What is the treatment for a furuncle (boil) over the nose?

Treatment of Furuncle Over the Nose

For a furuncle over the nose, apply moist heat several times daily to promote spontaneous drainage if the lesion is small, but perform incision and drainage if the furuncle is large, followed by a dry dressing—systemic antibiotics are only needed if fever, extensive cellulitis, multiple lesions, or immunocompromise is present. 1, 2

Initial Treatment Algorithm

Small Furuncles

• Apply moist heat (warm, moist compresses) several times daily to promote spontaneous drainage 1, 2
• Once drainage occurs, cover the area with a dry dressing 2
• This approach achieves cure rates of 85-90% without antibiotics 2

Large Furuncles

• Perform incision and drainage as the primary treatment (strong recommendation, high-quality evidence) 1, 2
• After drainage, cover the surgical site with a dry dressing rather than packing with gauze—packing adds unnecessary pain without improving outcomes 1, 2
• Drainage alone achieves cure rates of 85-90% regardless of antibiotic use 2

When to Add Systemic Antibiotics

Systemic antibiotics are usually unnecessary for simple furuncles after adequate drainage 1, 2, but prescribe them if any of the following are present:

• Fever or other evidence of systemic infection 1, 2
• Extensive surrounding cellulitis 1, 2
• Multiple lesions 1, 2
• Systemic inflammatory response syndrome (SIRS) 1
• Markedly impaired host defenses or immunocompromising conditions 1, 2

Antibiotic Selection When Indicated

• Choose an agent active against Staphylococcus aureus 1, 2
• Consider MRSA coverage in high-prevalence areas or if risk factors are present 1
• Oral options include trimethoprim-sulfamethoxazole, doxycycline, clindamycin, cephalexin, or dicloxacillin 2

Special Considerations for Nasal Location

Furuncles on the nose warrant particular attention due to the anatomic location and potential for complications, though the treatment principles remain the same as outlined above 1, 2. The nasal area has rich vascular supply with potential venous drainage to cavernous sinuses, making recognition of systemic signs particularly important 1.

Management of Recurrent Furunculosis

If the patient experiences recurrent episodes, implement the following:

Evaluation

• Evaluate for nasal colonization with S. aureus—this is the most important predisposing factor for recurrent furunculosis 1, 3
• Culture recurrent abscesses early to identify the causative organism and guide antibiotic selection 2
• Evaluate household members for S. aureus colonization and treat carriers if ongoing transmission is suspected 2, 3

Decolonization Strategy

• Intranasal mupirocin 2% ointment twice daily for 5 days each month reduces recurrences by approximately 50% 1, 2, 3
• Daily chlorhexidine body washes 1, 2, 3
• For children and adolescents with recurrent furunculosis, oral clindamycin 150 mg daily for 3 months decreases subsequent infections by approximately 80% 3
• Daily decontamination of personal items including towels, sheets, and clothes 1, 2

Hygiene Measures

• Thoroughly launder clothing, towels, and bedding in hot water 1, 3
• Use separate towels and washcloths 1, 3
• Improve personal hygiene with antibacterial soaps such as chlorhexidine 1, 2

Common Pitfalls to Avoid

• Do not pack the wound with gauze after drainage—this adds pain without benefit 1, 2
• Do not routinely prescribe antibiotics for simple furuncles after adequate drainage—they are unnecessary unless specific indications are present 1, 2
• Do not rely solely on topical decolonization for recurrent cases—intranasal mupirocin alone is insufficient 3
• Do not prescribe tetracyclines (including doxycycline) in children under 8 years of age 3
• Treating household contacts who are colonized is essential—studies show significantly fewer recurrences when preventive measures include both patient and household contacts 3