Folliculitis,
Furuncles, Carbuncles And AbscessesIntroduction: When
a skin infection is confined to a hair follicle, this is called a folliculitis.
However, when the infection spreads and involves the tissue around the hair
follicle as well, this is called a furuncle.
In males the back of the neck is an area where furuncles like to occur and if
several of them connect subcutaneously, this is called a carbuncle. Occasionally,
when these other condtions are not treated adequately, a skin
abscess might form, where some of the subcutaneous tissue has melted
away and formed a pus pocket. Diabetes predisposes to carbuncles. They tend to
develop slower (several days) and they dissolve very slowly (often weeks) leaving
behind a lot of scarring with defects (dimples) in the skin. Folliculitis,
furuncles and carbuncles are commonly due to Staphylococcus aureus, a bacterium,
which grows on agar plates in the laboratory as golden yellow spots. It is from
this appearance in culture that this bacterium got its name "aureus"
(=golden). With a penetrating wound from a gun shot injury, knife injuries
etc. bacteria from the skin or from the penetrating object get into the wound
and multiply within a short time. There is a limited time of 4 to 6 hours
that the physician has to clean up and close such a wound. If this time frame
is surpassed or if inadvertently pathological bacteria are left behind, an abscess
will form. This is an accumulation of pus under pressure. The danger , if this
is left alone, is that the bacteria will spread via the lymphatic and blood vessels
into the general circulation and into other vital organs. Staphylococcal sepsis,
pneumonia, arthritis,osteomyelitis as well as endocarditis can subsequently develop.
All of these conditions can be life threatening. Prompt recognition, accurate
diagnosis and swift treatment (see below) will save many lives. Signs
and symptoms: Folliculitis presents with
a pustule or reddish inflammation around a hair follicle. There may be
several spots of folliculitis. As the bacteria (mostly Staph. aureus) multiply
quickly, sometimes the spreading of the infection can be a problem such as in
bearded areas of males. Furuncles are acute localized
reddish nodules, which are painful, and tend to occur in the neck area, the face,
on breasts and buttocks. Often it starts as a pus blister (pustule), which then
breaks open and discharges pus and necrotic tissue. If furuncles occur at the
nose or the ears they are particularly painful. Carbuncles
are larger and deeper than furuncles, but otherwise are found in the same areas
and also tend to break open. Abscesses present as tender,
swollen areas of reddened skin, which are hot and tender to touch. There often
is a fever associated with it as toxins circulate in the system. If pus migrates
through the circulatory system, there could be other new abscesses form in other
organs. With a brain abscess there would be signs of a stroke (hemiplegia, with
half of the body paralyzed) and with abscesses in other organs there would be
specific symptoms in these organs. Diagnostic tests: The
diagnosis is mostly a clinical one. In other words, the symptoms and the history
will allow the physician to come to the diagnosis with high accuracy. In the case
of skin abscesses blood tests, blood cultures and some other tests may be needed
to help with the diagnosis. In deeper abscesses such tests as ultrasound, CT scan
and Gallium bone scan might be indicated. Marked increased white blood cell counts
(leukocytosis) is usually found in the case of an abscess. Treatment: For
folliculitis mupirocin ointment (brandname: Bactroban
ointment) is applied 3 to 4 times per day to the affected skin. This is
best complemented by oral administration of cloxacillin or cephalexin for 7 to
10 days to interrupt the cycle of reinfection. Furuncles and carbuncles
are treated by incision and drainage. Isotretinoin (brand name:
Accutane) is useful in severe acne cases where furuncles are frequently also found.
Oral antibiotics as for folliculitis are often also given, but for more prolonged
periods of time. A deep skin abscess needs incision
and drainage by a surgeon. In a large abscess gauze packing or a surgical drainage
tube may have to be inserted to allow the wound to heal by "secondary"
wound healing ("primary" is direct closure). Antibiotic coverage as
above is given at the same time. Close monitoring of the blood tests and of the
clinical condition for possible complications needs to be done (Ref. 3, p. 799
and Ref. 2, p. 460). Pain Control: There is an FDA approved
non-drug method available, IceWave
patches from Lifewave, which will control pain. This is mentioned in the
book "Breakthrough" by Suzanne Somers (Ref. 6) where newer insights
of antiaging medicine are also reviewed. Although the patches are placed over
acupuncture points, there are no needles involved. Nanotechnology, a newer technology,
was used in the manufacturing of these patches and infrared (heat) waves from
body heat are utilized to stimulate an acupuncture point, which modifies pain
perception and reduces pain to half or less. Medically this would be considered
an excellent pain reliever. For more info on the patches see the IceWave patches
from Lifewave link above (click "products"). In the US a 5 pack of the
IceWave spray is available that can be directly sprayed onto the skin in the area
where the pain is located. |
