What is the treatment for a furuncle?

Treatment of Furuncles

The recommended treatment for furuncles (boils) is incision and drainage for large furuncles, while small furuncles may be treated with moist heat application to promote spontaneous drainage. 1

Definition and Clinical Presentation

• Furuncles are infections of the hair follicle, usually caused by Staphylococcus aureus, where suppuration extends through the dermis into the subcutaneous tissue, forming a small abscess 1
• They present as inflammatory nodules with overlying pustules through which hair emerges 1
• When infection involves several adjacent follicles, it produces a carbuncle, which is a coalescent inflammatory mass with pus draining from multiple follicular orifices 1

Treatment Algorithm

For Small Furuncles:

• Apply moist heat to promote spontaneous drainage 1
• This approach is usually satisfactory for resolution 1
• Simply cover the area with a dry dressing after drainage 1

For Large Furuncles and All Carbuncles:

• Incision and drainage is the recommended treatment (strong, high-quality evidence) 1
• After drainage, cover the surgical site with a dry dressing rather than packing with gauze 1
• One small study found that packing caused more pain and did not improve healing compared to simply covering the incision site with sterile gauze 1

Antibiotic Therapy:

• Systemic antibiotics are usually unnecessary unless specific conditions are present 1
• Consider antibiotics only if the patient has:
  • Fever or other evidence of systemic infection 1
  • Extensive surrounding cellulitis 1
  • Systemic inflammatory response syndrome (SIRS) 1
  • Markedly impaired host defenses 1
  • Multiple lesions 1

For Antibiotic Selection (when indicated):

• Choose an agent active against S. aureus 1
• Consider MRSA coverage in high-prevalence areas or if risk factors are present 1

Management of Recurrent Furunculosis

• Evaluate for predisposing factors such as nasal colonization with S. aureus 1, 2
• For recurrent cases, consider:
  • Decolonization with intranasal mupirocin twice daily for 5 days each month (reduces recurrences by ~50%) 1
  • Daily chlorhexidine washes 1
  • Decontamination of personal items such as towels, sheets, and clothes 1
  • For recurrent furunculosis caused by susceptible S. aureus, clindamycin 150 mg daily for 3 months may decrease subsequent infections by ~80% 1

Important Caveats and Pitfalls

• Needle aspiration is not recommended for treatment of furuncles as it has low success rates (only 25% overall and <10% with MRSA infections) 1
• Gram stain and culture are not routinely necessary for typical cases but should be considered for recurrent infections 1, 2
• Adult patients with recurrent abscesses that began in early childhood should be evaluated for neutrophil disorders 1
• Carbuncles are more common in patients with diabetes and require more aggressive management 1
• Facial furuncles require special attention due to risk of complications from the proximity to central facial veins that drain to the cavernous sinus 3

Preventive Measures

• Improve personal hygiene with antibacterial soaps such as chlorhexidine 1
• Thoroughly launder clothing, towels, and bedding 1
• Use separate towels and washcloths 1
• Avoid sharing personal items 2