Furunculosis

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Basics

Description

  • Acute bacterial abscess of a hair follicle (often Staphylococcus aureus)
  • System(s) affected: skin/exocrine
  • Synonym(s): boils

Epidemiology

Incidence
  • Predominant age
    • Adolescents and young adults
    • Clusters have been reported in teenagers living in crowded quarters, within families, or in high school athletes.
  • Predominant sex: male = female

Prevalence
Exact data are not available.

Etiology and Pathophysiology

  • Infection spreads away from hair follicle into surrounding dermis.
  • Pathogenic strain of S. aureus (usually); most cases in United States are now due to community-acquired methicillin-resistant S. aureus (CA-MRSA), whereas methicillin-sensitive S. aureus (MSSA) is most common elsewhere (1).

Genetics
Unknown

Risk Factors

  • Carriage of pathogenic strain of Staphylococcus sp. in nares, skin, axilla, and perineum
  • Rarely, polymorphonuclear leukocyte defect or hyperimmunoglobulin E–Staphylococcus sp. abscess syndrome
  • Diabetes mellitus, malnutrition, alcoholism, obesity, atopic dermatitis
  • Primary immunodeficiency disease and AIDS (common variable immunodeficiency, chronic granulomatous disease, Chédiak–Higashi syndrome, C3 deficiency, C3 hypercatabolism, transient hypogammaglobulinemia of infancy, immunodeficiency with thymoma, Wiskott-Aldrich syndrome)
  • Secondary immunodeficiency (e.g., leukemia, leukopenia, neutropenia, therapeutic immunosuppression)
  • Medication impairing neutrophil function (e.g., omeprazole)
  • The most important independent predictor of recurrence is a positive family history.

General Prevention

Patient education regarding self-care (see “General Measures”); treatment and prevention are interrelated.

Commonly Associated Conditions

  • Usually normal immune system
  • Diabetes mellitus
  • Polymorphonuclear leukocyte defect (rare)
  • Hyperimmunoglobulin E–Staphylococcus sp. abscess syndrome (rare)
  • See “Risk Factors.”

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