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FurunculosisAka: Furuncle, Carbuncle, Skin Abscess, Skin Boil

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  1. See Also
    1. Deep Folliculitis
    2. Incision and Drainage
    3. Perianal Abscess
    4. Paronychia
    5. Hidradenitis Suppurativa
  2. Pathophysiology
    1. Hair Follicle infection that spreads to deeper tissue
      1. Often begins as Folliculitis
    2. Walled-off Nodule of purulent infection
      1. Firm wall with inner fluctuant core
    3. Carbuncles involve a coalition of furuncles
      1. Deeper, more extensive involvement
      2. Require greater degree of debridement
  3. Risk Factors
    1. Obesity
    2. Impaired Neutrophil function
    3. Corticosteroid use
    4. Diabetes Mellitus
  4. Causes
    1. Staphylococcus aureus (most common)
    2. Streptococcus species
    3. Mixed bacterial infection
  5. Signs
    1. Tender, erythematous skin mass
    2. Often spontaneously opens and drains to skin surface
    3. Distribution
      1. Occur most commonly in areas of increased friction
      2. Buttock
      3. Extremities
      4. Breast
        1. Lactating women: Associated with Mastitis
        2. Non-Lactating women: Usually subareolar
          1. Biopsy non-subareolar lesions
  6. Management: Acute Episode
    1. Trial of warm compresses for small abscesses
    2. Incision and Drainage
    3. Antibiotic
      1. Antibiotics usually not required once lesion opened
        1. Antibiotics do not shorten course of abscess
      2. Antibiotics indications (post-drainage)
        1. Cellulitis (see Cellulitis for antibiotic choices)
        2. Carbuncle
        3. Immunocompromised patients
  7. Management: Recurrent Episodes
    1. Optimize personal hygiene
    2. Mupirocin (Bactroban)
      1. Apply intranasally bid for 5 days
      2. Reduces nasal Staphylococcus aureus carriage
    3. Systemic antibiotic protocols (10 day course)
      1. Rifampin 600 mg PO qd and
      2. Dicloxacillin 500 qid or Septra DS bid
    4. Vitamin C 1 gram per day
      1. Effective in those with impaired Neutrophil function
  8. Complications
    1. Cellulitis
    2. Gangrene
    3. Necrotizing Fasciitis
    4. Hidradenitis Suppurativa
    5. Recurrent furunculosis
  9. References
    1. Derksen in Pfenninger (1994) Procedures, p. 50-3
    2. Gilbert (2002) Sanford Guide, p. 36-37
    3. Carroll (1996) Postgrad Med 100(3):311
    4. Stulberg (2002) Am Fam Physician 66(1):119

carbuncle (C0007078)

Definition (MSH)An infection of cutaneous and subcutaneous tissue that consists of a cluster of boils. Commonly, the causative agent is STAPHYLOCOCCUS AUREUS. Carbuncles produce fever, leukocytosis, extreme pain, and prostration.
ConceptsDisease or Syndrome (T047)
ICD9680.9
MSHD002270
Englishcarbuncle, Carbuncle of skin AND/OR subcutaneous tissue, Carbuncles
Spanishantrax, antrax cutaneo y/o subcutaneo, antrax de la piel Y/O del tejido celular subcutaneo, carbunco cutaneo y/o subcutaneo, carbunco de la piel Y/O del tejido celular subcutaneo
Parent ConceptsFurunculosis (C0016867), Bacterial Infections (C0004623), carbuncle (C0007078), Carbuncle/boil (C0157680), Infection of skin AND/OR subcutaneous tissue (C0178299), Soft tissue lesion (C0410013), Inflammation of specific body systems (C1285333)
SourcesAOD, COSTAR, CST, LCH, MSH, MTH, MTHICD9, NDFRT, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Furunculosis (C0016867)

Definition (MSH)A persistent skin infection marked by the presence of furuncles, often chronic and recurrent. In humans, the causative agent is various species of STAPHYLOCOCCUS. In salmonid fish (SALMONIDS), the pathogen is AEROMONAS SALMONICIDA.
ConceptsDisease or Syndrome (T047)
MSHD005667
EnglishFORUNCULOSIS, Furunculoses, Furunculosis, Furunculosis of skin AND/OR subcutaneous tissue, Recurrent boils, Recurring furuncles of skin, Recurring skin boils
Spanishdiviesos cutaneos recidivantes, forunculos cutaneos recidivantes, forunculosis, forunculosis de la piel Y/O del tejido celular subcutaneo, furunculos cutaneos recurrentes, furunculosis, furunculosis de la piel Y/O del tejido celular subcutaneo
Parent ConceptsSkin Disorders, General, Functional and NEC (C0549579), SKIN INFECTION/INFLAMMATION (C0549663), Fish Diseases (C0016154), Staphylococcal Skin Infections (C0038166), Skin Diseases, Infectious (C0037278), furuncle (C0242301)
SourcesCOSTAR, CSP, CST, DXP, LCH, MSH, NCI, NDFRT, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


furuncle (C0242301)

ConceptsDisease or Syndrome (T047)
ICD9680.9
MSHD005667
EnglishBoil, Boil of skin AND/OR subcutaneous tissue, Boils, furuncle, Furuncle of skin AND/OR subcutaneous tissue, Furuncles, Furunculus
Spanishdivieso de la piel Y/O del tejido celular subcutaneo, forunculo, forunculo de la piel Y/O del tejido celular subcutaneo, furunculo, furunculo de la piel Y/O del tejido celular subcutaneo
Parent ConceptsSkin Diseases, Infectious (C0037278), Bacterial Infections (C0004623), Carbuncle/boil (C0157680), Infection of skin AND/OR subcutaneous tissue (C0178299), furuncle (C0242301), Soft tissue lesion (C0410013), Inflammation of specific body systems (C1285333), Ambiguous concept (C1274012), Duplicate concept (C1274013)
SourcesAOD, COSTAR, CST, DXP, MSH, MTH, MTHICD9, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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