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Folliculitis is the inflammation of one or more hair follicles.

The condition may occur anywhere on the

skin with the exception of the palms of the hands and soles of the feet.
Most carbuncles, furuncles, and other cases of folliculitis develop from Staphylococcus aureus and
Pseudomonas aeruginosa.
Folliculitis starts when hair follicles are damaged by friction from clothing, an insect bite blockage of
the follicle, shaving, or braids too tight and too close to the scalp. In most cases of folliculitis, the
damaged follicles are then infected with the bacterium Staphylococcus.
Iron deficiency anemia is sometimes associated with chronic cases.
rash (reddened skin area)
pimples or pustules located around a hair follicle

may crust over

typically occur on neck, armpit, or groin area

may be present as genital lesions

itching skin
spreading from leg to arm to body through improper treatment of antibiotics
1.Topical antiseptic treatment is adequate for most cases
2.Topical antibiotics such as mupirocin or neomycin containing ointment
3.Some patients may benefit from systemic narrow-spectrum penicillinase-resistant penicillins (such
as dicloxacillin in US, or flucloxacillin in UK)
4.Fungal folliculitis can worsen with antibiotics and may require an oral antifungal such as
Fluconazole. Topical antifungals such as Econazole Nitrate may also be effective.

furuncle, is a deep folliculitis, infection of the hair follicle. It is most commonly caused by infection by
the bacterium Staphylococcus aureus, resulting in a painful swollen area on the skin caused by an
accumulation of pus and dead tissue.[1] Individual boils clustered together are called carbuncles.[2]
Staphylococcus is a genus of bacteria that is characterized by being round (coccus or spheroid
shaped), Gram-positive, and found as either single cells, in pairs, or more frequently, in clusters that
resemble a bunch of grapes. The genus name Staphylococcus is derived from Greek terms "staphyle"
and "kokkos" that mean "a bunch of grapes", which is how the bacteria often appears microscopically

(after Gram staining). In 1884, German physician Ottomar Rosenbach first described and named the
bacteria. Two major divisions of the genus Staphylococcus are separated by the bacteria's ability to
produce coagulase, an enzyme that can clot blood. Most human infections are caused by coagulasepositive S. aureus strains. Almost any organ system can be infected by S. aureus.
Signs and symptoms
Boils are bumpy red, pus-filled lumps around a hair follicle that are tender, warm, and very painful.
They range from pea-sized to golf ball-sized. A yellow or white point at the center of the lump can be
seen when the boil is ready to drain or discharge pus. In a severe infection, an individual may
experience fever, swollen lymph nodes, and fatigue. A recurring boil is called chronic furunculosis.[1]
[3][4][5] Skin infections tend to be recurrent in many patients and often spread to other family
members. Systemic factors that lower resistance commonly are detectable, including: diabetes,
obesity, and hematologic disorders.[6]
Usually, the cause is bacteria such as staphylococci that are present on the skin. Bacterial
colonization begins in the hair follicles and can cause local cellulitis and inflammation.[1][5][4]
Additionally, myiasis caused by the Tumbu fly in Africa usually presents with cutaneous furuncles.[7]
Risk factors for furunculosis include bacterial carriage in the nostrils, diabetes mellitus, obesity,
lymphoproliferative neoplasms, malnutrition, and use of immunosuppressive drugs.[8] Patients with
recurrent boils are as well more likely to have a positive family history, take antibiotics, and to have
been hospitalized, anemic, or diabetic; they are also more likely to have associated skin diseases and
multiple lesions.[9]
The most common complications of boils are scarring and infection or abscess of the skin, spinal
cord, brain, kidneys, or other organs. Infections may also spread to the bloodstream (sepsis) and
become life-threatening.[4][5] S. aureus strains first infect the skin and its structures (for example,
sebaceous glands, hair follicles) or invades damaged skin (cuts, abrasions). Sometimes the infections
are relatively limited (such as a stye, boil, furuncle, or carbuncle), but other times they may spread to
other skin areas (causing cellulitis, folliculitis, or impetigo). Unfortunately, these bacteria can reach the
bloodstream (bacteremia) and end up in many different body sites, causing infections (wound
infections, abscesses, osteomyelitis, endocarditis, pneumonia)[10] that may severely harm or kill the
infected person. S. aureus strains also produce enzymes and exotoxins (both secreted by staph) that
likely cause or increase the severity of certain diseases. Such diseases include food poisoning, septic
shock, toxic shock syndrome, and scalded skin syndrome.[11] Almost any organ system can be
infected by S. aureus.
In contrast to common belief, boils do not need to be drained in order to heal; in fact opening the
affected skin area can cause further infections.[12] In some instances, however, draining can be

