Folliculitis, Furuncles and Carbuncles

All of these represent a spectrum of hair follicle infections.

Folliculitis is a superficial infection of the follicle.  Furunculosis is deeper infection of the follicle (sometimes referred to as a boil).  Carbunculosis is when a group of adjacent follicles all become deeply infected.

  • Very, very common, particularly in adolescence

Aetiology

  • More common in skin which is already inflamed e.g. dermatitic skin
  • More common in patients with diabetes or who are immunosupressed
    • Carbuncles, in particular, are associated with malnutrition, prolonged steroid therapy, other skin disease and drug addiction
  • Staphylococcus aureus is almost always the infective organism.

Presentation

  • Folluculitis normally presents on hair bearing areas as small, multiple and pustular lesions
    • These may initially itch or can be slightly painful or tender
  • A furuncle (boil) usually presents as a solitary, tender and inflamed nodule on hair-bearing regions which tends to have a pustular head which may discharge later, before healing over (can scar)
    • Rarely there can be systemic features e.g. fever, malaise
  • A carbuncle usually starts as a smooth, dome-shaped, acutely tender and painful lesion which may start to discharge pus from multiple sites

Diagnosis/Management

  • Commonly a clinical diagnosis and will usually be self-limiting
  • Antibiotics are only really advised if there is surrounding cellulitis or if complications (e.g. on the face) are a risk (or if the patient is immunocomprimised)
    • Flucloxacillin first line
  • Incision and drainage may be appropriate for large/severe lesions

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