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Boils, carbuncles, folliculitis, paronychia and staphylococcal whitlow - Making a diagnosis
Boils and carbuncles

  • Symptoms:
    • Tenderness, which may be described as 'throbbing' with larger lesions, and is particularly severe if the lesion is in the nose or ear.
    • Occasionally with boils there may be mild constitutional symptoms, such as fever and malaise.
    • With carbuncles, there may be swelling of the affected area, and possibly high fever and malaise if the carbuncle is large [Hay and Adriaans, 2004].
  • Signs:
    • Boils can be single or occur in crops [Hay and Adriaans, 2004].
    • Boils initially appear as firm, erythematous nodules, which can become fluctuant (a wave-like feeling on palpating skin overlying a fluid-filled cavity with nonrigid walls, e.g. a cavity containing pus) and painful. They may rupture spontaneously, draining pus or necrotic material, healing to leave a violaceous macule and possibly a permanent scar [Pugh, 2000; Hay and Adriaans, 2004; Riain, 2006].
    • Commonly-involved sites for boils include hair-bearing areas of the face, neck, axillae, buttocks, groin, and the anogenital region [Hay and Adriaans, 2004; Ladhani and Garbash, 2005; Riain, 2006].
    • Carbuncles appear as tender, multiple abscesses with purulent drainage points along hair follicles, and inflammation of surrounding tissue [Ladhani and Garbash, 2005; Riain, 2006].
    • Common sites for carbuncles include the back of the neck, shoulders, hips, and thighs [Hay and Adriaans, 2004].
  • Investigations:

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