Folliculitis profunda (furuncle/carbuncle)

Last Updated: 2019-08-27

Author(s): -

Staphylodermia follicularis et perifollicularis profunda, Staphylodermia follicularis profunda necroticans, Staphylodermia follicularis profunda.

A boil is an often painful, abscending inflammation of the follicles and perifollicular with scarred healing. Several confluent boils combine to form a carbuncle.

Infection with Staphylococcus aureus, especially in patients with immunosuppression. Mostly by autoinoculation.

  • Furunkel:
  • Size-progressive pustules, which finally form a node with environmental edema. Fluctuation occurs in the course of time. Often additional crusts are visible. Pressure pain is typical. When split, pus empties. Partially red. General condition with febrile temperature, fatigue and fatigue.

 

  • Carbuncles:
  • Confluent boils. Oedem can result in rock-hard palpation, especially in the back area.

  • Clinic.
  • Blood count (e.g. leukaemia), ESR , temperature., possibly DM exclusion.
  • Nasal smear

Predilection sites include the outer auditory canal (extremely painful), upper lip, nose, neck, buttocks and inner thigh.

Locoregional lymphadenitis, thrombosis (sinus vein thrombosis) and thrombophlebitis in nasal and auricle furuncles, orbitaphlegmones, meningitides in centrofacial localization.

  • Inpatient admission, if: General symptoms (fever), boils on the face, immunosuppression.
  • Resting of the body part and elevated bearings.
  • Prohibition to speak in the case of labial furuncles.

  • Soft fare.
  • No manipulation by patients!

  • Wash bed linen and nightwear regularly.

  • Shorten fingernails.

 

Topical Therapy

  • Before opening the skin lesion
  • Ammonium bituminosulfonate (Ichtholan®) 10.20.50% ointment
  • (face, neck and in the genitoanal region only 20%)

 

  • After opening the skin lesion
  • Tamponade (impregnated gauze) with iodine-povidone (Betadine® solution)

 

  • Moist antimicrobial envelopes:
  • Polihexanide (Lavasept®) concentration, cong.
  • Tricolosan (Procutol)® skin washing emulsion

 

  NO RINSING WITH OCTENISEPT®! NECROSIS FORMATION IS POSSIBLE

 

Systemic Therapy

  • For example: Penicillinase resistant penicillins (flucloxacillin) 500mg p.o.
  • Application 3-4x per day 500mg approx. ½ to 1h before meals.
  • CI: liver dysfunction, mononucleosis, lymphatic leukemia, lactation.
  • Intravenous therapy is recommended for furuncles on the face!

 

  • For penicillin allergy::
  • Erythromycin
  • Application.: 4x daily 500 mg. p.o. (adults), maximum dose: 4 g/d (adult), 40 100 mg/kg bw/day (5-12 years).
  • CI: Hypersensitivities vs. Ingredients, liver dysfunction, simultaneous therapy with ergotamine or dihydroergotamine or hepatotoxic drugs, dose adjustment recommended for kidney or liver insufficiency.
  • CAVE:
  • If there are signs of hepato- or ototoxicity, immediate discontinuation is indicated.
  • Aggravation of myasthenia gravis.
  • In recurrent furuncles, immunodeficiency (HIV, DM and leukemia) should be excluded.
  • In the case of staphylococcal colonization of the nasal atrium, use of e.g:

 

  • Mupirocin (Bactroban®) nasal ointment 2x daily for 5-10 days.
  • CI: Breastfeeding, hypersensitivity to breastfeeding Ingredients.
  • Radiation therapy with e.g. red light and spa cell light can lead to a faster maturation of the follicle.
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