Boil (Furuncle)




A boil, also called a furuncle.



It is a is a deep folliculitis, an infection of the hair follicle. 



Boils are most commonly caused by infection by the bacterium Staphylococcus aureus.



A boil , is a painful swollen area on the skin caused by an accumulation of pus and dead tissue.



Individual boils clustered together are called carbuncles.



Boils are pus-filled lumps around a hair follicle that are tender, warm, and painful. 



Boils range from pea-sized to golf ball-sized. 



With a severe infection there  may fever, swollen lymph nodes, and fatigue. 



A recurring boil is called chronic furunculosis.



Skin infections tend to be recurrent.



 In many patients spread to other family members of the infections occur.



Underlying factors that lower resistance are often present: diabetes, obesity, and hematologic disorders.



Boils may appear on the buttocks,  near the anus, the back, the neck, the stomach, the chest, the arms or legs, ear canal, around the eye (stye), on the gum (gumboil).



Complications of boils: scarring and infection or abscess of the skin, spinal cord, brain, kidneys, or other organs, bacteremia and become life-threatening.



S. aureus strains infect the skin and its structures sebaceous glands, hair follicles or invade damaged skin cuts, or abrasions.



Usually  infections are relatively limited, such as a stye, boil, furuncle, or carbuncle, but may spread to other skin areas causing cellulitis, folliculitis, or impetigo.



These bacteria can reach the bloodstream disseminate  to many different body sites, causing wound infections, abscesses, osteomyelitis, endocarditis, pneumonia that may severely harm or kill the infected person. 



S. aureus strains also produce enzymes and exotoxins that likely cause or increase the severity of certain diseases: 


food poisoning, septic shock, toxic shock syndrome, and scalded skin syndrome.



Almost any organ system can be infected by S. aureus. 



Manipulating boils in the danger triangle of the face is dangerous if done outside a medical setting, as blood vessels in this area drain into the brain.



Bacterial colonization the skin  begins in the hair follicles and can cause inflammation.



Recurrent boils: associated with a positive family history, taking antibiotics, having been hospitalized, anemia, diabetes, and are more likely to have associated skin diseases and multiple lesions.



Associated with poor immune system function such as from HIV/AIDS, diabetes, malnutrition, or alcoholism, poor hygiene and obesity.



Antibiotic resistance may be associated with boil development.



Skin diseases favors recurrence of boils, due to persistent colonization of abnormal skin with S. aureus strains, such as is the case in persons with atopic dermatitis.



Hidradenitis suppurativa may be associated with recurrent boils 


under the arm, breast or in the groin area.



Diagnosis is by clinical evaluation which  may include culturing of the lesion.






It may clear up on its own without bursting.



More often often it needs to be opened and drained. 



Drainage usually occurs spontaneously within two weeks. 



Warm moist compress, both before and after a boil opens, can help speed healing. 



Antibiotic therapy may be recommended for large/recurrent boils or those that occur in sensitive areas: such as the groin, breasts, armpits, nostrils, or ear.



Prolonged antibiotics will lead to antibiotic resistance.



With a chronic boil surgery may be indicated.



Furuncles at risk of leading to serious complications: unusually large, lasting longer than two weeks, or occur in the middle of the face or near the spine.



Fever and chills associated with a boil, suggests  sepsis and requires an  immediate treatment is needed.



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