encouraged by application of a cloth soaked in warm salt water. Washing and covering the furuncle
with antibiotic cream or antiseptic tea tree oil[13] and a bandage also promotes healing. Furuncles
should never be squeezed or lanced without the oversight of a medical practitioner because it may
spread the infection.[1][5]
Furuncles at risk of leading to serious complications should be incised and drained by a medical
practitioner. These include furuncles that are unusually large, last longer than two weeks, or are
located in the middle of the face or near the spine.[1][5]
Antibiotic therapy is advisable for large or recurrent boils or those that occur in sensitive areas (such
as around or in the nostrils or in the ear).[3][1][5][4] Staphylococcus aureus has the ability to acquire
antimicrobial resistance easily, making treatment difficult. Knowledge of the antimicrobial resistance of
S. aureus is important in the selection of antimicrobials for treatment.[14] Poor personal hygiene
being common, the role of nasal S. aureus carrier may differ from communities with good hygienic
practices. Staphylococcus aureus re-infection may result from contact with infected family members,
contaminated fomites, or from other extra-nasal sites. This raises a suggestion to treat household
contacts and close contacts if recurrence persists, because it is likely that one or more contacts are
asymptomatic carriers of S. aureus. In addition to the increase in the cost of treatment in poor
countries, the possibility of developing drug resistance must be considered. The most important
independent predictor of recurrence is a positive family history. Boils are spread among individuals by
touching or bursting a boil. Furunculosis is a common disease, particularly with deficient hygiene. A
large number of S. aureus organisms are frequently present on the sheets and underclothing of
patients with furunculosis and may cause re-infection of patients and infection of other members of
the family.[9] The role of iron deficiency anemia in recurrent furunculosis was demonstrated, all
patients were free from recurrence during the six months follow-up period after iron supplementation.
[15] A variety of host factors, such as abnormal neutrophil chemotaxis, deficient intra-cellular killing,
and immuno-deficient states are of importance in a minority of patients with recurrent furunculosis.
[16] Health education about sound personal hygiene and correction of anemia should be mandatory
in management of furunculosis.[9] It was found that recurrence was significantly associated with poor
personal hygiene.[17] A previous study reported that MRSA infection was significantly associated with
poor personal hygiene. It was reported that frequent hand and body washing with water and
antimicrobial soap solution decreases staphylococcus skin colonization. Previous use of antibiotics is
associated with a high risk of recurrence. This may be due to the development of resistance to the
antibiotics used.[18] An associated skin disease favors recurrence. This may be attributed to the
persistent colonization of abnormal skin with S. aureus strains, such as is the case in patients with
atopic dermatitis.[18

A carbuncle is an abscess larger than a boil, usually with one or more openings draining pus onto
the skin. It is usually caused by bacterial infection, most commonly Staphylococcus aureus. The
infection is contagious and may spread to other areas of the body or other people. [1] Because the
condition is contagious, family members may develop carbuncles at the same time.

Often, the direct cause of a carbuncle cannot be determined. Things that make carbuncle infections
more likely include friction from clothing or shaving, generally poor hygiene and weakening of
immunity. For example, persons with diabetes and immune system diseases are more likely to
develop staphylococcal infections.
A carbuncle is made up of several skin boils. The infected mass is filled with fluid, pus, and dead
tissue. Fluid may drain out of the carbuncle, but sometimes the mass is so deep that it cannot drain
on its own. Carbuncles may develop anywhere, but they are most common on the back and the nape
of the neck.
The carbuncle may be the size of a pea or as large as a golf ball. It may be red and irritated, and
might hurt when touched. It may also grow very fast and have a white or yellow center. It may crust or
spread to other skin areas. Sometimes, other symptoms may occur, such as fatigue, fever and a
general discomfort or sick feeling. Itching may occur before the carbuncle develops.
The word is believed to have originated from the Latin: carbunculus, originally a small coal; diminutive
of carbon-, carbo: charcoal or ember, but also a carbuncle stone, "precious stones of a red or fiery
colour", usually garnets.[2]
Carbuncles usually must drain before they will heal. This most often occurs on its own in less than
two weeks. Placing a warm moist cloth on the carbuncle and soaking the affected area several times
each day helps it to drain, which speeds healing. Squeezing the carbuncle, or cutting it open without
medical supervision can spread and worsen the infection.
Treatment is needed if the carbuncle lasts longer than two weeks, returns frequently, is located on the
spine or the middle of the face, or occurs along with a fever or other symptoms. Treatment helps
reduce complications related to an infection. A doctor may prescribe antibacterial soaps and
antibiotics applied to the skin or taken by mouth. Deep or large lesions may need to be drained by a
health professional. Proper excision, by cruciate incision, under strict aseptic conditions will treat the
condition effectively.
Proper hygiene is very important to prevent the spread of infection. Hands should always be washed
thoroughly, preferably with antibacterial soap, after touching a carbuncle. Washcloths and towels
should not be shared or reused. Clothing, washcloths, towels, and sheets or other items that contact
infected areas should be washed in very hot (preferably boiling) water. Bandages should be changed
frequently and thrown away in a tightly-closed bag. If boils/carbuncles recur frequently, daily use of an
antibacterial soap or cleanser containing triclosan, triclocarban or chlorhexidine, can suppress staph
bacteria on the skin.

