Treatment and complication of Carbuncle, Boil and Abscess

Multiple deep seated abscess with subcutaneous tissue necrosis with multiple discharging sinus on surface is called carbuncle.

Clinical features:
a. Skin-red, indurate.
b. Subcutaneous tissue – painful, indurate.
c. Slough   out of skin.
d. Multiple discharging of sinuses.

Investigation:
1. Blood for Sugar.
2. Urine for sugar.
Complication of carbuncle:
a. Septicemia.
b. Epidermal abscess.
c. Meningitis.

Treatment of carbuncle:
a. Incision and drainage of pus and excision of all dead tissue
b. Control of diabetes mellitus.
c. Antibiotic : flucloxacillin 500 mg 6 hourly for 7-10 days
d. Regular local wound care.
e. Improvement of general condition of the patient.
f. Osmotic pest (MgSO4) supplements by infrared or short wave diathermy.
g. If required , skin graft after formation of granulation tissue.

Boil

It is an acute staphylococcal of the hair follicle with pre-folliculitis which usually proceeds to suppuration and central necrosis.

Clinical features :
a. Pain
b. Redness.
c. Local rise of temperature.
d. Visible involvement of a hair follicle.

Complication:
a. Cellulites.
b. Abscess.
c. Carbuncle.
d. Secondary boil.
e. Secondary infection of during lymph node.

Treatment:
a. Depletion of hair follicle.
b. Improvement of general condition of patient.
c. Treatment with proper antibiotics , according to C/S report. Eg Flucloxacillin  500 mg 6 hourly for 7-10 days.
d. Bed rest.
e. Regular dressing with antiseptic solution, like povidone iodine.



Abscess:

It is may be define as a collection of pus that has built up tissue of the body due to inflammation or infection of microorganism.

Classification:
generally it is two types

a.       Skin abscess (external)

b.      Internal abscess

Skin abscess a re common but internal abscess are harder to diagnosis and more serious. Skin abscess are also known cutaneous or subcutaneous abscess.

Other types :

a.       Acute abscess.

b.      Amebic abscess.

c.       Apicat abscess.

d.      Appendicle abscess.

e.      Bone abscess.

f.        Brain abscess.

g.       Dental abscess.

h.      Dry abscess.

i.         Gas abscess.

j.        Breast abscess.

Investigation :

1.       Blood for TC.

2.       Blood for DC.

3.       And ESR.

4.       FNAC (if pus is come out is is confirmatory)

Treatment:

1.       Incineration of pus under G/A.

2.       Pus send for culture media with culture sensitivity report.

3.       Appropriate antibiotics ie plucloxacillin 50mg 6 hourly per day.

4.       Bed rest

5.       Regular dressing   

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