Furunclosis/Boils/
 A furuncle (i.e, boil) is an acute inflammation arising
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deep in one or more hair follicles and spreading into the
surrounding dermis.
It is a deeper form of folliculitis.
Furunculosis refers to multiple or recurrent lesions.
Is a localized, painful, deep seated, red, hot, very tender,
inflammatory peri follicular abscess.
Common microorganism: staphylococcus aureus
It occurs at all age
Furunclosis/Boils/…cont.
 Most common on persons who are carriers of
staphylococcus, contact with oils or grease, diabetes,
poor habits of personal hygiene, immunosuppression,
alcoholism, obese, malnutrition, etc
 The lesion begins in the opening of hair follicle or
sebaceous gland
 prevalent in areas subjected to irritation, pressure,
friction, and excessive perspiration: back of the neck,
face, buttocks, thighs, perineum, breasts, axilla, nose,
genitallia, etc
Furunclosis cont’d
Sign and symptom
 Hard nodule initially then fluctuant abscess with centrally
yellow pustule, then ruptures in to an ulcer
 It can be isolated single lesion or few multiple lesion
 Hotness and pain at the site
 May start as a small, red, raised, painful pimple.
 Frequently, the infection progresses and involves the skin
and subcutaneous fatty tissue, causing tenderness, pain,
and surrounding cellulitis.
N.B. The area of redness and induration represents an
effort of the body to keep the infection localized.
Furunclosis (Boils)
Furunclosis cont’d
Diagnosis
 Gram stain of the pus
 Culture and sensitivity test of blood/pus
Furunclosis cont’d
Treatment
 Warm compresses to sooth and hasten maturation and
drainage of the lesion
 Warn patient not to squeeze or incise the lesion
 Incision and drainage when it is fluctuant
 Systemic antibiotics (cloxacillin, erythromycin, etc)
 Rest especially for genital areas.
 For the sever pain codien, morphine
Carbuncles (multiple furuncles)
 A carbuncle is an abscess of the skin and
subcutaneous tissue that represents an extension of a
furuncle that has invaded several follicles and is large
and deep seated.
 Is an aggregation of interconnected furuncles that
drain through multiple openings in the skin.
 Carbuncles appear most commonly in areas where the
skin is thick and inelastic.
 Exposure to grease and oil increase the risk.
 Microorganism mostly involved is staphylococcus
aureus
Carbuncles cont’d
 more likely to occur in patients with underlying systemic
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diseases, such as diabetes or hematologic malignancies, and
in those receiving immunosuppressive therapy for other
diseases.
more prevalent in hot climates, especially on skin beneath
occlusive clothing.
the extensive inflammation frequently prevents a complete
walling off of the infection;
absorption may occur, resulting in high fever, pain,
leukocytosis, and even extension of the infection to the
bloodstream.
Carbuncles cont’d
Sign and symptom
 Sites are back of the neck, shoulder, buttock, outer aspect
of the thigh and over the hip joints.
 Develop slowly than furuncle
 They can reach the size of an egg/small orange.
 Fever, chills, extreme pain, malaise.
 Because of the large size of the lesion and its delayed
drainage the patient is much sicker.
Carbuncles (multiple furuncles)
Carbuncles cont’d
Diagnosis
 Gram stain, and culture of the pus/blood
 Leucocytosis (12,000-20,000 mm3) normal 4,00010,000mm3
Treatment
 The same as furunclosis, plus
 Avoid friction and irritation from tight clothing.
 In treating staphylococcal infections, it is important not to
rupture or destroy the protective wall of induration that
localizes the infection.
 The boil or pimple should never be squeezed.
 Oral cloxacillin, dicloxacillin, and flucloxacillin are firstline medications.
 Cephalosporins and erythromycin are also effective.
Nursing Management
 Intravenous fluids, and fever reduction are indicated for
patients who are very ill or suffering with toxicity.
 Bed rest is advised for patients who have boils on the
perineum or in the anal region,
 When the pus has localized and is fluctuant, a small
incision with a scalpel can speed resolution by relieving
the tension and ensuring direct evacuation of the pus and
slough.
 The patient is instructed to keep the draining lesion
covered with a dressing.
Management cont’d
 Warm, moist compresses increase vascularization and
hasten resolution of the furuncle or carbuncle.
 The surrounding skin may be cleaned gently with
antibacterial soap, and an anti- bacterial ointment may be
applied.
 Nursing personnel should carefully follow isolation
precautions to avoid becoming carriers of staphylococci.
 Disposable gloves are worn when caring for these
patients.
Folliculitis
 Folliculitis: is an inflammation of the hair follicle caused
by bacterial or fungal origin that arises within the hair
follicles.
 Folliculitis commonly affects the beard area of men who
shave and women’s legs.
 Other areas include the axillae, trunk, and buttocks.
Sign and symptom
 Lesions may be superficial or deep; single or multiple
papules or pustules appear close to the hair follicles.
Folliculitis
Management
 Warm compress to relieve pain
 Clean with antibacterial soap
 Topical antibiotic ointment
 Systemic antibiotics for recurrent cases
 The only entirely effective treatment is to avoid shaving.
