Folliculitis, Furuncles and Carbunculosis
A bacterial infection of the hair follicle, folliculitis causes the formation of a pustule. The infection can be superficial (follicular impetigo or Bockhart's impetigo) or deep (sycosis barbae).
Furuncles, commonly known as boils, are another form of deep folliculitis. Carbuncles are a group of interconnected furuncles. The prognosis depends on the severity of the infection and the patient's physical condition and ability to resist infection.
The most common cause of folliculitis, furuncles, or carbuncles is coagulase-positive Staphylococcus aureus. Predisposing factors include an infected wound, poor hygiene, debilitation, diabetes, alcoholism, occlusive cosmetics, tight clothes, friction, chafing, incorrect shaving technique, exposure to chemicals, treatment of skin lesions with tar or with occlusive therapy, and immunosuppressive therapy.
Signs and Symptoms
Folliculitis, furuncles, and carbuncles have different signs and symptoms. Folliculitis pustules usually appear on the scalp, arms, and legs in children and on the trunk, buttocks, bearded face and legs in adults. Furuncles are hard, painful nodules that commonly develop on the neck, face, axillae, and buttocks. For several days, these nodules enlarge and then rupture, discharging pus and necrotic material. After the nodules rupture, pain subsides, but erythema and edema may persist for days or weeks. Carbuncles are extremely painful, deep abscesses that drain through multiple openings onto the skin surface, usually around several hair follicles. Fever and malaise may accompany these lesions, which are now rather rare.
The obvious skin lesion confirms folliculitis, furuncles, or carbuncles. Wound culture usually shows S. aureus. In carbuncles, patient history reveals preexistent furuncles. A complete blood count may show an elevated white blood cell count (leukocytosis).
The differential diagnosis for folliculitis includes pustular miliaria, varicella, and eczema with folliculitis. The differential diagnosis for furuncles includes necrotic herpes simplex and hidradenitis suppurativa.
Folliculitis is treated by cleaning the infected area thoroughly with antibacterial soap and water; applying warm, wet compresses to promote vasodilation and drainage from the lesions; applying topical antibiotics, such as mupirocin ointment or clindamycin or erythromycin solution; and, in extensive infection, administering systemic antibiotics (a cephalosporin or dicloxacillin).
Furuncles may require incision and drainage of ripe lesions after application of warm, wet compresses and systemic antibiotics after drainage.
Carbuncles require systemic antibiotic therapy as well as incision and drainage.
Special Considerations and Prevention Tips
Below are some Tips which will help to control the disease and prevent it from getting serious.
Care for folliculitis, furuncles, and carbunculosis is basically supportive and emphasizes teaching the patient scrupulous personal and family hygiene measures. Taking the necessary precautions to prevent spreading infection is also an important part of care.
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