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)[A].

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.”