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Furuncles

Furuncles are actually commonly called boils. These are infections involving hair follicles and may include adjacent subcutaneous tissue. They are red, painful hot and filled with pus. Generally these localized infections are caused by staph aureus but can be caused by other bacteria or fungi. They can be either single or can appear in clusters anywhere on the skin.

It is important for the lymphedema patient not to squeeze or pick at a furuncle.  The may lead to the spread of infection and can develop into erysipelas, cellulitis or lymphangitis.

Clinical:

Red tender inflammed spots

Pus filled

Painful or tender due to the infection.

According to Hopkins:

Differs from folliculitis which remains superficial, localized to epidermis and centered about hair follicles.

Diagnosis:

Diagnosis is generally done from simple physical examination.  Although, culture and sensitivity testing may be done, it is usually not  needed.

Complications:

Lymphedema patients must remember that the lymphedema limb is immunocompromised, so with any infection, even a furuncle, there is a serious possibility of the infection spreading and/or becoming serious.  Therefore, furuncles require proper care,  treatment and prevention.  

Possible complications of furuncles can include spread of infection to other parts of the body, abscess of kidneys or other body organs,  endocarditis, abscess formation and septic foci, sepsis. Other complications can include osteomyelitis, brain infection, spinal cord infection and there is risk of it becoming cellulitis, lymphangitis or turning into sepsis.

Treatment:

Generally, furuncles will heal by themselves.  For more serious or deeper ones, surgical drainage may be required based upon the longevity and severity of the furuncle. 

There is disagreement on the value of using topical antibiotics ointments, once the furuncle has actually formed as the infection is under the surface of the skin.

Oral antibiotics may be prescribed for more serious furuncles or for patients who are immunocompromised.  These antibiotics may include trimethoprim-sulfamethoxazole, levofloxacin and/or moxifloxacin.

Groups of Individuals at Risk

As  people with lymphedema, we are very at risk for any type of infection, including furuncles.  Other groups include:

Prevention:

There are a number of steps you can undertake to lesson your risks of developing a furncle, these include:

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Furuncles

Furuncles are skin abscesses caused by staphylococcal infection, which involve a hair follicle and surrounding tissue. Carbuncles are clusters of furuncles connected subcutaneously, causing deeper suppuration and scarring. They are smaller and more superficial than subcutaneous abscesses (see Bacterial Skin Infections: Cutaneous Abscess). Diagnosis is by appearance. Treatment is warm compresses and often oral antistaphylococcal antibiotics.

Both furuncles and carbuncles may affect healthy young people but are more common in the obese, the immunocompromised (including those with neutrophil defects), the elderly, and possibly those with diabetes. Clustered cases may occur among those living in crowded quarters with relatively poor hygiene or among contacts of patients infected with virulent strains. Predisposing factors include bacterial colonization of skin or nares, hot and humid climates, and occlusion or abnormal follicular anatomy (eg, comedones in acne). 

Furuncles are common on the neck, breasts, face, and buttocks. They are uncomfortable and may be painful when closely attached to underlying structures (eg, on the nose, ear, or fingers). Appearance is a nodule or pustule that discharges necrotic tissue and sanguineous pus. Carbuncles may be accompanied by fever and prostration.

Diagnosis is by examination. Material for culture should be obtained from patients with single furuncles on the nose or central face, from patients with multiple furuncles, and from immunosuppressed patients.

Treatment of a single lesion is intermittent hot compresses to allow it to point and drain spontaneously. A patient with a furuncle in the nose or central facial area or with multiple furuncles or carbuncles is given a penicillinase-resistant beta-lactam (dicloxacillin or cephlalexin 250 to 500 mg po qid. Use of initial empiric therapy against MRSA is not typically advised unless there is compelling clinical evidence (eg, contact with a documented case or outbreak; high culture-documented prevalence in a practice area). If resistant strains or complicated infection is clinically suspected, alternate empiric choices include trimethoprim-sulfamethoxazole, levofloxacin and moxifloxacin. Systemic antibiotics are also needed for larger lesions, lesions that do not respond to topical care, evidence of expanding cellulitis, immunocompromised patients, and patients at risk of endocarditis.
Systemic antibiotics are also needed for larger lesions, lesions that do not respond to topical care, evidence of expanding cellulitis, immunocompromised patients, and patients at risk of endocarditis.

