Folliculitis Furuncles Carbuncles

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Folliculitis, Furuncles, Carbuncles : 

Folliculitis, Furuncles, Carbuncles K. Michelle Pendergrass PhD(c), PNP, FNP-BC

Folliculitis : 

Inflammation of follicles, primarily hair follicles. Folliculitis: inflammation of hair follicle from Infection Chemical irritation injury Infectious causes Staphylococcus aureus (most common) Streptococcus species Mixed bacterial infection Folliculitis

Folliculitis : 

Folliculitis

Risk Factors Folliculitis : 

Local trauma Abrasion Surgical wounds or draining abscess Shaving Aggravates Staphylococcus aureus folliculitis Exposure to Occlusive Dressing Tar Adhesive plaster Plastic Occlusive Dressings Risk Factors Folliculitis

Symptoms/Signs : 

Symptoms Non-tender or minimally tender Variably pruritic Signs Symptoms/Signs

Furuncle : 

Abscess or boil Usually starts as folliculitis Deep folliculitis-spreads to deeper tissue Walled-off nodule of purulent infection Painful Firm or fluctuant Fever is uncommon Can be at any site Most often in areas of friction Furuncle

Furuncle : 

Furuncle

Carbuncles : 

Carbuncles involve a coalition of furuncles Deeper, more extensive involvement Require greater degree of debridement Furuncles and carbuncles uncommon in children Very painful and may have fever, chills Occur in areas with thick dermis (back of neck, lateral aspect of thigh Carbuncles

Carbuncles : 

Carbuncles

Carbuncles : 

Carbuncles

Risk Factors Furuncles and Carbuncles : 

Obesity Impaired Neutrophil function Corticosteroid use Diabetes Mellitus Risk Factors Furuncles and Carbuncles

Plan Folliculitis : 

Eliminate provocative agents Keep affected areas clean Consider warm, wet Burow's Solution Topical antibiotics Mupirocin (Bactroban) cream apply small amount TID to affected area x 7-10 days Erythromycin 2% solution BID x 7 days Clindamycin Solution BID x 7-10 days Plan Folliculitis

Burow’s Solution : 

Preparation Burow's Solution (Aluminum Acetate 1/20 or 1/40) Dissolve 1 packet in 1 pint water Application Soak 6-8 layers of gauze in solution Wring out gently, and apply to area for 15-20 min Change every 2-3 hours Burow’s Solution

Plan Acute: Furuncles Carbuncles : 

Trial of warm compresses for small abscesses Incision and Drainage Antibiotic Antibiotics usually not required once lesion opened Antibiotics do not shorten course of abscess Antibiotics indications (post-drainage) Cellulitis Carbuncle Immunocompromised patients Plan Acute: Furuncles Carbuncles

Recurrent Plan : 

Optimize personal hygiene Mupirocin (Bactroban) Apply intranasally bid for 5 days Reduces nasal Staphylococcus aureus carriage Systemic antibiotic protocols (10 day course) Rifampin 600 mg PO qd and Dicloxacillin 500 qid or Septra DS bid Vitamin C 1 gram per day Effective in those with impaired Neutrophil function Recurrent Plan

Complications : 

Cellulitis Gangrene Necrotizing Fasciitis Hidradenitis Suppurativa Recurrent furunculosis Complications

Follow-up and Referral : 

Culture recurrent abscesses Stress good hygiene to patient and family Stress good, frequent hand-washing and daily skin cleansing Refer Cutaneous abscesses on face, scalp and neck Refer for evaluation for diseases that may underlie recurrent furunculosis: immunodeficiency, diabetes mellitus, alcoholism, malnutrition, severe anemia Follow-up and Referral

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