FURUNCULOSIS CLINICAL FEATURES. A furuncle or boil is an acute, round, tender, circumscribed, perifollicular stap !lococcic abscess " ic #enerall!

ends in central suppuration. A carbuncle is merel! t"o more confluent lu#uncles, "it separate $ eads.$ T e lesions be#in, as a rule, in a air follicle, and often continue for a prolon#ed period b! autoinoculation. Some lesions disappear before rupture, but most under#o central necrosis and rupture t rou# t e s%in, disc ar#in# purulent, necrotic debris. Sites of predilection are t e nape, t e a&illae, and t e buttoc%s, but boils ma! occur an!" ere. ETIOLO'(. T e inte#rit! of t e s%in surface ma! be impaired b! irritation, pressure, friction, !per idrosis, dermatitis, dermatop !tosis, or s a)in#, amon# ot er factors. T is ma! pro)ide a portal of entr! for t e ubi*uitous S. aureus. Compromised local inte#rit! predisposes to infection. T e pro&imate cause is eit er conta#ion, or autoinoculation from a carrier focus, usuall! in t e, nose or crotc . Certain s!stemic disorders ma! predispose to furunculosis+ alco olism, malnutrition, blood d!scrasias, disorders of neutrop il function, iatro#enic or ot er immunosuppression, includin# AI,S, and diabetes. Atopic dermatitis, " ic predisposes to t e S. aureus carrier state, increases t e incidence of infections. -ospital Furunculosis. Epidemics of stap !lococcal infections occur in ospitals. .ar%ed resistance to antibacterial a#ents in t ese cases is commonplace. Attempts to control t ese outbrea%s center around meticulous and"as in#. In nurseries, Seeber# et al ac ie)ed a dramatic fall in neonatal coloni/ation and infections "it S. aureus and non0#roup A bot l!mp oc!tes and streptococci b! usin# a 1 per cent solution of c lor e&idine for s%in and umbilical cord care. -ISTO2AT-OLO'(. T ere is a deep abscess "it neutrop ils, and in lon#0standin# cases, plasma cells and forei#n0bod! #iant cells. TREAT.ENT. 3arm compresses and antibiotics ta%en internall! ma! arrest earl! furuncles. A penicillinase0resistant penicillin, er!t rom!cin, or a cep alosporin s ould be #i)en orall! in a dose of 4 to 5 #m per da! accordin# to t e se)erit! of t e case. 3 en t e lesions are incipient and acutel! inflamed, incision s ould be strictl! a)oided and moist eat emplo!ed. 3 en t e furuncle as become locali/ed and s o"s definite fluctuation, free incision, "it draina#e, s ould be made "it out dela!. T e ca)it! s ould be pac%ed "it a rubber dam or iodoform or 6aseline #au/e.