Boil

Last updated

Boils
Furoncle.jpg
Furuncle
Specialty
Symptoms
  • Painful
  • small
  • rough skin growth
Causes

A boil, also called a furuncle, is a deep folliculitis, which is an infection of the hair follicle. It is most commonly caused by infection by the bacterium Staphylococcus aureus , resulting in a painful swollen area on the skin caused by an accumulation of pus and dead tissue. [1] Boils are therefore basically pus-filled nodules. [2] Individual boils clustered together are called carbuncles. [3] Most human infections are caused by coagulase-positive S. aureus strains, notable for the bacteria's ability to produce coagulase, an enzyme that can clot blood. Almost any organ system can be infected by S. aureus.

Contents

Signs and symptoms

Close-up of boil showing sloughing and necrosis Riehl Zumbusch Tafel III (2).jpg
Close-up of boil showing sloughing and necrosis

Boils are bumpy, red, pus-filled lumps around a hair follicle that are tender, warm, and painful. They range from pea-sized to golf ball-sized. A yellow or white point at the center of the lump can be seen when the boil is ready to drain or discharge pus. In a severe infection, an individual may experience fever, swollen lymph nodes, and fatigue. A recurring boil is called chronic furunculosis. [1] [4] [5] [6] Skin infections tend to be recurrent in many patients and often spread to other family members. Systemic factors that lower resistance commonly are detectable, including: diabetes, obesity, and hematologic disorders. [7]

Boils may appear on the buttocks or near the anus, the back, the neck, the belly, the chest, the arms or legs, or even in the ear canal. [8] Boils may also appear around the eye, where they are called styes. [9]

Complications

The most common complications of boils are scarring and infection or abscess of the skin, spinal cord, brain, kidneys, or other organs. Infections may also spread to the bloodstream (bacteremia) and become life-threatening. [5] [6] S. aureus strains first infect the skin and its structures (for example, sebaceous glands, hair follicles) or invade damaged skin (cuts, abrasions). Sometimes the infections are relatively limited (such as a stye, boil, furuncle, or carbuncle), but other times they may spread to other skin areas (causing cellulitis, folliculitis, or impetigo). Unfortunately, these bacteria can reach the bloodstream (bacteremia) and end up in many different body sites, causing infections (wound infections, abscesses, osteomyelitis, endocarditis, pneumonia) [10] 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. Such diseases include food poisoning, septic shock, toxic shock syndrome, and scalded skin syndrome. [11]

Causes

Bacteria

Naturally the cause is bacteria such as staphylococci that are present on the skin. Bacterial colonisation begins in the hair follicles and can cause local cellulitis and inflammation. [1] [5] [6] Myiasis caused by the tumbu fly in Africa usually presents with cutaneous furuncles. [12] Risk factors for furunculosis include bacterial carriage in the nostrils, diabetes mellitus, obesity, lymphoproliferative neoplasms, malnutrition, and use of immunosuppressive drugs. [13]

Family history

People with recurrent boils are as well more likely to have a positive family history, take antibiotics, and to have been hospitalised, anemic, or diabetic; they are also more likely to have associated skin diseases and multiple lesions. [14]

Other

Other causes include poor immune system function such as from HIV/AIDS, diabetes, malnutrition, or alcoholism. [15] Poor hygiene and obesity have also been linked. [15] It may occur following antibiotic use due to the development of resistance to the antibiotics used. [16] An associated skin disease favors recurrence. This may be attributed to the persistent colonization of abnormal skin with S. aureus strains, such as is the case in persons with atopic dermatitis. [16] Boils which recur under the arm, breast or in the groin area may be associated with hidradenitis suppurativa (HS). [17]

Diagnosis

Diagnosis is made through clinical evaluation by a physician, which may include culturing of the lesion. [18] Evaluation can further include imaging, such as an ultrasound, to evaluate for formation of an abscess or other complications.