Hidradenitis suppurativa is a skin disease that most commonly affects areas bearing apocrine
sweat glands or sebaceous glands, such as the underarms, breasts, inner thighs, groin and buttocks.
The non-contagious disease manifests as clusters of chronic abscesses, epidermoid cysts,
sebaceous cysts, pilonidal cyst or multilocalised infections, which can be as large as baseballs or as
small as a pea, that are extremely painful to the touch and may persist for years with occasional to
frequent periods of inflammation, culminating in incision and drainage of pus, often leaving open
wounds that will not heal. For unknown reasons, people with hidradenitis develop plugging or clogging
of their apocrine glands. It causes chronic scarring and pus formation of the underarms (axilla) and
groin/inner thigh areas. The simple procedure of incision and drainage provides some relief from
severe, often debilitating, pressure pain. Flare-ups may be triggered by perspiration, hormonal
changes (such as monthly cycles in women), humidity and heat, and clothing friction. Persistent
lesions may lead to scarring and the formation of sinus tracts, or tunnels connecting the abscesses or
infections under the skin. At this stage, complete healing is usually not possible, and progression
varies from person to person, with some experiencing remission anywhere from months to years at a
time, while others may worsen and require multiple surgeries in order to live comfortably. Wound
dehiscence, a premature "bursting" open of a wound, often complicates the healing process.
Occurrences of bacterial infections and cellulitis (deep tissue inflammation) may occur at these sites.
HS pain and depression can be difficult to manage.[2]
HS often goes undiagnosed for years because patients are too ashamed to speak with anyone.[2]
When they do see a doctor or medical practitioner, the disease is frequently misdiagnosed or
prescribed treatments are ineffective, temporary and sometimes even harmful. There is no known
cure nor any consistently effective treatment. Carbon dioxide laser surgery is currently considered the
last resort for those who have advanced to its highest stage, where the affected areas are excised,
and the skin is grafted. Surgery does not always alleviate the condition, however, and can be very
Several articles and clinics consider this disease as widely misdiagnosed, due to the
misunderstanding of the causes and progression of the disease.[3] HS is neither the biblical stigmata,
leprosy nor caused by poor hygiene. HS is often called an 'orphan illness', due to little research being
conducted on the disease at this time. Because HS is considered a rare disease, its incidence rate is
not well known, but has been estimated as being between 1:24 (4.1%) and 1:600 (0.2%).[4]
Hydradenitis suppurativa occurs when apocrine glands become plugged. Lesions occur in areas of
the body with numerous apocrine glands such as the axilla, groin, and perianal region. This theory
includes most of the following potentials indicators:[21]
Post-pubescent individuals are more likely to exhibit HS.

Females are more likely than males.

Genetic predisposition among families of Sephardic Jewish, Italian, Greek, Middle Eastern and
Northern African ancestry.
Research is assessing possible relations with Hashimoto's thyroiditis, Crohn's disease, rheumatoid
arthritis, and squamous cell carcinoma.
Plugged apocrine (sweat) gland or hair follicle.
Excessive sweating.
Bacterial infection.
Sometimes linked with other auto-immune conditions.[22][23]
Androgen dysfunction.
Genetic disorders that alter cell structure.
Being overweight makes it worse, however this condition is not caused by obesity and weight loss
will improve but not cure it. Patients with more advanced cases may find exercise intolerably
painful, which may increase the rate of obesity among sufferers.
The historical understanding of the disease is that there are dysfunctional apocrine glands[17] or
dysfunctional hair follicles,[24] possibly triggered by a blocked gland, creating inflammation, pain, and
a swollen lesion. More recent studies imply there is an autoimmune component. [citation needed]
HS is not caused by any bacterial elements.
Triggering factors
There are a number of triggering factors that should be taken into consideration, as it is advisable to
avoid such triggers.
Obesity[25] is an exacerbating rather than a triggering factor,[26] through mechanical irritation,
occlusion, and maceration.
Tight clothing,[25] and clothing made of heavy, non-breathable materials.
Smoking[27] tobacco products.
Deodorants, depilation products, shaving of the affected area their association with hidradenitis
suppurativa is still an ongoing debate amongst researchers.[28]
Drugs, in particular oral contraceptives[29] (i.e. oral hormonal birth control; "the pill") and lithium.[30]
Hot and especially humid climates [31] (dry/arid climates often cause remission).
Predisposing factors
Genetic factors:[26] an autosomal dominant inheritance pattern has been postulated.[32]
Endocrine factors: sex hormones, principally an excess of androgens, are thought to be involved,
although the apocrine glands are not sensitive to these hormones.[33] Women often have
outbreaks before menstruation and post-pregnancy, and the disease usually remits during
pregnancy and after menopause.
Severe complications
In disease stage III, fistulas left undiscovered, undiagnosed, or untreated, can lead to the
development of squamous cell carcinoma, a rare cancer, in the anus or other affected areas.[34][35]

