Innovative Management of Recurrent Furunculosis

One of the most common bacterial infections of the skin and soft tissue is furunculosis (boil), an inflammatory nodule that involves the hair follicle, with small abscess formation extending through the dermis into the subcutaneous layers. Treatment of recurrent furunculosis is a difficult and challenging process. The mainstay of therapy is incision and drainage of a furuncle coupled with bacterial culture. Affected patients and their family members must practice good hygiene, predicated with regular hand washing, fomite cleaning, and avoiding contact with contaminated skin.

Dermatologists confront a variety of cutaneous infections in an era when infections are becoming more prevalent and also more aggressive. For example, the emergence of organisms with rapidly expanding resistance leads to common skin commensals causing life-threatening conditions. Such skin and soft tissue infections (SSTIs) are frequent causes of emergency room visits and hospitalizations. Most of the treatment of SSTIs is based primarily on anecdotal evidence and addresses only acute management; thus, recommendations in this body of evidence may be inadequate to suggest appropriate steps to prevent recurrent or relapsing cutaneous infection.

One of the most common bacterial infections of the skin and soft tissue is furunculosis (boil), an inflammatory nodule that involves the hair follicle, with small abscess formation extending through the dermis into the subcutaneous layers ( Fig. 1 ). Etiologically, a furuncle is essentially the suppurative sequela of folliculitis. When infection involves several adjacent follicles, producing a coalescent inflammatory mass with pus draining from multiple orifices, the larger nodule is then termed a carbuncle.