presentation, pathophysiology and treatment of Folliculitis,boil( Furuncle), carbuncle

1. Folliculitis
Boil
Carbuncle
Harendra Kumar
AIIMS Patna

2. Folliculitis
Definition :- Folliculitis is the infection and inflammation
of one or more hair follicles.
The condition may occur anywhere on the skin except
the palms of the hands and soles of the feet.

3. Superficial Folliculitis
Etiology
Infectious
S. aureus
Chemicals
mineral oils,
vegetable oils,
(occupational/cosme
tic exposure)
Mechanical
Pseudofolliculitis
After shaving in the
beard region.
Postwaxing folliculitis

4. Clinical Features
dome-shaped follicular pustules.
Pseudofolliculitis seen in the beard
area, thighs and arms

5. Treatment
Infectious folliculitis :- Topical antibiotics for localized
lesions and systemic antibiotics for extensive lesions.
Chemical and mechanical folliculitis:-
• Removal of trigger
• Topical steroid-antibiotic combination.
• Retinoic acid - for pseudofolliculitis

6. Deep Folliculitis
Etiology :- S. aureus.
Clinical features:-
• Deep seated, erythematous follicular
papules and pustules.
• Beard area and scalp are commonly
involved.
Treatment:- Systemic antibiotics.

7. Boil (Furuncle)
• Infection of hair follicle with Staphylococcus aureus.
• may be associated with perifoliiculitis, which may proceed to
suppuration.
Starts with painful and indurated swelling
gradually extends

8. Clinical features:-
There will be tremendous tenderness with surrounding edema
softening at the centre on the summit of which a small pustule appears.
may burst spontaneously discharging greenish slough.
a deep cavity develops lined by granulation tissue, which heals by itself.
After a couple of days

9. Sites:-
• common on the back and neck.
• Perianal boils when rupture form sinuses.
• Ear

10. Complications:-
• Perianal boils when rupture form sinuses.
• Cellulitis
• Hydradenitis.
• Infection of regional lymph nodes.

11. Treatment:-
• Antibiotics :-
Topical - mupirocin, sodium fusidate ( if few lesions )
Systemic anti-staphylococcal drugs - flucloxacillin
(If many lesion)
• Incision and drainage

12. Carbuncle
• Bigger form of boil
• Cause:- Staphylococcus aureus
• infective gangrene of the subcutaneous tissue
• Generally men above 40 yrs, mostly Diabetic
• commonly seen on on back, in the nape of the neck

13. commences as painful and stiff swelling
spreads very rapidly with marked induration.
Subsequently the central part softens
Vesicles
Pustule
These burst allowing the discharge to come
out through several openings in the skin

15. (cribriform appearance of the carbuncle is pathognomonic)
These openings enlarge
ultimately coalesce to produce an ulcer
ashy-grey slough forms at the floor
Finally the slough separates
leaving an excavated granulating
surface, which heals by itself

16. • The sloughing process may extend deeply into the muscle or
even bone.
• Constitutional symptoms and toxaemia may vary according to
the degree of the resistance of the individual.
• The resistance of the individual is poor as in a diabetic subject.

17. Treatment
• Drainage of the deep-seated pockets of pus.
• Aggressive treatment with flucloxacillin or other
penicillinase-resistant antibiotics.

18. Thank You