Recurrent Furunculosis - Causes, Symptoms, and Treatment

Introduction

Apart from Staphylococcus aureus, other bacteria can also cause furuncles. The furuncles appear red, swollen and have tender nodules on the hair-bearing regions of the body. Furunculosis tends to recur and can spread to other family members. A furunculosis is called recurrent if there are three or more recurrences within a period of 12 months. The condition is recurrent since a majority of the people with furunculosis are nasal carriers of Staphylococcus aureus.

What Is the Site of Occurrence of Furunculosis?

Furunculosis usually appears on the areas of the body with hair follicles but is predominant in areas where hair and sweat exist together. These areas include:

• Facial region.

• Behind the ears.

• Groin (the area where the thigh meets the abdomen).

• Armpits.

• Thighs.

• Neck.

• Buttocks.

• Under the breasts.

Furuncles in the vulvovaginal and perirectal area and on the buttocks are caused by enteric species like Enterobacteriaceae, and Enterococci. Corynebacterium, S.epidermidis, and S.pyogenes may also cause furunculosis. The main cause of these infections is due to immunodeficiency.

Why Does Recurrent Furunculosis Occur?

The bacteria Staphylococcus aureus is primarily responsible for causing furuncles but other bacteria may also be involved. Once the bacteria infect the hair follicles and the surrounding skin, white blood cells rush to fight against the infection. These white blood cells release pus that gets accumulated under the skin. This explains why a furuncle or a boil begins as a small, red lump and progresses into a painful eruption.

What Are the Clinical Features of Recurrent Furunculosis?

Furuncles most commonly occur in the extremities and can result in scarring upon healing. The signs and symptoms are as follows:

• Appear as red, swollen, and tender nodules of different sizes and sometimes may occur with an overlying pustule (a small pimple or blister on the skin containing pus).

• If numerous neighboring follicles get infected, they may combine and form a larger nodule called a carbuncle.

• The center portion of the nodule on the skin surface gets filled with white or yellow pus that is visible and is referred to as ‘coming to a head’. The pus contains a combination of bacteria and white blood cells.

• The size of the bump can be as big as that of a golf ball.

• It can grow quickly.

• Oozing, weeping, or crusting is observed.

Individuals with one or two boils usually do not have any recurrences once the boils clear up. But, furunculosis has a tendency to recur and in case of recurrence, it transmits to other family members. Other symptoms may include:

• Fever.

• Fatigue.

• A general feeling of illness.

• The skin turns red before the boil develops.

• Itching sensation before the development of the boil.

Who Are at Risk of Getting Recurrent Furunculosis?

The following are at an increased risk of developing recurrent furunculosis:

• Athletes participating in sports involve increased contact with each other and in those who share their equipment.

• Those with a compromised immune system like people with diabetics, or HIV, those undergoing chemotherapy to treat cancer, and those taking certain types of medications.

• Individuals with a skin condition that involves scratching or injury to the skin like eczema, or scabies.

• Carriers of S.aureus.

• Obese people.

• Undernourished people.

• People residing close to each other like in homeless shelters, prisons, or military barracks.

How Is Recurrent Furunculosis Diagnosed?

Since recurrent furunculosis is caused by a microorganism, diagnosis involves taking simple culture swabs. The physician examines the furuncles physically and swabs should be collected not only from the pus or fluids from the furuncles but also from the carrier sites such as the perineum and nostrils. To identify any immunocompromising condition like diabetes, urine and blood glucose tests, glycated hemoglobin (HbA1C), and a full blood count can be suggested to rule out other conditions. Immunological evaluation might be required in cases of recurrences or signs of other internal diseases.

How Is Recurrent Furunculosis Treated?

Usually, no treatment is necessary for one or two boils, however, if the boil continues to be large, very painful, and unruptured for more than two weeks, medical intervention may be required. Common treatment modalities include:

• Persistent furuncles can be treated through incision and drainage as these encourage healing.

• Warm compresses should be given at the site of furuncles for at least 20 minutes three to four times a day as this can accelerate the rupture of the furuncle. A warm and moist compress should be applied at regular intervals in a day to enhance drainage. The warm compress can be given even after the furuncle has ruptured to offer relief.

• If the furuncle begins to drain, the area should be washed clean with an antibiotic soap, and triple antibiotic ointment should be applied and covered with a loose bandage. This process should be continued two to three times a day till the skin heals completely.

• The boil or the furuncle should never be popped by ourselves as it can worsen the infection.

• Hands and the site of the furuncle should be washed thoroughly with an antibacterial soap to prevent the staphylococcus bacteria from spreading to other parts of the body.

• Hand sanitizer should be used regularly and antibiotic or antiseptic gel can be applied to the inside of the nostrils.

• The surface of the skin can be wiped with 70 percent Isopropyl alcohol in water for a week as this helps to keep the skin dry.

• A topical antiseptic like Chlorhexidine cream or povidone-iodine can be applied on the furuncles and covered with gauze.

• Oral antibiotics if needed may be prescribed by the physician. Sometimes, special antibiotics like Clindamycin, Rifampicin, Cephalosporins, and Fusidic acid may be suggested by doctors.

• Other family members too must follow the skin cleansing protocol and the physician might suggest such members apply topical antibiotics in their nostrils if they are also carriers of Staphylococcus aureus.

What Are the Complications of Recurrent Furunculosis?

The most common complication of recurrent furunculosis is scarring. A few other complications include:

• MRSA- An infection caused by methicillin-resistant S.aureus is called MRSA. These strains can complicate the treatment and might require special antibiotics. Skin infection due to MRSA can cause systemic infections like pneumonia and respiratory distress, myositis (a condition that causes the muscles to be weak, tired, and painful), and necrotizing fasciitis (a serious bacterial infection that destructs tissues under the skin).

• Sepsis- There can be an infection in the bloodstream following a bacterial infection like furuncle called bacteremia. If it is not treated appropriately, it can result in severe organ dysfunction like sepsis.

How Can Recurrent Furunculosis Be Prevented?

By following certain simple measures, recurrent furunculosis can be prevented in the following ways:

• Proper personal hygiene and knowledge of wound care are necessary.

• Regular hand washing with soap and water, taking regular showers, and using alcohol-based hand gel is advised.

• Sharing or reusing personal care products like linens, towels, disposable or electrical razors, and towels in the infected area should be avoided.

• Frequently touched surfaces like door knobs, bathtubs, toilet seats, or counters that may contact the skin should be disinfected frequently.

• A well-balanced diet containing adequate proportions of fruits, vegetables, and meat should be taken.

• A clean handkerchief should be maintained and one must not pick their nose as this can transfer the infection to the nose.

• Underclothes and other clothes should be washed regularly.

• Tight-fitting clothes should be avoided as they can cause increased sweating. Towels, clothing, bedding, or other equipment should not be shared with others when one has furunculosis.

• Iron-deficient individuals can take iron supplements as these can help reduce infection.

• Consuming 100 mg of Vitamin C daily has been found to promote the activity of neutrophils.

Conclusion

Furunculosis is a condition that affects the skin, can be recurrent, and can spread to other family members both directly or indirectly. It is caused by Staphylococcus aureus and the resistant strain called MRSA complicates the treatment. One must contact the doctor if the furuncle causes terrible pain or remains unruptured. The furuncle can be treated with antibiotics or through incision and drainage by the physician. Self-treatment like popping, squeezing, or cutting the furuncle should strictly be avoided as it can worsen the infection and cause scarring.