SKIN ABSCESS, FURUNCLE, CARBUNCLE OR BOIL
By Gary M. White, MD
These pus-filled nodules definitely needed to be drained. Staphylococcus grew out.
An abscess, furuncle and carbuncle are all terms for infections, usually bacterial, of the skin.
- An abscess is an area containing a localized accumulation of pus.
- A furuncle is an inflammatory lesion in which the bacterial infection extends beyond one follicle.
- A carbuncle is an area of infection where pus emanates from multiple openings.
- A boil is a less precise term that refers to an inflamed and usually tender nodule of the skin. It typically represents a localized infection by a bacteria, usually staphylococcus aureus. If left untreated, it often comes to a head, ruptures and heals. Alternatively, it may resolve without rupture.
- Within the differential diagnosis of an acutely inflamed nodule is a ruptured epidermal inclusion cyst whose contents are sterile. Often, it is difficult to tell the difference. See also furuncle.
- The majority of abscesses grow out Staphylococcus aureas and many methicillin-resistant.
The patient experiences the acute onset of one or more inflammatory, tender papulonodules. Individual lesions may be hard or fluctuant and when ruptured, drain pus. The typical life cycle is for the lesion to start out firm and red, then over several days to a week come to a head, perhaps with a yellowish-white color, and then rupture and drain.
- Incision and Drainage if fluctuant
- Culture the pus
- Oral antibiotics
For fluctuant abscesses, incision and drainage is the most important intervention. In a study of small abscess less than 5 cm, the addition of oral clindamycin or TMP-SMX increased cure rates at 10 days from 69 to 82% [Robert S Daum MD as reported in Dermatology News Dec 2016].
Consensus guidelines [Clin Infect Dis 2014 Jul 15; 59:e10] recommend adding oral antibiotics if systemic signs and symptoms of infection or elevated white blood count are present. Some experts recommend for all abscess culturing the pus and covering with oral antibiotics until the culture is back. Some stop the antibiotic if the staphylococcus is methicillin-senstitive and the patient is doing well. See also cellulitis for treatment recommendations.
A draining abscess on the knee with surrounding cellulitis.
A small abscess of the chest that grew out MRSA.
Several grouped abscesses.
A small abscess in the axilla.
Another abscess in the axilla.
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