What is the treatment for a furuncle?

Treatment of Furuncles

The primary treatment for furuncles is incision and drainage for larger lesions, while small furuncles may be managed with moist heat application to promote spontaneous drainage. 1, 2

Initial Management

Small Furuncles

• Apply moist heat or warm compresses to promote spontaneous drainage 2
• No systemic antibiotics needed for uncomplicated cases 1

Large Furuncles

• Incision and drainage is the definitive treatment 1, 2
• Probe the cavity to break up loculations 1
• Simply cover the surgical site with a dry dressing after drainage 1, 2
• Avoid packing the wound with gauze as it may cause more pain without improving healing 2

When to Add Antibiotics

Systemic antibiotics are generally unnecessary for uncomplicated furuncles but should be added in the following situations:

• Presence of fever
• Systemic symptoms
• Extensive surrounding cellulitis
• Multiple lesions
• Immunocompromised patients
• Diabetic patients with poorly controlled diabetes 1, 2

When antibiotics are indicated, they should target Staphylococcus aureus, including MRSA coverage in high-risk patients 2.

Management of Recurrent Furunculosis

For patients with recurrent episodes:

1. Improve personal hygiene:

   • Use antibacterial soaps such as chlorhexidine 1, 2
   • Thorough laundering of clothing, towels, and bedding 1
   • Separate use of towels and washcloths 1

2. Decolonization for S. aureus carriers:

   • Intranasal mupirocin and daily chlorhexidine washes 2
   • Application of mupirocin ointment twice daily for the first 5 days each month (reduces recurrences by ~50% in nasal carriers) 2

3. For persistent recurrent cases:

   • Consider clindamycin 150 mg daily for 3 months 2
   • Evaluate for neutrophil disorders if recurrent abscesses began in early childhood 2

Special Considerations

Diabetic Patients

• Maintain optimal glycemic control to prevent recurrent skin infections 2
• Seek immediate medical care if infection is accompanied by fever, severe pain, or rapid spread 2

Carbuncles

• These are coalescent inflammatory masses with pus draining from multiple follicular orifices 1
• Always require incision and drainage 1
• More common on the back of the neck and in diabetic patients 1

Common Pitfalls to Avoid

1. Unnecessary antibiotic use: Antibiotics are not needed for uncomplicated, drained furuncles 1, 2

2. Inadequate drainage: Ensure complete evacuation of pus and break up loculations 1

3. Neglecting family members in recurrent cases: Culture swabs from family members and close contacts are important to identify and control the chain of infection in recurrent cases 3

4. Confusing furuncles with other conditions: Differentiate from folliculitis (more superficial) and epidermoid cysts 1

5. Missing systemic illness: Be vigilant for signs of systemic infection that would necessitate more aggressive treatment 1, 2