Definition

A furuncle, commonly known as a boil, is a localized infection characterized by a buildup of pus in the skin tissue. It is typically caused by a Staphylococcus infection affecting the hair follicles (the pores where hair grows) and the surrounding tissues. Unlike a furuncle, a carbuncle is a cluster of multiple furuncles that are interconnected beneath the skin. Furuncles can develop on various body parts, including the neck, chest, face, and buttocks.

This disease can cause quite severe pain and cause them to feel uncomfortable sensations, especially when furuncle occurs on body parts prone to irritation, friction, or pressure, such as the armpits, buttocks, back, neck, and face. Furuncles are often seen as small boils filled with pus.

Causes

Furuncle occurs due to bacterial infection of Staphylococcus aureus. The infection involves the subcutaneous tissues in areas with hair follicles and the surrounding tissues. Staphylococcus bacteria are often found on moist and irritated areas, such as the armpits, buttocks, back, neck, and face.

Staphylococcus aureus can cause infections in:

• Dry skin
• Skin injured by cuts, scratches, or friction

When bacteria invade the skin and cause an infection, the immune system tries to eliminate the bacteria, and this causes pus to form. Pus can build up in the skin layers, forming a painful pus-filled sac (abscess).

Risk factor

Generally, furuncles can occur in all age groups regardless of gender. However, several factors can specifically increase the risk of furuncle, such as:

• Have a compromised immune system 
• Have certain medical conditions that can slow down the wound-healing process
• Have chronic skin disease
• Obesity
• Diabetes 
• Live in a densely populated environment with poor hygiene
• Close contact with other people who have been infected with Staphylococcus aureus or have furuncles
• Elderly

Symptoms

In cases of furuncles, small boils initially appear on the skin. These boils gradually enlarge, forming a reddish bump. As the bump increases in size, it may soften due to the accumulation of pus. One early symptom to watch for is dry skin, which can create an environment conducive to bacterial growth and the development of furuncles.

Usually, the bumps can be painful or sore. Other symptoms, such as hair loss, can occur due to inflammation and abscesses on the skin, making it easier for the hair to be pulled out or fall out.

Diagnosis

The doctor can diagnose this condition by examining the appearance of the skin lesions. You may be asked about your symptoms, daily habits, potential risk factors that could exacerbate the condition, and any medications you have been using.

However, in some cases, a skin sample may be taken and sent to a laboratory for further analysis. In the laboratory, the skin sample will be examined under a microscope. This procedure benefits patients with recurrent infections or those who have not responded to adequate therapy. This type of examination is called a biopsy.

In patients with recurrent infections with a slow healing process, further tests can be done to determine whether the bacteria are resistant to antibiotics. This test is important so your doctor can prescribe appropriate medicines to improve the therapeutic effect, accelerate recovery, and reduce the risk of recurrent infection.

Management

Generally, warm compresses could be applied to the infected and inflamed skin. Warm compresses aim to reduce pain and help to drain the pus so that the swelling can be reduced. If you have an abscess, the doctor may perform a procedure to incise and drain the abscess. 

In deep infections, it is common that abscesses cannot be removed completely. In this condition, the doctor will insert sterile gauze so the abscess can be removed optimally. If the abscess is not completely drained, it could increase the risk of recurrent infection in patients, so the abscess must be made sure to be completely clean. 

The doctor will also prescribe antibiotics to fight the bacterial infection. Antibiotics can be given as topical medications such as creams or ointments and oral medicines. Doctors generally prescribe oral antibiotics when there are multiple lumps, lumps with large size, recurrent infections, and other conditions.

Complications

Rarely the bacteria can enter the bloodstream and travel to other organs. This infection is dangerous as it can cause more severe infections and spread to other organs, such as the heart (endocarditis) and bones (osteomyelitis).

Another complication of furuncle is methicillin-resistant Staphylococcus aureus (MRSA) infection. This condition occurs because the bacteria become resistant and cannot be treated with several antibiotics. This infection is difficult to treat and requires a certain class of antibiotics to provide maximum and adequate therapy to patients.

Prevention

You can prevent and reduce the risk of Staphylococcus aureus infections by improving personal and environmental hygiene. If you have furuncles, take the following steps to prevent the infection from spreading to other parts of the body:

• Wash your hands frequently and avoid touching the infected bump to prevent the infection from spreading to other parts of the body
• Keep the infected lesion clean or cover the lesion with sterile gauze
• It is best to avoid sharing personal items such as towels, clothing, or hair shavers with others
• Wash your items in warm water to help kill the bacteria
• Avoid close contact with others suffering from complications such as methicillin-resistant Staphilococcus aureus (MRSA) infection

When to see a doctor?

Furuncles on the face, especially near the eyes, can interfere with vision. If you experience this, you should not touch the furuncles as there is a risk of spreading the bacterial infection to your eyes.

In addition, you should also consider consulting a doctor if your skin lesion is very painful, accompanied by fever, and does not improve within two weeks or more. Furuncles that occur repeatedly despite treatment also need special treatment. This is because it is suspected that the bacteria that cause furuncles have become resistant to the antibiotics given in the treatment. Further examination is needed to confirm this.

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