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Boils & Carbuncles - Coggle Diagram
Boils & Carbuncles
Definition
A boil (or furuncle) 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.
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A carbuncle occurs when several adjacent boils join beneath the skin. It is an inflammatory mass that drains pus through many follicular orifices.
less common, mostly in men, middle age to older age group
Complications
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Spread of infection such as cellulitis; thrombophlebitis; and less commonly, septic arthritis, osteomyelitis, endocarditis, sepsis, and brain abscess
Systemic reactions, such as staphylococcal scalded-skin syndrome.
Cavernous sinus thrombosis — this is rare, and can result from boils or carbuncles on the lips, nose or cheek
Causes
meticillin-resistant Staphylococcus aureus (MRSA) and Panton-Valentine leukocidin (PVL-SA),
Staphylococcal carriage, usually in the anterior nares, may be responsible for recurrent boils and carbuncles
Staphylococcus aureus (S. aureus). They are contagious and may spread to other areas of the body or to other people.
Risk Factors
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Treatment with corticosteroids or immunosuppressive drugs, such as disease modifying anti-rheumatic drugs.
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Dietary problems -Obesity, malnutrition
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Common DDx
Cystic acne — associated with nodules, papules, and comedones and usually confined to the face and trunk.
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Epidermoid cyst (ruptured) — a round, unilocular cyst of the dermis that is lined by epidermis and contains sebum and keratin. These are frequently seen in severe acne. They may become inflamed and tender intermittently and discharge pus.
Folliculitis — a superficial infection of the hair follicles, which develop into small inflammatory papules or pustules.
Hidradenitis suppurativa — a chronic inflammatory suppurative disease of the apocrine sweat glands causing painful, inflamed nodules and sterile abscesses. Consider this if only the groin and the axillae are involved.
Diagnosis
Boils- painful lump-occur in hair-bearing sites, especially those subject to friction or perspiration, such as the face, neck, axilla or buttocks.
Examine site, size, surrounding skin, exudate. Check for systemic symptoms and cellulitis
Carbuncles- red, painful lump, increased in size over days usually occur over nape of neck, back and thighs.
Examine site, size, surrounding skin, exudate. Check for systemic symptoms and cellulitis
Admission
If systemically unwell, cellulitis and requires IV Abx
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Is immunocompromised as a result of an underlying disease (such as diabetes) or medication (such as corticosteroids).
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Treatment
If small may be managed in primary care, and covered with sterile dressing
Swab- if not responding to Rx or recurring, multiple lesions, diabetics, immunocompromized or known to MRSA colonized
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Prescribe Abx if fever, cellulitis, lesion is on face, a carbuncle, pain or severe discomfort, comorbidities. Flucloxacillin 1st Line Clarithromycin
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