furuncles/carbuncles non-scaly nodules. what is it? (boil) an acute, round, tender, circumscribed,...

Furuncles/Carbuncles

Non-scaly Nodules

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 integrityAlcoholismMalnutritionBlood dyscrasiaImmunosuppressionDrug-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

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.

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