What are boils under the arm pits called in diabetic patients?

Boils Under the Armpits in Diabetic Patients

Boils under the armpits in diabetic patients are clinically known as furuncles or carbuncles, depending on their size and complexity. These are deep skin infections that develop in hair follicles and surrounding tissue, commonly occurring in areas with hair, sweat, and friction such as the armpits 1.

Types of Boils in Diabetic Patients

• Furuncles: Single, painful nodules that form around hair follicles, filled with pus and caused primarily by Staphylococcus aureus infection 2
• Carbuncles: Larger, more severe infections consisting of multiple interconnected furuncles with several openings on the skin surface 3

Why Diabetic Patients Are Prone to Boils

Diabetic patients are particularly susceptible to skin infections including furuncles and carbuncles due to:

• Impaired immune function, especially neutrophil dysfunction 4
• Poor circulation due to peripheral vascular disease 4
• Hyperglycemia creating favorable conditions for bacterial growth 4
• Increased skin colonization with pathogenic bacteria, particularly S. aureus 4
• Reduced ability to detect minor trauma due to neuropathy 4

Management of Furuncles/Carbuncles in Diabetic Patients

For Small Furuncles:

• Apply moist heat or warm compresses to promote spontaneous drainage 2
• Keep the area clean with antibacterial soap 2
• Cover with a dry dressing after drainage occurs 2

For Large Furuncles or Carbuncles:

• Incision and drainage is the primary treatment with strong evidence supporting this approach 2
• Probing the cavity to break up loculations may be necessary 2
• Cover the surgical site with a dry dressing after drainage 2
• Avoid packing the wound with gauze as it may cause more pain without improving healing 2

Antibiotic Therapy:

• Systemic antibiotics are generally unnecessary for uncomplicated furuncles 2
• Antibiotics should be added when:
  • Fever or systemic symptoms are present
  • Extensive surrounding cellulitis exists
  • Patient has systemic inflammatory response syndrome
  • Patient has markedly impaired host defenses (as is common in poorly controlled diabetes) 2
• When antibiotics are needed, empiric therapy should target S. aureus, including MRSA coverage in high-risk patients 4

Prevention of Recurrent Boils

Diabetic patients with recurrent furuncles should:

• Maintain optimal glycemic control 4
• Improve personal hygiene with antibacterial soaps like chlorhexidine 2
• Consider decolonization regimen for S. aureus carriers:
  • Intranasal mupirocin twice daily for 5 days each month (reduces recurrences by ~50%)
  • Daily chlorhexidine washes
  • Daily decontamination of personal items 2
• For persistent recurrent cases, consider clindamycin 150 mg daily for 3 months 2

When to Seek Immediate Medical Attention

Diabetic patients should seek immediate medical care if:

• The boil is accompanied by fever or severe pain
• The infection appears to be spreading rapidly
• There are multiple boils or a carbuncle
• The boil is on the face or spine
• The patient has poorly controlled diabetes 4

Proper identification and management of these infections are crucial in diabetic patients as they can progress rapidly and lead to serious complications if not treated appropriately.