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Boils, carbuncles, folliculitis, paronychia and staphylococcal whitlow - Management
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Definition
- Folliculitis is superficial infection of the hair follicles which develop into small inflammatory papules or pustules.
For someone with a suspected boil, carbuncle, folliculitis, acute paronychia or staphylococcal whitlow, what assessment do I need to make?
- Size and position of the lesion.
- Presence of pus or fluctuance (wave-like feeling on palpating skin overlying a fluid-filled cavity with nonrigid walls).
- Symptoms suggesting systemic spread of infection.
- Whether a swab is required.
In depth
Do I need to take a swab (boils, carbuncles, folliculitis, paronychia, staphylococcal whitlow)?
- Swabs are not routinely required for initial management.
- Swabs are indicated if the lesion is getting worse over 48 hours despite antibiotic treatment, or there is no response to empirical antibiotic treatment within 5–7 days.
In depth
How should I manage folliculitis?
- Advise people to avoid aggravating factors (e.g. tight clothing or occlusive dressings or plasters, and, if shaving, to shave in the direction of hair growth).
- Daily washing with an antiseptic product may help to prevent or control mild cases.
- For localized folliculitis, topical fusidic acid can be used.
- If folliculitis is more extensive or severe, empirical treatment with oral antibiotics may be needed.
In depth
Which antibiotic should I prescribe (if indicated)? (boils, carbuncles, folliculitis, paronychia, staphylococcal whitlow)
- Oral flucloxacillin is recommended for empirical treatment.
- Oral erythromycin (or clarithromycin if erythromycin is not tolerated) is an alternative for people with penicillin allergy.
In depth
How long should I prescribe antibiotics for? (boils, carbuncles, folliculitis, paronychia, staphylococcal whitlow)
- A 7-day course of empirical antibiotic treatment is recommended.
In depth
How should I manage recurrent or chronic folliculitis?
- Swab the lesion to confirm the causative organism and antibiotic sensitivities.
- Consider whether the cause could be non-infective.
- Consider whether the diagnosis is correct.
- If staphylococcal infection is confirmed, check for carriage of Staphylococcus aureus.
In depth
How should I assess and manage staphylococcal carriage?
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