Boils L02.92

Bacterially induced, corium and subcutaneous (deep folliculitis), painful, staphylococcal, abscessed inflammation of a hair follicle with retracted scar healing. Furunculus maligna is the name given to the (in Central Europe very rare) anthrax carbuncle with extensive central necrosis.

Exact data are missing. A prevalence of 0.2-1.2/100 persons/year is given for the age group 30-50 years.

Mostly infection with Staphylococcus aureus, especially in patients with a weakened immune system. Development from folliculitis. Several boils can conflate to form a carbuncle.

Preferably neck, buttocks, inner thigh, outer auditory canal, upper lip (see lip furuncle).

• Folliculitis simplex: only superficial infection of the follicle (ostiofolliculitis) Pustular formation around a hair shaft.
• Infected epidermoid cyst: painful, inflammatory lumps, usually appearing suddenly after an attempt to squeeze out
• Lymphomatoid papulosis: slowly growing painless lump. No abscess formation. Diagnosis: biopsy.
• Trichophytia profunda: furuncoloid nodule, mostly in children, low painfulness. Diagnosis: biopsy.
• Furuncoloid myiasis: typical traveler's dermatosis. Slowly growing. No significant painfulness.
• Leishmaniasis: typical traveler's dermatosis (where the olive tree grows). Slowly growing inflammatory granuloma, not fluctuating, central ulceration
• Boils in groins/axillae:
  • Hidradenitis suppurativa: rarely acute. Mostly occurring as a recurrent process over many years.
• Boils in the eyelid area:
  • Hordeolum (barleycorn): bacterial infection of the eyelashes. Typical localisation and anamnesis

• Regional lymphangitis, lymphadenitis
• in nasal and upper lip furuncles: infectious thrombosis of the cavernous sinus and thrombophlebitic sepsis possible (very rare complication)
• Recurrent furuncle formation (see below furunculosis) in immunologically disturbed patients
• Fiasciitis necroticans: Rare, life-threatening, fulminant, deep, phlegmonous infection of the skin, subcutis and fasciae occurring in diabetics after trivial injuries.
• Facial furuncle (esp. furuncle/carbuncle of the centrofacial region)
  • Due to the topographical proximity to the eye and brain region, there is an increased risk of complications, which is why i.v. antibiotic therapy is always required!
  • Complications: Orbital phlegmon, meningitis, sinus cavernosus thrombosis

Immobilize the affected part of the body, elevate as much as possible. No manipulation: no pressing on the boil! In case of facial furuncle: bed rest, no talking, as well as change to soft, passed fare.

• So-called "pull ointments" and the application of moist heat are traditionally used. 10, 20 or 50% ichthyol ointments are called "pull-alves". On the neck, face and genitals, however, these shale oil sulfonates should only be used up to 20%.
• Damp warm compresses at the beginning with antimicrobial additives such as polihexanide (Serasept, Prontoderm), diluted potassium permanganate solution(light pink), quinolinol (e.g. Chinosol 1:1000) or R042, polyvidone-iodine solution(e.g. Betaisodona solution). In addition, 0.5% Clioquinol in Lotio alba R050 or Clioquinol ointment (Linola-Sept), also treat the surrounding area.
• Incision and drainage of the abscess cavity is necessary in case of significant fluctuation of the abscess. Irrigation with polihexanide solution or polyvidon iodine solution(e.g. Betaisodona solution) insertion of a gauze strip soaked with polyvidon iodine ointment.

• Intravenous antibiotic therapy: In the case of facial furuncles, intravenous antibiotics, e.g. with oxacillin (e.g. InfectoStaph), should be preferred: Adults 2-4 g/day i.v. in 4-6 ED, children 1-6 years 1-2 g/day i.v. in 4 doses, infants over 3 months 4 times/day 20 mg/kg bw, infants up to 3 months 3 times/day 20 mg/kg bw, in newborns and premature infants the indicated dose should only be administered twice/day.
• Peroral antibiotic therapy: adults, adolescents, children from 6 years InfectoStaph Kps. 2-3 g/day in 4-6 doses. Children 1-6 years 2 g/day in 4 sessions. In case of severe infections, doubling of the dose is possible.
• In case of suspected penicillin allergy to erythromycin (e.g. Monomycin Kps.): Adults, children over 8 years: 4 times/day 250 mg or 2 times/day 500 mg p.o. Infants, toddlers: Monomycin juice/infant juice 30-50 mg/kg bw/day in 3-4 single doses at meals.
• Alternatively, the more stomach-tolerant Roxithromycin (Rulid Filmtbl.): Adults, adolescents (over 40 kg) 2 times/day 150 mg p.o. or 1 time / day 300 mg p.o. In advanced liver disease dose halve. Children, infants receive Rulid junior Btl. 30-50 mg/kg bw/day in 3-4 doses before meals.
• In case of resistance to the above antibiotics, use vancomycin: adults 4 times/day 0.5 g i.v. or twice/day 1.0 g i.v., children > 1 year 40 mg/kg bw in 2-4 doses, infants < 1 week 20 mg/kg bw in 2 doses, infants > 1 week 30 mg/kg bw in 3 doses.

Alternative: Immobilization, warm and moist compresses, after opening the furuncle drainage with marigold mother tincture diluted in Ringer's solution (1:20).

Althaeae folium, Althaeae radix, Foenugraeci Semen, Meliloti herba, Melaleuca alternifolia, Myrrh, see also under Arctii radix

1. Schöfer H et al (2011) S2k + IDA Guideline: Diagnosis and therapy of Staphylococcus aureus infections of the skin and mucous membranes. AWMF Guideline

2. van Bijnen EM et al(014) Evidence-based primary care treatment guidelines for skin infections in Europe: a comparative analysis.Eur J Gen Pract 20: 294-300.