- 1 Introduction
- 2 Symptoms and clinical features of furunculosis (boils)
- 3 Differential diagnoses
- 4 Complications of furunculosis (boils)
- 5 Investigations
- 6 Treatment for furunculosis (boils)
- 7 Treatment objectives
- 8 Drug treatment
- 9 1. Drainage
- 10 2. Topical antibiotics
- 11 3. Systemic antibiotics
- 12 Surgical treatment
- 13 Recurrent furunculosis (boils) Prevention
- 14 Referral Criteria
Furunculosis (which is also called Boils) is an infection of a hair follicle by staphylococcal organisms, that leads to an inflammation.
A carbuncle is merely two or more confluent furuncles, with separate heads nodule, with a pustular centre.
Recalcitrant cases of furunculosis may occur with a background of:
- immune suppression
- Blood dyscrasias
- Disorders of neutrophil function
Boils may occur in patients with atopic dermatitis.
It may be iatrogenic
Symptoms and clinical features of furunculosis (boils)
- It can be found on all body sites where hairs are present.
- It starts with a small, yellow creamy
pustule that rapidly evolves into a red nodule, often with a central yellow plug
- As the lesion expands, it becomes:
- Painful and tense
- associated with local oedema, lymphangitis, regional lymphadenopathy and fever
- Eventually, the central part of the nodule becomes soft and drains spontaneously
Healing occurs after about 1 – 2 weeks with scar formation
- Cutaneous myiasis
- Acne inversa in the axilla or groin
Complications of furunculosis (boils)
- Carvenous sinus thrombosis when the lesions are on the head and neck.
- Wound swab for bacteriology and sensitivity
- Full Blood Count with differentials
- Fasting blood glucose
- HIV screening
Treatment for furunculosis (boils)
- Treat infection
- Correct predisposing factors
- Prevent complications
Abscesses are incised and drained. Intermittent hot compresses are used to facilitate drainage.
2. Topical antibiotics
For mild cases (few pustules without fever or systemic manifestations)
Adults and children:
- Apply 12 hourly for 7 days
Gentamicin 0.3% cream
- Apply 12 hourly for 7 days
3. Systemic antibiotics
This is usually unnecessary except for head and neck lesions, or when the boil is accompanied by fever, chills, regional lymphadenopathy, or a feeling of being unwell and in immunocompromised patients.
Note that resistance may set in with prolonged use of Systemic antibiotics.
- Adult: 960 mg orally every 12 hours for 5-10 days
- 6 weeks – 5 months: 120 mg;
- 6 months -5 years: 240 mg; 6-12 years: 480 mg taken orally every 12 hours for 5-10 days
- Adult: 300 to 600 mg orally every 6 to 8 hours:
Doxycycline or minocycline
- Adult: 100 mg orally every 12 hours.
- Adult and child over 8years 250-500 mg orally every 6 hours or-1g 12 hourly for 5-10 days
- up to 2 years: 125 mg orally every 6 hours;
- 2-8 years: 250 mg every 6 hours for 5 10days
- A small puncture wound often gives less of a scar than allowing spontaneous rupture; it also reduces the pain
- Should be under antibiotic cover to prevent septicaemia
Recurrent furunculosis (boils) Prevention
To prevent furunculosis (boils) from becoming recurrent:
- Treat possible predisposing factors such as obesity, diabetes etc
- Apply liquid soap containing either chlorhexidine gluconate with isopropyl alcohol or 2 to 3% chloroxylenol
- Give maintenance antibiotics over 1 to 2 months.
Refer for hospital care and treatment if spreading rapidly or cellulitis, osteomyelitis or septicaemia develops.