Treatment

A boil may clear up on its own without bursting, but more often it will need to be opened and drained. This will usually happen spontaneously within two weeks. Regular application of a warm moist compress, both before and after a boil opens, can help speed healing. The area must be kept clean, hands washed after touching it, and any dressings disposed of carefully, in order to avoid spreading the bacteria. A doctor may cut open or "lance" a boil to allow it to drain, but squeezing or cutting should not be attempted at home, as this may further spread the infection. Antibiotic therapy may be recommended for large or recurrent boils or those that occur in sensitive areas (such as the groin, breasts, armpits, around or in the nostrils, or in the ear). [1] [4] [5] [6] An antibiotic should not be used for longer than one month, with at least two months (preferably longer) between uses, otherwise it will lose its effectiveness. [19]

Furuncles at risk of leading to serious complications should be incised and drained if antibiotics or steroid injections are not effective. These include furuncles that are unusually large, last longer than two weeks, or occur in the middle of the face or near the spine. [1] [6] Fever and chills are signs of sepsis and indicate immediate treatment. [20]

Staphylococcus aureus has the ability to acquire antimicrobial resistance easily, making treatment difficult. Knowledge of the antimicrobial resistance of S. aureus is important in the selection of antimicrobials for treatment. [21]

See also

Related Research Articles

<span class="mw-page-title-main">Abscess</span> Localized collection of pus that has built up within the tissue of the body

An abscess is a collection of pus that has built up within the tissue of the body. Signs and symptoms of abscesses include redness, pain, warmth, and swelling. The swelling may feel fluid-filled when pressed. The area of redness often extends beyond the swelling. Carbuncles and boils are types of abscess that often involve hair follicles, with carbuncles being larger. A cyst is related to an abscess, but it contains a material other than pus, and a cyst has a clearly defined wall.

<span class="mw-page-title-main">Impetigo</span> Human disease (bacterial infection)

Impetigo is a bacterial infection that involves the superficial skin. The most common presentation is yellowish crusts on the face, arms, or legs. Less commonly there may be large blisters which affect the groin or armpits. The lesions may be painful or itchy. Fever is uncommon.

<i>Staphylococcus aureus</i> Species of Gram-positive bacterium

Staphylococcus aureus is a gram-positive spherically shaped bacterium, a member of the Bacillota, and is a usual member of the microbiota of the body, frequently found in the upper respiratory tract and on the skin. It is often positive for catalase and nitrate reduction and is a facultative anaerobe that can grow without the need for oxygen. Although S. aureus usually acts as a commensal of the human microbiota, it can also become an opportunistic pathogen, being a common cause of skin infections including abscesses, respiratory infections such as sinusitis, and food poisoning. Pathogenic strains often promote infections by producing virulence factors such as potent protein toxins, and the expression of a cell-surface protein that binds and inactivates antibodies. S. aureus is one of the leading pathogens for deaths associated with antimicrobial resistance and the emergence of antibiotic-resistant strains, such as methicillin-resistant S. aureus (MRSA), is a worldwide problem in clinical medicine. Despite much research and development, no vaccine for S. aureus has been approved.

Methicillin-resistant <i>Staphylococcus aureus</i> Bacterium responsible for difficult-to-treat infections in humans

Methicillin-resistant Staphylococcus aureus (MRSA) is a group of gram-positive bacteria that are genetically distinct from other strains of Staphylococcus aureus. MRSA is responsible for several difficult-to-treat infections in humans. It caused more than 100,000 deaths worldwide attributable to antimicrobial resistance in 2019.

<span class="mw-page-title-main">Folliculitis</span> Human and animal disease of follicles

Folliculitis is the infection and inflammation of one or more hair follicles. The condition may occur anywhere on hair-covered skin. The rash may appear as pimples that come to white tips on the face, chest, back, arms, legs, buttocks, or head.

<span class="mw-page-title-main">Osteomyelitis</span> Infection of the bones

Osteomyelitis (OM) is an infection of bone. Symptoms may include pain in a specific bone with overlying redness, fever, and weakness. The long bones of the arms and legs are most commonly involved in children e.g. the femur and humerus, while the feet, spine, and hips are most commonly involved in adults.

<span class="mw-page-title-main">Clindamycin</span> Antibiotic

Clindamycin is a lincosamide antibiotic medication used for the treatment of a number of bacterial infections, including osteomyelitis (bone) or joint infections, pelvic inflammatory disease, strep throat, pneumonia, acute otitis media, and endocarditis. It can also be used to treat acne, and some cases of methicillin-resistant Staphylococcus aureus (MRSA). In combination with quinine, it can be used to treat malaria. It is available by mouth, by injection into a vein, and as a cream or a gel to be applied to the skin or in the vagina.

<span class="mw-page-title-main">Carbuncle</span> Cluster of boils caused by bacterial infection

A carbuncle is a cluster of boils caused by bacterial infection, most commonly with Staphylococcus aureus or Streptococcus pyogenes. The presence of a carbuncle is a sign that the immune system is active and fighting the infection. The infection is contagious and may spread to other areas of the body, or other people; those living in the same residence may develop carbuncles at the same time. In the early 21st century, infection involving methicillin-resistant Staphylococcus aureus (MRSA) has become more common.

