Furuncle

Furuncle 

Furuncle (tetanus) is an acute purulent inflammation of the hair follicle with the involvement of adjacent tissues in the process: sebaceous and sweat glands and skin. It is caused, as a rule, by staphylococci, less often by other purulent flora. In the focus of inflammation, melting,  and death of tissues takes place, which takes the form of a necrotic rod.

Furuncles occur at any age. Men have furuncles more often, which is probably because women pay more attention to skincare. They can appear on any part of the body where there is hair, including the nose and groin area.

Furuncles on the face and upper lip are the most dangerous. 

Classification 

There is no clinical classification of furuncles, they are part of the purulent processes of the skin (pyoderma). This group of diseases also includes hidradenitis (purulent inflammation in the armpits), phlegmon (a spilled subcutaneous purulent process), hysteria, and some other surgical infections. 

To better understand the specifics of the process, surgeons divide furuncles by location and extent of inflammation. 

According to localization, teals are: 

• face;
• nose;
• heads;
• back;
• chest;
• hands;
• anogenital area, etc.

According to their prevalence, they are single and multiple.

Pathogenesis and stages of development

The main factor that causes purulent-necrotic inflammation is staphylococcal infection. These microorganisms live on the skin and in case of the appearance of favorable conditions for them, penetrate deep into the hair follicle, where they begin to multiply actively feeding on sebum.

Staphylococci are a strong irritant for the immune system as a result of which inflammation develops quickly violently and with necrosis.

According to this, the doctor chooses appropriate treatment for different types of furuncles with specially selected antibiotics.

In its development furuncle undergoes several stages:

• microorganisms penetrate deep into the hair follicle;
• feeding on sebum, multiply violently;
• the reaction of immunity leads to the formation of edema, due to which the outflow paths for sebaceous and sweat glands are blocked;
• a dense infiltrate is formed;
• immune cells of the skin try to destroy pathogens and die and a pus core is formed;
• in the case of a favorable course, the inflammation melts the skin that covers the abscess, and the rod with pus comes out;
• a wound is formed at the place of the hair bulb, which heals with a scar.

Initially, inflammation, edema, and infiltration build up over several hours. And from the beginning of the process to the opening of the abscess, as a rule, 8–14 days pass.

Provocative factors

The following factors contribute to the development of purulent inflammation of the hair bulb:

• insufficient skin hygiene;
• mechanical damage to it;
• unbalanced diet;
• diabetes;
• hypovitaminosis and other unfavorable moments for health.

Often, a furuncle on the face appears as a result of attempts at self-treatment, squeezing acne rash.

Symptoms

A person needs to recognize the initial stages of purulent inflammation of the hair bulb to seek medical help in time.

Characteristic symptoms of a furuncle:

• a red focus and swelling appear on the skin, around the hair, or the pore of the hair bulb;
• the focus becomes painful from the first minutes, and the pain often pulsates;
• swelling increases, an infiltrate of 0.5 to 2.5 cm in size is formed;
• in the center, at the place of the dead hair follicle, a purulent core forms, its top can be seen under the skin as a white dot or spot;
• at this stage, the general condition may worsen - temperature up to 38 degrees, poor appetite, fatigue, weakness, headache;
• by 7–10 days, the purulent core peels off and can come out;
• a large hole remains, the diameter of the rod, and the skin around it is still inflamed;
• the wound heals from the inside, forming scar tissue.

Attempts to squeeze out an abscess can lead to skin injuries and the spread of pus deep into the tissues. This leads to the formation of a large crater, after which an unattractive wide scar remains.

Children need special attention: in a child, purulent inflammation may have a different course than in adults: with a more turbulent picture and a more pronounced deterioration of the general condition.

Furunculosis

This is the name of the process when a person simultaneously has several furuncles on one or different parts of the body. At the same time, different cells are at different stages of development.

Well-being worsens in proportion to the number of furuncles. A similar condition is characteristic of people with foci of chronic infection in the body.

Carbuncle

Serious surgical pathology, when several adjacent hair follicles become inflamed at the same time. The focus is large, abscesses merge. If there is a furuncle, the rod will be single, if a carbuncle develops, there will be several of them.