Incision and drainage are occasionally necessary and are indicated to speed resolution when the furuncle or carbuncle is fluctuant.

Furuncles frequently recur and can be prevented by applying of liquid soap containing either chlorhexidine gluconate with isopropyl alcohol or 2 to 3% chloroxylenol by giving maintenance antibiotics over 1 to 2 mo. Patients with recurrent furunculosis should be treated for predisposing factors such as obesity, diabetes, occupational or industrial exposure to inciting factors, and nasal carriage of Staphylococcus aureus or methicillin-resistant S. aureus (MRSA) colonization.

Last full review/revision October 2007 by A. Damian Dhar, MD

Content last modified October 2007

Merck

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Furuncles

Paul Auwaerter, M.D. and Ciro R. Martins, M.D. 
09-06-2007

PATHOGENS

CLINICAL

DIAGNOSIS

TREATMENT

General Management / Topical Care

Systemic Therapy--adult

Recurrent Furunculosis

OTHER INFORMATION

John Hopkins

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External Links

Furuncle

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

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Furuncle

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

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Furuncle

http://www.umm.edu/ency/article/001474.htm

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Furuncles and carbuncles

Skin abscesses, furuncles, and carbuncles

http://www.uptodate.com/contents/skin-abscesses-furuncles-and-carbuncles

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Diagnostic Images

Google

http://images.google.com/images?hl=en&q=furuncles&gbv=2

Yahoo

http://images.search.yahoo.com/search/images?p=furuncles&fr=yfp-t-501&toggle=1&cop=mss&ei=UTF-8

DermnetNZ

http://www.dermnet.com/thumbnailIndex.cfm?moduleID=3&moduleGroupID=53&groupIndex=0&numcols=0

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Diagnostic Codes and External Resources

L02 Cutaneous abscess, furuncle and carbuncle
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 )
L02.1 Cutaneous abscess, furuncle and carbuncle of neck
L02.2 Cutaneous abscess, furuncle and carbuncle of trunk
Abdominal wall
Back [any part, except buttock]
Chest wall
Groin
Perineum
Umbilicus
Excludes: breast ( N61 )
hip ( L02.4 )
omphalitis of newborn ( P38 )
L02.3 Cutaneous abscess, furuncle and carbuncle of buttock
Gluteal region
Excludes: pilonidal cyst with abscess ( L05.0 )
L02.4 Cutaneous abscess, furuncle and carbuncle of limb
Axilla
Hip
Shoulder
L02.8 Cutaneous abscess, furuncle and carbuncle of other sites
Head [any part, except face]
Scalp
L02.9 Cutaneous abscess, furuncle and carbuncle, unspecified
Furunculosis NOS

2008 ICD-9-CM Diagnosis 680.9

Carbuncle and furuncle of unspecified site

680.9 also known as:

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Related Lymphedema People Medical Blogs and Pages:

Bacterial Infections

http://bacteriainfections.blogspot.com

Antibiotics

http://antibioticinformation.blogspot.com/

Cellulitis

http://cellulitisinfections.blogspot.com/

MRSA Information

http://mrsainformation.blogspot.com/

Antibiotic Glossary

http://www.lymphedemapeople.com/phpBB2/viewforum.php?f=34

Antibiotic Therapy, Types of Antibiotics

http://www.lymphedemapeople.com/thesite/lymphedema_antibiotics.htm

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How to Treat a Lymphedema Wound 

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Fungal Infections Associated with Lymphedema 

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