<span class="mw-page-title-main">Cellulitis</span> Bacterial infection of the inner layers of the skin called the dermis

Cellulitis is usually a bacterial infection involving the inner layers of the skin. It specifically affects the dermis and subcutaneous fat. Signs and symptoms include an area of redness which increases in size over a few days. The borders of the area of redness are generally not sharp and the skin may be swollen. While the redness often turns white when pressure is applied, this is not always the case. The area of infection is usually painful. Lymphatic vessels may occasionally be involved, and the person may have a fever and feel tired.

<span class="mw-page-title-main">Amoxicillin/clavulanic acid</span> Combination antibiotic medication

Amoxicillin/clavulanic acid, also known as co-amoxiclav or amox-clav, sold under the brand name Augmentin, among others, is an antibiotic medication used for the treatment of a number of bacterial infections. It is a combination consisting of amoxicillin, a β-lactam antibiotic, and potassium clavulanate, a β-lactamase inhibitor. It is specifically used for otitis media, streptococcal pharyngitis, pneumonia, cellulitis, urinary tract infections, and animal bites. It is taken by mouth or by injection into a vein.

<span class="mw-page-title-main">Paronychia</span> Medical condition

Paronychia is an inflammation of the skin around the nail, which can occur suddenly, when it is usually due to the bacterium Staphylococcus aureus, or gradually when it is commonly caused by the fungus Candida albicans. The term is from Greek: παρωνυχία from para 'around', onyx 'nail', and the abstract noun suffix -ia.

Hidradenitoo is any disease in which the histologic abnormality is primarily an inflammatory infiltrate around the eccrine glands. This group includes neutrophilic eccrine hidradenitis and recurrent palmoplantar hidradenitis.

<span class="mw-page-title-main">Skin flora</span> Microbiota that reside on the skin

Skin flora, also called skin microbiota, refers to microbiota that reside on the skin, typically human skin.

<span class="mw-page-title-main">Adenoiditis</span> Medical condition

Adenoiditis is the inflammation of the adenoid tissue usually caused by an infection. Adenoiditis is treated using medication or surgical intervention.

Incision and drainage (I&D), also known as clinical lancing, are minor surgical procedures to release pus or pressure built up under the skin, such as from an abscess, boil, or infected paranasal sinus. It is performed by treating the area with an antiseptic, such as iodine-based solution, and then making a small incision to puncture the skin using a sterile instrument such as a sharp needle or a pointed scalpel. This allows the pus to escape by draining out through the incision.

<span class="mw-page-title-main">Staphylococcal infection</span> Medical condition

A staphylococcal infection or staph infection is an infection caused by members of the Staphylococcus genus of bacteria.

Skin and skin structure infections (SSSIs), also referred to as skin and soft tissue infections (SSTIs), or acute bacterial skin and skin structure infections (ABSSSIs), are infections of skin and associated soft tissues. Historically, the pathogen involved has most frequently been a bacterial species—always, since redescription of SSSIs as ABSSSIs—and as such, these infections require treatment by antibiotics.

Perianal cellulitis, also known as perianitis or perianal streptococcal dermatitis, is a bacterial infection affecting the lower layers of the skin (cellulitis) around the anus. It presents as bright redness in the skin and can be accompanied by pain, difficulty defecating, itching, and bleeding. This disease is considered a complicated skin and soft tissue infection (cSSTI) because of the involvement of the deeper soft tissues.

Staphylococcus schleiferi is a Gram-positive, cocci-shaped bacterium of the family Staphylococcaceae. It is facultatively anaerobic, coagulase-variable, and can be readily cultured on blood agar where the bacterium tends to form opaque, non-pigmented colonies and beta (β) hemolysis. There exists two subspecies under the species S. schleiferi: Staphylococcus schleiferi subsp. schleiferi and Staphylococcus schleiferi subsp. coagulans.

