Folliculitis, Furunculosis And Carbunculosis

Folliculitis - a bacterial infection of the hair folliclecauses the formation of a pustule. The infection can be superficial (follicular impetigo or Bockhart's impetigo) or deep (sycosis barbae). Folliculitis also may lead to the development of furuncles (furunculosis), commonly known as boils, or carbuncles (carbunculosis). These disorders may be recurrent and are particularly troublesome to healthy young adults. The prognosis depends on the severity of the infection and on the patient's physical condition and ability to resist infection.

Causes

The most common cause of folliculitis, furunculosis, or carbunculosis is coagulase-positive Staphylococcus aureus. Predisposing factors include an infected wound elsewhere on the body, poor personal hygiene, debilitation, diabetes mellitus, occlusive cosmetics, tight clothes, friction, incorrect shaving technique, exposure to chemicals (cutting oils), and management of skin lesions with tar or with occlusive therapy, using steroids. Folliculitis may be caused by bacteria other than S. aureus, especially as a sequela to erythromycin and tetracycline therapy.

Furunculosis commonly follows folliculitis that is exacerbated by irritation, pressure, friction, or perspiration. Carbunculosis develops more slowly and usually follows persistent S. aureus infection and furunculosis.

Symptoms

In folliculitis: pustules usually appear on the scalp, arms, and legs in children; on the faces of bearded men (sycosis barbae); and on the eyelids (sties).

Pain

In furunculosis may develop hard painful nodules (furuncles). Nodules commonly appear on the neck, face, axillae, and buttocks. As they become enlarge after several days, they rupture, discharging pus and necrotic material.

Pain

Erythema and edema may persist for several weeks.

In Carbunculosis: the patient develops extremely painful deep abscesses. These drain through multiple openings onto the skin surface, usually around several hair follicles.

Fever
Malaise

Diagnostic tests

Wound culture shows S. aureus. A complete blood count may reveal an elevated white blood cell count (leukocytosis).

Treatment

Treatment, with emphasis on site care and drug therapy, includes:

cleaning the infected area thoroughly with soap and water
applying hot, wet compresses to promote vasodilation and drainage from the lesions
administering topical antibiotics, such as mupirocin and clindamycin or erythromycin solution
administering systemic antibiotics (cephalosporin or dicloxacillin) in extensive infection and in carbunculosis.

Patients with furunculosis also may require incision and drainage of ripe lesions after application of hot, wet compresses and topical antibiotics after drainage.

Prevention

Good general health and hygiene may help prevent some staph skin infections. These infections are contagious, so care must be taken to avoid contamination of other skin areas or other people.

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