Furunclulosis

A furuncle (“boil”) is a deep, painful inflammation of a hair follicle which leads to abscess with an accumulation of pus and necrotic tissue. It appears on the hair-bearing parts of the skin and the infectious agent is Staphylococcus aureus and other bacterias. The inflammation is annoying, unsightly, very contagious and relatively harmless if it is not localized in the nasolabial region. Furuncles are red, swollen, and tender nodules of varying size and at times with an overlying pustule. Few adjacent infected follicles may coalesce and form a larger nodule, known as a carbuncle. Frequently they are seen on the extremities and upon healing may lead to scarring.

The infection is most often caused by microorganism and resistance toward antimicrobials is an increasing problem. Furunculosis is a skin condition which tends to be recurrent and often spreads to family members either directly by skin contact or indirectly. Three or more attacks of furunculosis within a 12 month period is defined as Recurrent and its management is difficult and often disappointing. Recurrent furunculosis is most often caused by methicillin-susceptible S. aureus. However, community-acquired MRSA has become endemic in the US and in many countries constituting an emerging problem worldwide. S. aureus colonizes in the anterior nares which has a definite role in the etiology of chronic or recurrent furunculosis. Colonization also occurs in warm, moist skin folds such as behind ears, under pendulous breasts, and in the groin. Bacteria other than S. aureus especially, enteric species such as Enterobacteriaceae and Enterococci and Corynebacterium, S. epidermidis, and S. pyogenes may also be present in furunculosis.

For the diagnosis of furunculosis, a general clinical examination along with culture swabs of the lesions and carrier sites such as nostrils and perineum is performed. Blood and urine investigations are also carried out to rule out any underlying diabetes and systemic infection or other internal diseases. With each succeeding furuncle, the skin of the region becomes more widely and heavily seeded with the offending bacteria. Furunculosis is persistent despite local and systemic treatment and relapses often occur in the original site. The organisms growing in furuncle can become part of the resident flora and can live on the skin for long periods of time and so it is difficult to eradicate them.

Bacteria are first deposited superficially in the hair pits and then by the natural processes of reproduction and invasion, they are carried slowly toward the roots of the hairs aided by rubbing, scratching and squeezing on the part of the patient. The morbidity associated with furunculosis may be considerable and therefore treatment is important. During the furuncle development, it may be treated with hot compresses, but they may do equally well if left strictly alone. A sulfathiazole paste dressing is suggested to be applied just before rupture and this treatment can be used to advantage during the period of discharge. The essential component of furuncle treatment is hygiene education and this approach will lead to a treatment that is more effective and efficient.