 Other treatments include using special lotions or
antibiotics or using a hand brush to dislodge the hairs
mechanically.
Management cont’d
 If the patient must remove facial hair, a depilatory cream
or electric razor may be more appropriate than a straight
razor.
Impetigo
 Impetigo is a common superficial skin bacterial infection.
 Is an acute, contagious, rapidly spreading cutaneous
infection
 Causative agents are staphylococcus aureus or a Bhemolytic streptococcus or both
 Bullous impetigo, a more deep-seated infection of the
skin caused by S. aureus
Impetigo cont’d
 Is characterized by the formation of bullae (i.e, large,
fluid-filled blisters) from original vesicles.
 The bullae rupture, leaving raw, red areas.
 The exposed areas of the body, face, hands, neck, and
extremities are most frequently involved.
 It is particularly common among children living in poor
hygienic conditions.
Impetigo cont’d
 It often follows pediculosis capitis (head lice), scabies
(itch mites), herpes simplex, insect bites, poison ivy, or
eczema.
 Chronic health problems, poor hygiene, and malnutrition
may predispose an adult to impetigo.
 Some people have been identified as asymptomatic
carriers of S. aureus, usually in the nasal passages.
Sign and Symptom
 Superficial pustules or blisters which becomes oozing
with yellow crusts
 Blisters break easily and form golden crusts
 If the scalp is involved, the hair is matted, which
distinguishes the condition from ringworm.
Diagnosis
 Clinical
 Culture and sensitivity
Impetigo
Medical Management
 Reduces contagious spread, treats deep infection, and
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prevents acute glomerulonephritis (i.e, kidney infection),
In nonbullous impetigo, benzathine penicillin or oral
penicillin may be prescribed.
Bullous impetigo is treated with a penicillinase-resistant
penicillin (eg, cloxacillin, dicloxacillin).
In penicillin-allergic patients, erythromycin is an effective
alternative.
Topical antibacterial therapy (eg, mupirocin) may be
pre scribed when the disease is limited to a small area.
Management
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KMNO4 bath or wet dressing-in mild forms
GV paint-in mild forms
Prevent spreading by not sharing towels and ointment
Change clothes, towels and sheets frequently
 Cut finger nails short to minimize damage to lesion and to
prevent autoinoculation from scratching
 Don’t use Vaseline (use aqueous creams instead)
Nursing Management
 The nurse instructs the patient and family members to bathe at
least once daily with bactericidal soap.
 Cleanliness and good hygiene practices help prevent the
spread of the lesions from one skin area to another and from
one person to another.
 Each person should have a separate towel and wash cloth,
because impetigo is a contagious disorder.
 KMNO4 bath or wet dressing-in mild forms
 GV paint-in mild forms
 Prevent spreading by not sharing towels and ointment
 Change clothes, towels and sheets frequently
 Cut finger nails short to minimize damage to lesion and to
prevent autoinoculation from scratching
 Don’t use Vaseline (use aqueous creams instead)
Fungal skin disorder
Dermatophytosis (Mycosis)
 Is a fungal infection of the skin, hair and nails
Types
a. Tinea pedis (Athlete’s foot)
 Is itchy, whitish scaling lesions and inflammation of the
superficial skin of the feet and inter-digital spaces of the
toes
 It is especially prevalent in those who use communal
showers or swimming pools
 Often seen in people wearing rubber boots/shoes
Tinea pedis (Athlete’s foot)
Clinical Manifestations
 Tinea pedis may appear as an acute or chronic infection on
the soles of the feet or between the toes.
 The toenail may also be involved.
 Lymphangitis and cellulitis occur occasionally when
bacterial superinfection occurs. Sometimes, a mixed
infection involving fungi, bacteria, and yeast occurs.
Management
 Keep the space in between the toes dry : after washing,
expose to air, Gv paint, wear cotton socks, don’t wear
shoe that are too tight/hot, changing socks daily prevents
reinfection.
 Imidazole cream/ whitfield’s ointment twice daily until
symptoms disappear for a total of 4 weeks
 Treat secondary bacterial infection if present
 Expose to the air
 Avoid wearing too hot shoe
Tinea corporis (Tinea circinata)
 A fungal infection that affects the trunk, legs,
arms/neck, excluding the beard area, feet, hands and
groin
 Is fungal infection of the skin most common on the
exposed surfaces of the body.
 Sites are face, arms and shoulders.
 Lesions are round and scaling at the periphery with a
tendency to central healing
 Intensive itching is there
 Frequent causes of tinea corporis is the presence of an
infected pet in the home.
Tinea corporis (Tinea circinata)
Management
 Imidazole cream/whitfield’s ointment twice daily for
a minimum of 4 weeks
 Continue treatment until one week, after
symptoms have cleared
 Multiple, widespread lesions may be treated
systematically
 Griseofulvin 500mg once daily for 2-6 wks (1015mg/kg)
 Ketoconazole 200mg once/twice daily x 2-4wks
 When there is sever itching antihistamines /mild
steroids can be added