Carbuncle - Causes, Signs & Symptoms, Risk Factors, Diagnosis, & Treatment

A carbuncle is an infection of the hair follicles, that extends into the surrounding skin and underlying subcutaneous tissue. This is a gross image of a carbuncle. It affects males more than the females, and common in young to middle aged adults, and very rare in children.
Although they can arise at any hairy region, carbuncles are more common in areas with thick skin, such as posterior neck, back, and thigh.
A carbuncle starts as a folliculitis, which progresses to a furuncle. When several furuncles are combined together, a carbuncle is formed.
The commonest causative organism for carbuncle is staphylococcus aureus. Occasionally, they are caused by anerobic organisms.
Predisposing factors for carbuncle include, eczema, where the skin integrity is disrupted. Diabetes. Alcoholism. Malnutrition. Immunodeficiency. Poor personal hygiene. Obesity. Overcrowding. Excessive sweating. And anemia.
Individuals with carbuncles present with reddish, tender, and fluctuant nodules, which have multiple draining sites. They start as small nodules, and then slowly enlarge. As already mentioned, they occur in hair bearing areas.
Trauma to carbuncles can lead to oozing of their content.
Individuals may also have systemic symptoms, such as fever. lymphadenopathy. Fatigue. And malaise.
Diagnosis of carbuncle is based on patient’s history and physical examination findings. Before starting antibiotics, samples should be sent for culture and antibiotic sensitivity test.
If there are systemic symptoms, other basic investigations such as complete blood count and C reactive protein levels can be evaluated.
Carbuncles require both surgical and medical treatment. They should be incised and drained under local anesthesia.
After adequate drainage, the cavity is packed with iodoform strips or gauze to assist further drainage as you can see in this picture.
After drainage, antibiotics should be started.
Commonly used antibiotics include, cloxacillin, flucloxacillin, and cephalosporins. If methicillin resistant staphylococcus aureus is suspected, vancomycin should be indicated.

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