Please enable JavaScript.
Coggle requires JavaScript to display documents.
Boils and carbuncles (Risk factors (Male gender, Contact sports,…
Boils and
carbuncles
Epidemiology
Boils common in adolescence and YA
Carbuncles rarer, more in middle aged men
Pathophysiology
Agent
S aureus, MRSA, PVL-SA
Mechanism
Staph carriage can cause
recurrent boils/carbuncles
Most carriage is on the nose
Risk
factors
Male gender
Contact sports
Adolescence
Poor hygeine
Skin condition e.g. eczema
Steroid use
Immunocompromised
Malnutrition
Clinical
presentation
Boil
Hair areas .e.g face, neck, axilla, buttocks
Erythematous, raised nodule, firm, tender,
may have pus, fluctuence
Carbuncle
Large, red, dome shaped, very tender, pus drainage from multiple orrifices, yellow/gret irregular crater
Differentials
Infection
Folliculitis
Acne
Osteomyelitis
Neoplastic
Epidermoid cyst
Complications
Infection spread
Cellulitis, thrombophlebitis,
septic arthritis, sepsis
CVST
Rare
Scarring
Prognosis
Most boils heal without complications
Carbuncles may heal slowly and scar
Definition
Boil (furuncle)
Infected hair follicle with purulent
extension into SC and abscess
Carbuncle
Joining of adjacent boils to
form an inflammatory mass
Diagnosis
Examination
Derm
Tender, erythematous nodule,
pus leak, fluctuant, warm
Investigations
Bedside
Obs (?sepsis)
Swabs
For MCS (if septic, persistent/recurrent, not responding to treatment, immunocompromised, MRSA colonisation)
Bloods
FBC, CRP, U+E, LFT,
cultures (if septic)
History
DH
Meds (e.g. steroids), allergies
FH
Boils, carbuncles, acne
PMH
Known medical conditions
e..g immunosuppression
SH
Living arrangements, occupation,
smoking, alcohol
PC/HPC
Site, onset, character (pain, itch, pus, heat),
spreadiing, associated symptoms (fever, malaise)
Previous episodes, known staph carriage
Management
Medical
Abx
Indication: systemically unwell,
facial lesions or carbuncles
E.g. flucloxacillin
Analgesia
Indication: pain
E.g. paracetamol, ibuprofen
Surgical
I+D
Indication: large, unresponsive to medical tx
MOA: incise and clear pus and debry
Conservative
Information and advice
Warm compresses (aid drainage)
Lifestyle (hygeine, hand washing, separate face cloth, lightfitting loose clothes, avoid contact others e.g. sports)
