Carbunculosis, Folliculitis, and Furunculosis Nursing Guide

This course is intended as a Quick Reference for Carbunculosis, Folliculitis, and Furunculosis and will cover an overview and nursing considerations utilizing the nursing process.

Etiology and Epidemiology

Carbunculosis‚ folliculitis‚ and furunculosis are conditions that involve the infection of one or more hair follicles.

• Folliculitis is a common skin condition characterized by inflammation of a single hair follicle due to chemical or microbial irritation.
• A furuncle (furunculosis), or boil, is a skin abscess that develops in a hair follicle and spreads into the surrounding dermis. It typically occurs on the face, the axillae, the scalp, or the inguinal (groin) area.
• A carbuncle (carbunculosis) is a slow-growing abscess that involves a cluster of furuncles (Clebak & Malone, 2018).

All three conditions can be traced to primary inflammation of hair follicles due to infection or follicular occlusion. When bacterial infection is the cause, it typically involves Staphylococcus aureus strains.

The location of inflammation for the three above-described conditions is as follows:

• Folliculitis: superficial layer of the follicle
• Furuncle: deeper layers with tender nodules and single area of drainage
• Carbunculosis: several follicles involved as deep abscesses with more than one drainage point

Complications from carbunculosis, folliculitis, and furunculosis include:

• Cellulitis
• Permanent hair loss
• Septicemia
• Scarring
• Spread of infection to other organs

The risk factors for carbunculosis, folliculitis, and furunculosis include:

• Cosmetics
• Chronic colonization of S. aureus
• Debilitated status
• Diabetes mellitus
• Hot tub use
• Improper shaving techniques
• Obesity
• Poor hygiene
• Tight or restrictive clothing

Diagnosis

• Viral cultures
• Fungal cultures
• Gram staining of microorganisms
• Punch biopsies
• Nares cultures with familial colonization
• Incision and cultures of drainage

Management

• Cleanse infected area with soap and water.
• Administer medications.
• Apply warm compresses.
• Avoid occlusive dressings.
• For most cases, good hand washing and use of antibacterial soap is sufficient.
• Topical antibiotics (Gram-positive and Gram-negative activity) (Hirabayashi et al., 2018):
  • Erythromycin 2% (Akne-Mycin®)
  • Clindamycin (Cleocin T®)
  • Mupirocin 2% (Bactroban®)
• Oral antibiotics:
  • Cephalexin (Keflex®)
  • Clindamycin (Cleocin®)
  • Rifampin (Rifadin®)
  • Ciprofloxacin (Cipro®)
• Antiviral agents:
  • Famciclovir (Famvir®)
• Antifungal agents (Wang et al., 2018):
  • Ketoconazole (Nizoral®)
  • Terbinafine (Lamisil AT®)
• Incision and drainage needed with recurrent furuncles or carbuncles.

Nursing Considerations

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnosis, interventions, expected outcomes, and education for individuals with Carbunculosis, Folliculitis, and Furunculosis are listed below.

Assessment

• History
  • Discomfort at site of inflammation
  • Drainage at site
  • Malaise
  • Pruritus
  • Presence of risk factors listed above
• Physical Examination
  • Folliculitis
  • Pustules over affected hairs
  • May arise in beard area and eyelid (stye)
• Furunculosis
  • Erythema around nodule
  • Pus appearing with nodule rupture
  • Pain and induration
  • Found on face, axillae, scalp, or inguinal area
• Carbunculosis
  • Erythema, pain, and edema at site
  • Hard nodules under the skin
  • Abscess drainage through multiple sites
  • Fever

Nursing Diagnosis/Risk For

• Alteration in comfort
• Disturbed body image
• Impaired skin integrity
• Impaired tissue integrity
• Infection

Interventions

• Application of warm compresses
• Administration of prescribed medications, as ordered
• Assistance with self-care, when necessary
• Universal precautions with infection
• Wound care
• Monitor for:
  • Adverse drug reactions
  • Pain control
  • Worsening of symptoms

Expected Outcomes

• Reduce signs and symptoms of infection
• Decrease pain levels
• Express feelings of disturbed body image

Individual/Caregiver Education

• Disease process and treatment
• Importance of taking or applying prescribed medications
• Infection prevention
• Proper handwashing and hygiene techniques
• Follow-up care after two weeks to monitor response to treatment
• Referral for diagnosis of underlying causes (furunculosis or carbunculosis)
• Avoiding shaving affected area until lesions have resolved
• Good hygiene practices
• Proper sanitation of hot tubs
• Soaking razors in 70% alcohol to reduce bacterial/fungal growth
• Washing all bathing suits, wetsuits, and towels with hot water and antimicrobial soap
• Weight management

Content Release Date

4/1/2022

Content Expiration

12/31/2024

Course Contributor

The content for this course was created by Rakesh Tripath, MPH, BSN, RN, CEN. He is a Certified Emergency Nurse (CEN) with extensive experience primarily in acute care settings. Mr. Tripathi has considerable experience in travel nursing, as well as more than decades of general nursing experience. He has conducted nursing research for the European governments and worked as a nursing lecturer for Glasgow Caledonian University (GCU) Scotland, affiliate colleges, and has practived nursing in Asia, the UK, and the U.S.

Resources

Furuncles and Carbuncles

References

• Clebak, K. T., & Malone, M. A. (2018). Skin infections. Primary Care: Clinics in Office Practice, 45(3), 433-454. https://doi.org/10.1016/j.pop.2018.05.004
• Hirabayashi, M., Takedomi, H., Ando, Y., & Omura, K. (2018). Neck carbuncle associated with methicillin-susceptible Staphylococcus aureus bacteraemia. Case Reports, 2018, bcr-2018. https://doi.org/10.1136/bcr-2018-226935
• Kircik, L. H. (2016). Advances in the Understanding of the Pathogenesis of Inflammatory Acne. Journal of drugs in dermatology: JDD, 15(1 Suppl 1), s7-10. https://europepmc.org/article/med/26741394
• Stevens, D. L., & Bryant, A. E. (2017). Necrotizing soft-tissue infections. New England Journal of Medicine, 377(23), 2253-2265. https://doi.org/10.1056/NEJMra1600673
• Tu, W. T., Chin, S. Y., Chou, C. L., Hsu, C. Y., Chen, Y. T., Liu, D., ... & Shih, Y. H. (2018)
  Utility of Gram staining for diagnosis of Malassezia folliculitis. The Journal of dermatology, 45(2), 228-231. https://doi.org/10.1111/1346-8138.14120
• Wang, X., Yang, Y., Li, R., & Yu, J. (2018). Two Cases of Dermatophytic Granuloma Successfully Treated with Terbinafine. Mycopathologia, 183(3), 611-614. https://doi.org/10.1007/s11046-017-0237-2