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  • • Furuncles and carbuncles: Cutaneous abscess that begin in skin glands and hair follicles

    • Furuncles (boils) usually start in infected hair follicles, some caused by retained foreign bodies and other injuries

    • Infection can spread as cellulitis or form a subcutaneous abscess

    • Furuncles may take a phlegmonous form, ie, extend into the subcutaneous tissue, forming a long, flat abscess

    • Furuncles can be multiple and recurrent (furunculosis)

    • Carbuncle is a deep-seated mass of fistulous tracts between infected hair follicles

    • Staphylococci and anaerobic diphtheroids are most common organisms

    • Hidradenitis suppurativa is a serious skin infection of the axillae or groin consisting of multiple abscesses of the apocrine sweat glands

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Epidemiology

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  • • Furunculosis usually occurs in young adults and is associated with hormonal changes resulting in impaired skin function

    • Carbuncles on the back of the neck are seen almost exclusively in diabetic patients or other relatively immunocompromised patients

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Symptoms and Signs

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  • • Furuncles itch and cause pain

    • Skin first becomes red and then turns white and necrotic over the top of the abscess

    • Surrounding erythema and induration

    • Regional lymphadenopathy

    • Carbuncles start as furuncles, with infection dissecting through dermis and subcutaneous tissue in connecting tunnels; extensions open to the surface, giving the appearance of large furuncles with many pustular openings

    • Patients may be febrile and mildly toxic

    Hidradenitis: Abscesses are concentrated in the apocrine gland areas, ie, the axillae, groin, and perineum

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  • • Rheumatoid nodules

    • Gout

    • Bursitis

    • Sinusitis

    • Erythema nodosum

    • Fungal infections

    • Benign or malignant skin tumors

    • Sebaceous or epithelial inclusion cysts

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  • • History and physical exam

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  • • Drainage of abscesses

    • Invasive carbuncles treated by excision and antibiotics

    • Extensive laundering of all personal clothing

    • Excision is continued until sinus tracts are removed, usually far beyond the cutaneous evidence of suppuration

    • Hidradenitis is usually treated by drainage of the individual abscess followed by careful hygiene

    • Apocrine sweat-bearing skin must be excised; if the deficit is large, closure with a skin graft may be indicated

    • Avoidance of antiperspirant and deodorant

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Surgery

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Indications

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  • • Diabetic or immunocompromised patients require urgent attention

    • Abscesses on the face usually must be treated with antibiotics as well as by prompt incision and drainage

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Medications

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  • • Use of antibiotics depends on location of the abscess and extent of infection

    • Washing with soaps containing hexachlorophene

    • Topical and systemic antibiotics may be beneficial

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Complications

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  • • Suppurative phlebitis when located near major veins

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Prognosis

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  • • Left untreated or inadequately treated may lead to infiltration of adjacent organs and body cavities

    • Without adequate excision, hidradenitis may become chronic and disabling

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References

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