What is the treatment for a furuncle (boil) under the breast?

Treatment of Furuncle Under the Breast

The primary treatment for a furuncle (boil) under the breast is incision and drainage, which is considered the definitive management for large furuncles. 1

Initial Management

Assessment and Drainage

• Evaluate for signs of systemic infection (fever >38°C, tachycardia >90 beats/min, tachypnea >24 breaths/min, or abnormal WBC count) 1

• For small furuncles:

  • Application of moist heat may be sufficient to promote spontaneous drainage 1
  • Warm compresses can help bring the furuncle to a head

• For larger furuncles:

  • Incision and drainage is the recommended treatment 1
  • Procedure involves:
    • Making an incision over the fluctuant area
    • Thorough evacuation of pus
    • Probing the cavity to break up loculations 1
  • Simply cover the surgical site with a dry dressing after drainage 1
    • Note: Packing with gauze is not necessary and may cause more pain without improving healing 1

Antibiotic Therapy

Systemic antibiotics are usually unnecessary for uncomplicated furuncles after adequate drainage, unless specific conditions are present 1:

Indications for antibiotics:

• Presence of systemic inflammatory response syndrome (SIRS)
• Extensive surrounding cellulitis
• Multiple lesions
• Immunocompromised host
• Markedly impaired host defenses
• Severe systemic manifestations of infection

Antibiotic options when indicated:

• For MRSA coverage (if suspected or prevalent in your area):

  • Trimethoprim-sulfamethoxazole (TMP-SMX) 1-2 DS tablets twice daily 1
  • Doxycycline 100 mg twice daily 1
  • Clindamycin 300-450 mg three times daily 1

• For MSSA coverage:

  • Cephalexin 500 mg four times daily 1
  • Dicloxacillin 500 mg four times daily 1

Special Considerations for Breast Location

• The inframammary fold creates a warm, moist environment that can promote bacterial growth
• Ensure thorough drying of the area after bathing
• Consider using absorbent powders or cotton undergarments to reduce moisture
• For furuncles under the breast, ensure adequate drainage as the anatomical location may lead to poor drainage and recurrence

Management of Recurrent Furunculosis

If furuncles recur under the breast, consider the following 1:

1. Search for local causes:

   • Hidradenitis suppurativa
   • Foreign material
   • Underlying skin conditions

2. Decolonization regimen:

   • Intranasal mupirocin twice daily for 5 days
   • Daily chlorhexidine washes
   • Daily decontamination of personal items (towels, sheets, clothes)

3. For persistent recurrences:

   • Consider a 5-10 day course of antibiotics active against the cultured pathogen 1
   • For nasal S. aureus carriers, mupirocin ointment applied to the anterior nares twice daily for the first 5 days each month can reduce recurrences by approximately 50% 1

Prevention Measures

• Maintain good personal hygiene
• Use antibacterial soap (chlorhexidine) for bathing
• Avoid sharing personal items
• Keep the inframammary area clean and dry
• Wear clean, loose-fitting cotton undergarments
• Change undergarments daily

When to Seek Further Medical Attention

• Worsening pain, redness, or swelling despite treatment
• Development of fever or other systemic symptoms
• Multiple or recurrent furuncles
• Immunocompromised status
• Failure to improve within 48-72 hours after drainage

Remember that furuncles under the breast require special attention to hygiene and may be prone to recurrence due to the warm, moist environment of the inframammary fold.