Furuncles/Carbuncles Non-scaly Nodules Furuncles/Carbuncles

What is it? (Boil) an acute, round , tender, circumscribed, perifollicular staphylococcal abscess, that ends in central suppuration

Furuncle

Carbuncle

Causative agent Staphylococcus aureus Gram (+) cocci Skin flora (20-40% adults are nasal carriers) Causes a wide range of illness Spreads by physical contact

Some disappear before rupture Most undergo central necrosis and rupture, discharging purulent material and necrotic debris Common sites; nape, axillae, and buttocks

Risk factors/Predisposing factors Disruption of skin integrity Alcoholism Malnutrition Blood dyscrasia Immunosuppression Drug-resistant Staph. Improper Handwashing

Treatment Apply warm compress and oral antibiotics (1-2g/day) Penicillinase resistant penicillin 1st gen. Cephalosporin Bactroban, to prevent recurrence Surgical incision and drainage 4% Chlorhexidine for skin and umbilical cord care Penicillinase resistant penicillin; Cloxacillin, Dicloxacillin, Methicillin, Nafcillin, Oxacillin 1st gen. Cephalosporin; Surgery for localized fluctuating furuncle or if antibiotic therapy fails. Afterwards Bactroban should be applied or another antibiotic taken internally

Chronic Furunculosis Usually common Autoinoculation and familial spread Region of furuncles may be a source of colonization to areas with cuts, excoriation, or eczematous change. Autoinoculation especially is nasal carriers

Control of Chronic Furunculosis Recurrence prevented by daily Chlorhexidine wash Frequent handwashing Laundering of bedding and clothing Bactroban ointment 2x /day Rifammpin(600mg) + dicloxacillin (for MSSA)/ Co-trimoxazole (for MRSA) for 10 days Clindamycin(150mg) for 3 months