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BOILS & CARBUNCLES (Admission & referral ((Consider admission for…
BOILS & CARBUNCLES
Definition
A boil is an infection of the hair follicle where there is purulent extension into the subcutaneous tissue, in which a small abscess forms. It is a deep-seated inflammatory nodule.
A carbuncle occurs when several adjacent boils join beneath the skin. It is an inflammatory mass that drains pus through many follicular orifices.
Admission & referral
Arrange for urgent same-day incision and drainage for:All fluctuant boils, unless they are small, (in which case they will usually drain spontaneously after application of moist heat. All fluctuant carbuncles.
Incision and drainage may sometimes be performed in primary care if the lesion is small and the expertise and facilities are available. Otherwise, the person should be referred to a surgical unit or emergency department, according to local protocol.
If incision and drainage are carried out in primary care, the lesion should be covered with a sterile dressing afterwards, as this helps to prevent autoinoculation.
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Is immunocompromised as a result of an underlying disease (such as diabetes or medication (such as corticosteroids
Primary care management
Advise the person to apply moist heat three to four times a day to alleviate pain, localize the infection, and hasten the drainage of pus.
Advise the person to seek medical advice if the boil or carbuncle becomes fluctuant, as they may need incision and drainage.
Advise the person to seek urgent medical advice if they become systemically unwell or develop cellulitis.
Prescribe a 7-day course of oral antibiotics if the person does not need admission but:◦The person has a fever, the peson has cellulitis, lesion is on th face, the lesion is a carbuncle, the person is in pain or sever discomfort, there are other comorbidities such as diabetes or immunosuppression.
Flucloxacillin is 1st line management, clarithromycin can also be used.
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