Furuncle, Carbuncle, & Hidradenitis Suppurativa

• • 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

Epidemiology

• • 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

Symptoms and Signs

• • 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

• • Rheumatoid nodules

  • Gout

  • Bursitis

  • Sinusitis

  • Erythema nodosum

  • Fungal infections

  • Benign or malignant skin tumors

  • Sebaceous or epithelial inclusion cysts

• • History and physical exam

• • 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

Surgery

Indications

• • 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

Medications

• • 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

Complications

• • Suppurative phlebitis when located near major veins

Prognosis

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

  • Without adequate excision, hidradenitis may become chronic and disabling