Staphylococcus pseudintermedius is a gram positive coccus bacteria of the genus Staphylococcus found worldwide. It is primarily a pathogen for domestic animals, but has been known to affect humans as well. S. pseudintermedius is an opportunistic pathogen that secretes immune modulating virulence factors, has many adhesion factors, and the potential to create biofilms, all of which help to determine the pathogenicity of the bacterium. Diagnoses of Staphylococcus pseudintermedius have traditionally been made using cytology, plating, and biochemical tests. More recently, molecular technologies like MALDI-TOF, DNA hybridization and PCR have become preferred over biochemical tests for their more rapid and accurate identifications. This includes the identification and diagnosis of antibiotic resistant strains.

References

  1. 1 2 3 4 5 MedlinePlus Encyclopedia : Furuncle
  2. ↑ "Causes and Cures of Skin". Healthguidance.org. Retrieved 26 July 2014.
  3. ↑ MedlinePlus Encyclopedia : Carbuncle
  4. 1 2 Blume JE, Levine EG, Heymann WR (2003). "Bacterial diseases". In Bolognia JL, Jorizzo JL, Rapini RP (eds.). Dermatology. Mosby. p. 1126. ISBN   0-323-02409-2.
  5. 1 2 3 4 Habif, TP (2004). "Furuncles and carbuncles". Clinical Dermatology: A Color Guide to Diagnosis and Therapy (4th ed.). Philadelphia PA: Mosby.
  6. 1 2 3 4 5 Wolf K; et al. (2005). "Section 22. Bacterial infections involving the skin". Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology (5th ed.). McGraw-Hill.
  7. ↑ Steele RW, Laner SA, Graves MH (February 1980). "Recurrent staphylococcal infection in families". Arch Dermatol. 116 (2): 189–90. doi:10.1001/archderm.1980.01640260065016. hdl: 1765/7628 . PMID   7356349.
  8. ↑ "Boils, Carbuncles and Furunculosis". Patient.info. Retrieved 26 July 2014.
  9. ↑ "Boils, Kidshealth". 13 September 2011. Retrieved 26 July 2014.
  10. ↑ Lina G, Piémont Y, Godail-Gamot F, Bes M, Peter MO, Gauduchon V, Vandenesch F, Etienne J (November 1999). "Involvement of Panton-Valentine leukocidin-producing Staphylococcus aureus in primary skin infections and pneumonia". Clin Infect Dis. 29 (5): 1128–32. doi: 10.1086/313461 . PMID   10524952.
  11. ↑ "Staph Infection Causes, Symptoms, Treatment – Staph Infection Diagnosis". eMedicineHealth.
  12. ↑ Tamir J, Haik J, Schwartz E (2003). "Myiasis with Lund's fly (Cordylobia rodhaini) in travellers". J Travel Med. 10 (5): 293–95. doi: 10.2310/7060.2003.2732 . PMID   14531984.
  13. ↑ Scheinfeld NS (2007). "Furunculosis". Consultant. 47 (2). Archived from the original on 23 November 2012. Retrieved 31 August 2009.
  14. ↑ El-Gilany AH, Fathy H (January 2009). "Risk factors of recurrent furunculosis". Dermatol Online J. 15 (1): 16. doi:10.5070/D39NG6M0BN. PMID   19281721.
  15. 1 2 Demos, M; McLeod, MP; Nouri, K (October 2012). "Recurrent furunculosis: a review of the literature". The British Journal of Dermatology. 167 (4): 725–32. doi:10.1111/j.1365-2133.2012.11151.x. PMID   22803835. S2CID   25415894.
  16. 1 2 Laube S, Farrell M (2002). "Bacterial skin infection in the elderly: diagnosis and treatment". Drugs & Aging. 19 (5): 331–42. doi:10.2165/00002512-200219050-00002. PMID   12093320. S2CID   24264303.
  17. ↑ "What is this boil like abscess under your arm, breast or groin". The Hidradenitis Suppurativa Trust. Archived from the original on 29 September 2015. Retrieved 28 September 2015.
  18. ↑ "Furuncles and Carbuncles". Merck Manuals Professional Edition. August 2017. Retrieved 29 April 2018.
  19. ↑ Mayo Clinic Archived 15 August 2012 at the Wayback Machine
  20. ↑ "Boils and carbuncles: Complications - MayoClinic.com". Archived from the original on 15 August 2012. Retrieved 14 August 2012.
  21. ↑ Nagaraju U, Bhat G, Kuruvila M, Pai GS, Babu RP (2004). "Methicillin-resistant Staphylococcus aureus in community-acquired pyoderma". Int J Dermatol. 43 (6): 412–14. doi:10.1111/j.1365-4632.2004.02138.x. PMID   15186220. S2CID   38742158.
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