Pharmacotherapy of Folliculitis, Furunculosis and Carbuncles
PST 06106
Basic Pharmacotherapy
Session 19: Pharmacotherapy of Folliculitis,
Furunculosis
and
Carbuncles
Learning Objectives
By the end of this session students are expected to be able to:
Define folliculitis,
furunculosis
and carbuncles
Explain pathophysiology of folliculitis,
furunculosis
and carbuncles
Explain the clinical presentation of folliculitis,
furunculosis
and carbuncles
Outline diagnosis of folliculitis,
furunculosis
and carbuncles
Describe pharmacological treatment of folliculitis,
furunculosis
and carbuncles
Describe the monitoring of folliculitis,
furunculosis
and carbuncles
therapy
Activity: Buzzing
What are Folliculitis, Furunculosis and Carbuncles?
Definition of Folliculitis, Furunculosis and Carbuncles
Folliculitis
, Furunculosis and Carbuncles
Folliculitis is inflammation of the hair follicle and is caused by physical injury, chemical irritation, or infection.
Infection occurring at the base of the eyelid is referred to as a stye.
Folliculitis is a superficial infection with pus present only in the dermis
,
Furuncles and carbuncles occur when a follicular infection extends from around the hair shaft to involve deeper areas of the skin.
A furuncle, commonly known as an
abscess
or
boil,
is a walled-off mass of purulent material arising from a hair follicle.
Definition of Folliculitis, Furunculosis and Carbuncles
The lesions are called
carbuncles
when they coalesce and extend to the
subcutaneous tissue
.
This aggregate of infected hair follicles forms deep masses that generally open and drain through multiple sinus tracts.
S. aureus
is the most common cause of folliculitis, furuncles, and carbuncles.
Inadequate chlorine levels in whirlpools, hot tubs, and swimming pools have been responsible for outbreaks of folliculitis caused by
P. aeruginosa
.
Pathophysiology of Folliculitis, Furunculosis and Carbuncles
The skin and subcutaneous tissues normally are extremely resistant to infection but may become susceptible under certain conditions.
Even when high concentrations of bacteria are applied topically or injected into the soft tissue, resulting infections are rare.
Several host factors act together to confer protection against skin infections.
Because the surface of the skin is relatively dry and has a pH of approximately 5.6, it is not conducive to bacterial growth.
Continuous renewal of the epidermal layer results in the shedding of
keratocytes
, as well as skin bacteria.
In addition, sebaceous secretions are hydrolyzed to form free fatty acids that strongly inhibit the growth of many bacteria and fungi.
Pathophysiology of Folliculitis, Furunculosis and Carbuncles
Conditions that may predispose a patient to the development of skin infections include
H
igh
concentrations of bacteria (>10 5 microorganisms),
E
xcessive
moisture of the skin,
I
nadequate
blood supply,
A
vailability
of bacterial nutrients, and
Damage to the corneal layer allowing for bacterial penetration.
The majority of Skin and Soft Tissue Infections result from the disruption of normal host defenses by processes such as skin puncture, abrasion, or underlying diseases (e.g., diabetes).
The nature and severity of the infection depend on both the type of microorganism present and the site of
inoculation
Clinical presentation and diagnosis of Folliculitis, Furunculosis and Carbuncles
Folliculitis
Pruritic, erythematous papules typically appear within 48 hours (range: 6 to 72 hours) of exposure to large numbers of organisms.
Papules evolve into pustules that generally heal in several days.
Systemic signs such as fever and malaise are uncommon, although they have been reported in cases caused by
P. aeruginosa
Clinical presentation and diagnosis of Folliculitis, Furunculosis and Carbuncles Cont.…
Furuncles/
Furunculosis
Furuncles can occur anywhere on hairy skin but generally develop in areas subject to friction and perspiration.
Furuncles are discrete lesions, whether occurring as singular or multiple nodules.
The lesion starts as a firm, tender, red nodule that becomes painful and fluctuant.
Lesions often drain spontaneously.
Lesions caused by CA-MRSA often have necrotic centers characteristic of “spider bites.”
Culture of lesion for laboratory investigation to conform the
presence
and the type of the pathogen
Clinical presentation and diagnosis of Folliculitis, Furunculosis and
Carbuncles Cont.…
Carbuncles
Carbuncles are broad, swollen, erythematous, deep, and painful follicular masses.
Carbuncles commonly develop on the back of the neck and are more likely to occur in patients with diabetes.
Unlike folliculitis and furuncles, carbuncles are commonly associated with fever, chills, and malaise.
Bacteremia with secondary spread to other tissues is common
Culture of lesion for laboratory investigation to conform the
prensence
and the type of the pathogen
Activity
: Small Group Discussion
What is the treatment of Folliculitis, Furunculosis and Carbuncles?
Pharmacological treatment of Folliculitis, Furunculosis and Carbuncles
Treatment of folliculitis generally requires only local measures, such as warm moist compresses or topical therapy (e.g., clindamycin, erythromycin, mupirocin
,
or benzoyl peroxide).
Topical agents generally are applied two to four times daily for 7 days.
Small furuncles generally can be treated with moist heat, which promotes localization and drainage of pus.
Large and/or multiple furuncles and carbuncles require incision and drainage.
Systemic antibiotics are usually not necessary unless accompanied by fever or extensive cellulitis.
Treatment of more severe infections generally consists of a penicillinase-resistant penicillin (such as
dicloxacillin
) or a first-generation cephalosporin (such as cephalexin) for 5 to 10 days
Drug Treatment
Monitoring of Folliculitis , Furuncles and Carbuncles Therapy
Many follicular infections resolve spontaneously without medical or surgical intervention.
Lesions should be incised if they do not respond to a few days of moist heat and nonprescription topical agents.
Following drainage, most lesions begin to heal within several days without antimicrobial therapy.
Any patient who is unresponsive to several days of therapy with a penicillinase-resistant penicillin or first-generation cephalosporin should have a culture and
sensitivity
Performed
because of the increasing frequency of MRSA.
Key Points
Folliculitis
is inflammation of the hair follicle and is caused by physical injury, chemical irritation, or infection
Symptoms of Folliculitis include Pruritic, erythematous papules typically appear within 48 hours (range: 6 to 72 hours) of exposure to large numbers of organisms
Treatment of folliculitis generally requires only local measures, such as warm moist compresses or topical therapy
Evaluation
What
are Folliculitis, Furuncles and Carbuncles?
What is the pathophysiology of
Folliculitis, Furuncles and Carbuncles?
What are the signs and symptoms of Folliculitis, Furuncles and Carbuncles?
How is the treatment of Folliculitis, Furuncles and Carbuncles?
References
Wells
BG,
DiPiro
J,
Schwinghammer
T (2013),
Pharmacotherapy Handbook
(6
th
Ed). New York, NY: McGraw-Hill.
DiPiro
JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey ML, (2008):
Pharmacotherapy: A Pathophysiologic Approach
(7
th
ed
): New York, NY: McGraw-Hill.
Katz M D.,
Matthias KR.,
Chisholm-Burns M A.,
Pharmacotherapy(2011)
Principles & Practice Study Guide: A Case-Based Care Plan Approach
:
New York, NY: McGraw-Hill.
Schwinghammer
TL, Koehler JM (2009)
Pharmacotherapy Casebook: A Patient-Focused Approach
(7
th
ed
): New York, NY: McGraw-Hill.
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