Other stage III chronic sequelae may also include anemia, multilocalised infections, amyloidosis, and
arthropathy. Stage III complications have been known to lead to death, but clinical data is still
Potential complications
Contractures and reduced mobility of the lower limbs and axillae due to fibrosis and scarring.
Severe lymphedema may develop in the lower limbs.
Local and systemic infections (meningitis, bronchitis, pneumonia, etc.), which may even progress to
Interstitial keratitis.
Anal, rectal, or urethral fistulas in anogenital hidradenitis suppurativa.[36]
Normochromic or hypochromic anemia.[37]
Squamous cell carcinoma: this has been found on rare occasions in chronic hidradenitis
suppurativa of the anogenital region.[38] The mean time to the onset of this type of lesion is 10
years or more and the tumors are usually highly aggressive.
Tumors of the lung and oral cavity, probably related to the high level of smoking among these
patients, and liver cancer.[39]
Hypoproteinemia and amyloidosis, which can lead to renal failure and death.[40]
Seronegative and usually asymmetric arthropathy: pauciarticular arthritis, polyarthritis/polyarthralgia
Treatments may vary depending upon presentation and severity of the disease. Due to the poorly
studied nature of this disease, the effectiveness of the drugs and therapies listed below is not yet
clear, and patients should discuss all options with their doctor or dermatologist. Nearly a quarter of
patients state that nothing relieves their symptoms.[42] A list of treatments that are possible
treatments for some patients is as follows.

Changes in diet avoiding inflammatory foods, foods high in refined carbohydrates.

Warm compresses,[43] hydrotherapy, balneotherapy.

Icing the inflamed area daily until pain reduction is noticed.

Weight loss in overweight and obese patients, as well as smoking cessation can improve or
even alleviate many symptoms of Hidradenitis suppurativa: Obese and overweight
patients should be helped to lose weight[26] in all cases of HS regardless of which
stage patient may be in.

Antibiotics Taken orally, these are used for their anti-inflammatory properties rather than to
treat infection. The most effective is a combination of Rifampicin [300 mg twice a day]
and Clindamycin [300 mg twice a day] given concurrently for 23 months. This brings
about remission in around three quarters of cases.[44] A few popular antibiotics used to
treat HS include tetracycline, minocycline, and clindamycin.

Corticosteroid injections. Also known as intralesional steroids: can be particularly useful for
localized disease, if the drug can be prevented from escaping via the sinuses.

Vitamin A supplementation

Anti-androgen therapy: hormonal therapy with cyproterone acetate and ethinyloestadiol proved
effective in randomized control trials. It is of note that dosages reported have been very

IV or subcutaneous infusion of anti-inflammatory (anti-TNF-alpha) drugs such as infliximab

(Remicade), etanercept (Enbrel),[46] and adalimumab.[47] This use of the drugs is not
currently Food and Drug Administration (FDA) approved and is somewhat controversial,
and therefore may not be covered by insurance.

Zinc gluconate taken orally has been shown to induce remission. Recommended dose is at
least 30 mg taken 3 times daily (90 mg/day). Toxicity is known to occur at doses
exceeding 1000 mg/day.[48]

Chlorhexidine (Hibiclens) plus an antibiotic soap for cleansing the skin surface.
Hexachlorophene shower with liquid soap like Phisohex, covering sores with Metrolotion
after medicated showers. These are considered to be general measures, and are the
foundation of any good medical treatment and management plans for HS.

Turmeric capsules orally or through topical application. The active ingredient in the tumeric
spice is curcumin.[citation needed]

Infliximab: a chimeric monoclonal anti-TNF antibody has demonstrated efficacy in treating HS.

Topical clindamycin has been shown to have an effect in double-blind placebo controlled
Surgical therapy

When the process becomes chronic, wide surgical excision is the procedure of choice. Wounds in the
affected area do not heal by secondary intention, and immediate application of a split thickness skin
graft is more appropriate.[21]
Electron beam radiotherapy has been a successful treatment of hidradenitis, especially in Europe; it is
not a common treatment option in most of the United States, as radiation oncologists generally refuse
to treat patients with non-malignant diseases because of the potential for secondary radiation-induced
tumors in the long term.