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Q. I get recurrent boils on stomach, thighs, and back even after several antibiotics. Why?

Answered by
Dr. Subhash Kashyap
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Aug 27, 2020

Hi doctor,

I have had boils/eruptions on my stomach, thighs and back for the past one or two years. My local dermatologist had diagnosed this as furunculosis and I completed several courses of antibiotics and two weeks of Rcin course as well. However, once the treatment was discontinued, these boils kept coming back.

Over the year, the frequency of the boils has drastically reduced. I now have them for five to six weeks as compared to getting new boils almost every day. Whenever I get these boils it is very painful and distracting. What can I do to permanantly get rid of this condition? I am attaching pictures of the boils.

#

Hi,

Welcome to icliniq.com.

Unfortunately, your photos are not zoomed clear (attachment removed to protect patient identity), but whatever I made out I go with furunculosis and your clinical history and response also favor that. Furuncles are caused by a bacteria staphylococcus aureus. It is a hard bacteria very resistant to antibiotics, but our body do have some kind of resistance to it. In chronic furunculosis, this resistance is specifically altered and reduced in some people which lead to this infection. It typically forms pus-filled lesions anywhere over the body where the skin barrier is disrupted.

R-cin is the fist-line of treatment but it also responds to Doxycycline, Azithromycin, Amoxyclav and so depending upon person to person. After a successful remission with Rcin, or other agent you need to follow some precautions.

Keep body emoliated with aloe vera moisturizer. Avoid scratching. Do not use harsh soaps. Use Mupirocin ointment twice daily over armpits, umbilicus, groins and perineum, ear canal, nose inside. Use earbud to apply for one month.

Avoid touching any part unnecessarily with hand particularly the above ones, as they harbor these bacteria.

I hope this helps.


The Probable causes:

S.aureus.

Investigations to be done:

Pus culture.

Preventive measures:

As advised.


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Thank you doctor,

It is very helpful for me. I have two follow-up questions for you.

Any steps you suggest I can take to improve immune system response? Should I redo Rcin/Doxycycline course or can I directly start implementing the preventive measures you prescribed?

#

Hi,

Welcome back to icliniq.com.

This immunity defect is specifically defected against S.aureus and believed to be mediated by genes. So as such not known to be boosted by any agent. But variability is observed overtime like you say you are improving, you may get complete remission. Obesity, family history, poor self-hygiene, diabetes, other skin allergy, or disease are risk factors.

Additional preventive measures. Use Chlorhexidine body wash or soap in addition to Mupirocin. Avoid sharing towels, razors, etc. Family members are sometimes carrier but you are susceptible, take precaution. Wash beddings properly and regularly.

Treat anemia if low hemoglobin. If you do not have lesions at present no need to take an antibiotic course, but if lesions, I recommend Linezolid 600 mg BD for two weeks and follow precautions always.

I hope this helps.


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Thank you doctor,

I will follow all your advice diligently and let you know if it goes after one month. Just one last final question for you Hibiclen's Chlorhexidine body wash seems to be very difficult to find. I called a few local drug stores, and they did not have it. I also checked online, it is easily available in US but very expensive to import to India.

If possible, can you please recommend any place I get it from? Or some alternative that I can buy.

#

Hello,

Welcome back to icliniq.com.

Use Cetrim soap or any antibacterial soap. Chlorhexidine kills all bacteria but not marketed much India at this concentration. The idea is to kill maximum staphylococcus aureus.


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