carbuncle

1. 1. FOLLICULITIS
• Inflammation beginning within the hair follicle
• Could be superficial and Deep, Infectious or Non-infectious.
• Infectious causes include Baceria (S. aureus, Ps. aueroginosa, gram negatives),
Fungi (Dermatophytes, Pitrosporum, Candida spp.), Viruses (Herpes Simplex,
Mulluscum Contagiosum).
• Classified according to;
-The depth of invasion and
-Microbial etiology.
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2. Folliculitis
• Superficial infection of the hair
follicle
• Self-limiting
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3. HISTORY
• Duration of lesions
• Skin Symptoms- Usually non tender or slightly tender may be
pruritic.
• Constitutional Symptom- Uncommonly, tender regional
lymphadenitis
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4. Risk Factors Folliculitis
• Local trauma
–Abrasion -Tight closing
–Surgical wounds or draining abscess
–Shaving
• Aggravates Staphylococcus aureus folliculitis
• Exposure to Occlusive Dressing
–Adhesive plaster
–Plastic Occlusive Dressings ,
–positioning,
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5. Physical Examination
Skin lesion
• Type - papules or pustules surounded by ert
• Color- Erythema surrounding follicle. In darker skin types, post
inflammatory hyper pigmentation.
• Arangement -Scattered, discrete or, more frequently, grouped and clustered.
• Distrubution - face ,bread area, scalp, Neck ,trunk, legs, buttoks,
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6. Folliculitis
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7. Folluculitis at different sites
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8. Perfollicular inflamation &pustules on the buttoks due to Trichophtom
rubrum
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9. • Pseudofolliculitis barbae
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10. Folliculitis keloidalis
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11. FURUNCLES AND
CARBUNCLES
• A furuncle or boilis a deep-seated inflammatory nodule that
develops around a hair follicle, usually from a preceding, more
superficial folliculitis and often evolving into an abscess.
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12. •-A BOIL is a common, painful infection of a hair follicle and the surrounding skin.
•- It begins as a red lump, then fills with pus as white blood cells rush in to fight the
infection.
• -Goodhome care can often clear up a single boil, also known as a skin abscess.
•An inflammed pus filled swelling on the skin.
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13. • Furuncles arise in hair-bearing sites, particularly in regions
subject to friction, occlusion, and perspiration, such as the neck,
face, axillae, and buttocks.
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14. Furuncle
• Deeper-seated thanfolliculitis
• Pyogenic - abscess
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15. History
• Furuncle/Boil
-the lesions appear with in days
-fever is uncommon.
-pain full when it enlarges.
• Curbuncle
-slightly the same.
-extermly pain full
- fever, chills,and malasia
etc
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16. • Multiple furuncles
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17. CARBUNCLES.
• A carbuncle is a more extensive, deeper, communicating,
extremely painful
• Common at the nape of the neck, the back, or thighs
• The resulting permanent scar
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18. CURBUNCLE
•The involved area is red and indurated, and multiple pustules soon appear
on the surface, draining externally around multiple hair follicles.
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19. Predisposing Factors
• Poor Immunity, defects in neutrophil function
• Diabetes
• Bad Hygiene- bathing habit
• Tight Clothes – due to friction their will be skin laceration,
• Poor Nutrition
• Exposure to Strong Chemicals
• Side Effects of Medications -like steroides
• Extraction of hair such as plucking or waxing
• Shaving hairy regions
• Occlusion of hair-bearing areas facilitates growth of microbes: clothing,
• plastic film, adhesive plaster, position
• Tropical climate with high temperatures and high relative humidity.
• Systemic antibiotic promotes growth of gram-negative bacteria in areas of acne.
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20. Diagnosis
• Clinical
• Gram stain of pus- clusters of Gram-positive cocci
• CBC: Increased leukocyte count.
• Culture: isolation of S. aureus on culture confirms the
diagnosis.
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21. Rx Folliculitis
• Eliminate aggraveting agents,
• Wash with soap or benzoyl peroxide preparation.
• Keep affected areas clean
• Topical antibiotics
– Mupirocin (Bactroban) cream apply small amount TID to affected area
x 7-10 days.
– Erythromycin 2% solution BID x 7 days
– Clindamycin Solution BID x 7-10 days
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22. Rx Boils And Carbuncles
• Simple furunculosis -Trial of warm compresses.
• Incision and drainage followed by
-Dicloxacillin 250 to 500 mg (adult dose) q.i.d. for 10 days
-Cephalexin 250 to 500 mg (adult dose) for 10 days; 40 to 50 mg/kg/day (children) for 10 days
-Augmentin 20 mg/kg/day t.i.d. for 10 days
• Second line (penicillin allergy)
-Erythromycin ethylsuccinate: 25-500 mg q.i.d./10 dys
-Clarithromycin: 250 to 500 mg b.i.d. for 10 days
- Azithromycin: 250 mg q.d. for 5 to 7 days
-Clindamycin 150 to 300 mg (adult dose) q.i.d. for 10 dys.
• Methicillin-Resistant S. aureus (MRSA)
-Ciprofloxacin 500 b.i.d. for 7 days.
-Vancomycin -Intravenous administration for severe infections 22

23. PROGNOSIS AND CLINICAL
COURSE.
• Most cases resolve with incision, drainage and systemic
antibiotic treatment.
• The major problems with furunculosis and carbuncles are
bacteremic spread of infection and recurrence.
• Invasion of the bloodstream may occur, resulting in metastatic
infection such as osteomyelitis, acute endocarditis, or brain
abscess.
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