Purulent inflammation is violent and active, intoxication occurs, and body temperature rises. In this case, surgical help is urgently needed.

Complications of furuncle

An acute purulent infection is always dangerous. We recommend contacting the Universum clinic in case of the appearance of at least one such abscess, whether in an adult or a child.

Without treatment or when trying to squeeze out the rod, there is a high risk of encountering complications:

• the formation of a large accumulation of pus - an abscess;
• the spread of pus and infection in the subcutaneous tissue with the formation of phlegmon;
• the entry of microbes into the bloodstream, in this regard, boils on the face and lips are especially dangerous;
• damage to organs of the lymphatic system - lymphangitis, lymphadenitis;
• sepsis (blood infection).

A dangerous complication of a furuncle is the screening of infection in the internal organs with the formation of purulent foci, for example - kidney furuncle, and infectious endocarditis.

Diagnostics

It is not difficult for an experienced surgeon to diagnose a furuncle. For this, the clinic doctor only needs to examine the patient and interview him.

Attention is paid to two points:

• identify the causative agent and establish which antibiotics it is sensitive to;
• determine the cause of the abscess or furunculosis to develop measures to prevent such situations from recurring.

If the patient suffers from recurrent boils or furunculosis, a more careful examination is required:

• clinical blood analysis;
• tests for viral infections;
• Ultrasound of internal organs;
• blood culture for sterility;
• Search for the source of chronic infection - X-ray of the frontal and nasal sinuses, consultation with an otorhinolaryngologist, dentist, and fluorography.

It is sometimes necessary to consult a children's gastroenterologist or a pediatrician.

Treatment

A single small furuncle with a low risk of complications is treated locally. Ointment dressings with an antibiotic are used, in the initial stages, irradiation with a quartz lamp, UHF is useful.

The decision to remove the boil is taken because of the danger it poses. Squeezing is not allowed. In aseptic conditions, the surgeon carefully opens the abscess and uses tweezers to remove the pus core that has formed.

In addition, it may be necessary to conduct a course of systemic antibiotic therapy using drugs to which the causative agent has preserved sensitivity. For poor general health, detoxification therapy is carried out. It is advisable to administer a staphylococcal vaccine, toxoid.

As a rule, furuncle treatment is carried out on an outpatient basis. An abscess is opened to the patient and then the person comes for dressings for several days.

Inpatient care becomes necessary in the event of the development of complications of purulent inflammation.

Prevention

To reduce the risk of furuncles, it is necessary to follow the rules of personal hygiene and eliminate a source of chronic infection in the body.

We recommend:

• use scrubs;
• regularly wash and take a shower, and bath;
• lead an active, healthy lifestyle;
• to eat rationally and in a balanced way
• do not engage in self-treatment of skin pathology without consulting a doctor;
• control the level of glucose in the blood.

Visit the dentist on time, and treat chronic infections. If necessary, the clinic will organize a consultation with a dermatologist and endocrinologist.

Literature

1. Chiller K et al. Skin microflora and bacterial infections of the skin. J Investig Dermatol Symp Proc. 2001 Dec;6(3):170-4. doi: 10.1046/j.0022-202x.2001.00043.x. PMID: 11924823.
2. Banker LS, Ho SC. Nonhealing boils. J Fam Pract. 2022 Apr;71(3):133-140. doi: 10.12788/jfp.0383. PMID: 35561239.
3. Demos M, McLeod MP, Nouri K. Recurrent furunculosis: a review of the literature. Br J Dermatol. 2012 Oct;167(4):725-32. doi: 10.1111/j.1365-2133.2012.11151.x. PMID: 22803835.
4. Lin HS et al. Interventions for bacterial folliculitis and boils (furuncles and carbuncles). Cochrane Database Syst Rev. 2021 Feb 26;2(2):CD013099. doi: 10.1002/14651858.CD013099.pub2. PMID: 33634465; PMCID: PMC8130991.
5. Yagi S et al. Infective Endocarditis from Furuncle with Meningitis Complication Caused by Methicillin-resistant Staphylococcus aureus. Intern Med. 2021 Oct 15;60(20):3251-3255. doi: 10.2169/internalmedicine.6902-20. Epub 2021 Apr 19. PMID: 33867390; PMCID: PMC8580777.