00:02
Welcome to our lecture on Furuncles and
Carbuncles.
00:07
What is a furuncle ? The other lay term
language for uncle is a boil.
00:11
It's deep infection of a hair follicle.
00:14
And a carbuncle, on the other hand,
is clusters of furuncles that are
subcutaneously connected.
00:20
So furuncle, it's one boil,
and carbuncle is a combination of
boils. And this tends to occur deep down in
the follicle.
00:30
It's common in adolescence and early adult
life,
and carbuncles are relatively rare compared
to fair angles.
00:38
What are some of the risk factors?
Obesity, immunodeficiency,
for example, patients who have HIV
infection , AIDS, or are on chemotherapy for
malignancy and older
people. Diabetes mellitus is also a
predisposing factor for
carbuncles of our ankles.
00:56
Of course smoking and low hemoglobin anemia.
01:00
So what are the etiological agents of these
two conditions,
it's usually due to staph aureus.
01:07
And of course, methicillin resistant staph
aureus is a common
finding. Which areas are affected in patients
with furuncles or
carbuncles: the face,
the neck, the axillae,
and the buttocks. Now let's focus on the
ankle.
01:26
How do we describe it?
Clinically, it's a tender red perifollicular
swelling,
which can lead to a pustule that discharge
necrotic tissue and pus.
01:37
And remember, in dark skin,
you may not actually appreciate the erythema,
or the redness, may lead to a permanent scar
after
healing. And then again in black patients you
may even get post-inflammatory
hyperpigmentation that we spoke about.
01:53
So we spoke about the furuncle.
01:56
Now let's move on and talk about furunculosis
.
02:00
It's acute and recurrent appearance of
multiple furuncles on multiple skin
sites. So now you can differentiate between a
furuncle,
furunculosis and now we're moving on to the
third type the carbuncle.
02:15
So how do we define a carbuncle.
02:17
It's a hard, painful red lump about 3 to 10cm
in
diameter. You can get suppuration,
which is
pus that is discharged from the multiple
follicular orifices.
02:31
It may be associated with malaise,
fever, lymphangitis that is
inflammation of your lymphatic vessels,
and lymphadenitis,
which is inflammation and painful lymph
nodes.
02:44
The complications include abscesses,
cellulitis,
post-inflammatory hyperpigmentation,
which is unique to dark skin.
02:52
So how do we diagnose these conditions?
The clinical history and physical examination
findings are important.
03:00
As we have described,
a password for microbiological examination
is prudent. And this should be sent for
microscopy culture and
sensitivity. And now looking at the
differential diagnosis.
03:14
One of the differential diagnoses is
superficial staphylococcal folliculitis.
03:19
Perifollicular swelling not seen unlike in
furuncle and
carbuncle. The second one is a ruptured
epidermoid cyst,
which is a sterile, purulent,
keratinous material that is seen coming
out of an epidermoid cyst.
03:37
You can also confuse it with pharyngula
meiosis,
but usually here you see larva,
but this is not commonly seen.
03:46
Management of these conditions involve
incision and drainage of an
abscess. Usually MRSA effective
antibiotics are recommended as well.
04:00
The antibiotics that are effective against
MRSA are tetracyclines
and trimethoprim sulfamethoxazole.
The lecture Furuncles and Carbuncles in Darker Skin by Ncoza Dlova is from the course Bacterial Skin Infections in Patients with Darker Skin.
What is the key characteristic that differentiates a carbuncle from a furuncle?
Which systemic symptom is commonly associated with carbuncles but not typically with simple furuncles?
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