cut or scrape, can develop into an abscess should it then become infected with bacteria.

Who is most likely to develop a boil?

Anyone can develop a boil. However, people with certain illnesses or medications that impair the body's immune system (the natural defense system against foreign materials or microbes) are more likely to develop boils. Among the illnesses that can be associated with impaired immune systems are diabetes and kidney failure. Diseases, such as hypogammaglobulinemia, that are associated with deficiencies in the normal immune system can increase the tendency to develop boils.

Many medications can suppress the normal immune system and increase the risk of developing boils. These medications include cortisone medications (prednisone and prednisolone) and medications used for cancer chemotherapy.

What is the treatment for a boil?

Most simple boils can be treated at home. Ideally, the treatment should begin as soon as a boil is noticed since early treatment may prevent later complications.

The primary treatment for most boils is heat application, usually with hot soaks or hot packs. Heat application increases the circulation to the area and allows the body to better fight off the infection by bringing antibodies and white blood cells to the site of infection.

As long as the boil is small and firm, opening the area and draining the boil is not helpful, even if the area is painful. However, once the boil becomes soft or "forms a head" (that is, a small pustule is noted in the boil), it can be ready to drain. Once drained, pain relief can be dramatic. Most small boils, such as those that form around hairs, drain on their own with soaking. On occasion, and especially with larger boils, the larger boil will need to be drained or "lanced" by a health-care practitioner. Frequently, these larger boils contain several pockets of pus that must be opened and drained.

Antibiotics are often used to eliminate the accompanying bacterial infection. Especially if there is an infection of the surrounding skin, the doctor often prescribes antibiotics. However, antibiotics are not needed in every situation. In fact, antibiotics have difficulty penetrating the outer wall of an abscess well and often will not cure an abscess without additional surgical drainage.

When should I seek medical attention?

Any boil or abscess in a patient with diabetes or a patient with an underlying illness that can be associated with a weakened immune system (such as cancer, rheumatoid arthritis, etc.) should be evaluated by a health-care practitioner. Additionally, many medicines, especially prednisone, that suppress the immune system (the natural infection-fighting system of the body) can complicate what would be an otherwise simple boil. Patients who are on such medications should consult their health-care practitioner if they develop boils. (If you are not sure about your medications' effects on the immune system, your pharmacist may be able to explain to you which medicines to be concerned about.)

Any boil that is associated with a fever should receive medical attention. A "pilonidal cyst," a boil that occurs between the buttocks, is a special case. These almost always require medical treatment including drainage and packing (putting gauze in the opened abscess to assure it continues to drain). Finally, any painful boil that is not rapidly improving should be seen by the health-care practitioner.

What can be done to prevent boils (abscesses)?

There are some measures that you can take to prevent boils from forming. The regular use of antibacterial soaps can help to prevent bacteria from building up on the skin. This can reduce the chance for the hair follicles to become infected and prevent the formation of boils. In some situations, your health-care practitioner may recommend special cleansers such as pHisoderm to even further reduce the bacteria on the skin. When the hair follicles on the back of the arms or around the thighs are continually inflamed, regular use of an abrasive brush (loofah brush) in the shower can be used break up oil plugs and build up around hair follicles.

Pilonidal cysts can be prevented by avoiding continued direct pressure or irritation of the buttock area when a local hair follicle becomes inflamed. At that point, regular soap and hot water cleaning and drying can be helpful.

For acne and hidradenitis suppurativa (see above), antibiotics may be required on a long-term basis to prevent recurrent abscess formation. As mentioned above, surgical resection of sweat glands in the involved skin may be necessary. Other medications, such as isotretinoin (Accutane), can be used for cystic acne and have been helpful in some patients with hidradenitis suppurativa. Recurrences are common in patients with hidradenitis suppurativa.

Finally, surgery may occasionally be needed, especially in pilonidal cysts that recur, but also for hidradenitis suppurativa. For pilonidal cysts, surgically removing the outer shell of the cyst is important to clear the boil. The procedure is typically performed in the operating room. For hidradenitis suppurativa, extensive involvement can require plastics surgical repair.

Boils At A Glance

MedicineNet (1)

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ICD-10

Includes: boil
furunculosis
Excludes: anal and rectal regions ( K61.- )
genital organs (external):
· female ( N76.4 )
· male ( N48.2 , N49.- )
L02.0 Cutaneous abscess, furuncle and carbuncle of face
Excludes: ear, external ( H60.0 )
eyelid ( H00.0 )
head [any part, except face] ( L02.8 )
lacrimal:
· gland ( H04.0 )
· passages ( H04.3 )
mouth ( K12.2 )
nose ( J34.0 )
orbit ( H05.0 )
submandibular ( K12.2 )

ICD-9

2008 ICD-9-CM Diagnosis 680.9

Carbuncle and furuncle of unspecified site

  • 680.9 is a specific code that can be used to specify a diagnosis
  • 680.9 contains 11 index entries
  • View the ICD-9-CM Volume 1 680.* hierarchy

680.9 also known as:

  • Boil NOS
  • Carbuncle NOS
  • Furuncle NOS

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Diagnostic Images

Carbuncles, Boils - Google

http://images.google.com/images?um=1&hl=en&q=carbuncle+&btnG=Search+Images

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External Links:

Carbuncles

Carbuncles

A cluster of furuncles with subcutaneous spread of staphylococcal infection,
resulting in deep suppuration, often extensive local sloughing, slow
healing, and a large scar.

http://www.merck.com/mmpe/sec10/ch119/ch119f.html#sec10-ch119-ch119g-666

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Furuncles

Furuncle

http://www.medical-library.org/journals2a/furuncle.htm

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Furuncles and Carbuncles

http://www.merck.com/mmpe/sec10/ch119/ch119f.html#sec10-ch119-ch119g-666

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Furuncles

Johns Hopkins

http://www.hopkinsguides.com/hopkins/ub/view/Johns_Hopkins_ABX_Guide/540235/all/Furuncle_Carbuncle

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Boils

Boils and carbuncles From Mayo Clinic

http://www.mayoclinic.com/health/boils-and-carbuncles/DS00466

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Boils

http://www.dermnetnz.org/bacterial/boils.html

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