Deep-seated infection of the hair follicles

Causes

• Bacterial infection with Staphylococcus aureus leading to the collection of pus

Clinical features

• Common in people with poor general health, diabetes or the debilitated

• Presentation usually occurs with one or more acute, tender, painful swellings (furuncles) at site of infection

• Most common on neck, breasts, face, and buttocks

• The swelling becomes fluctuant, may point after 3 days

Differential diagnosis

• Carbuncles
• Acne

Investigations

Multiple furuncles: pus swab for Gram staining and C&S

Management

Apply intermittent moist heat to allow lesion to point and drain spontaneously

- extensive incision may spread the infection

Cover with clean dressing

If in the nose or central facial area or if occurring in immunocompromised patients:

Give 5-7 days systemic antibiotic based on C&S results cotrimoxazole 960mg every 12 hours

HC2

child: 24mg/kg per dose

or erythromycin 250mg every 6 hours

child: 7.5mg/kg per dose

or flucloxacillin 250-500mg every 6 hours before food child: 12.5-25mg/kg per dose

HC4

If more extensive lesions with collections of pus:

Give systemic antibiotic as above
When lesion is ready, incise, drain and dress

If recurrent: check for diabetes mellitus and HIV

Prevention

• Personal hygiene with use of antiseptic soap