Management of Axillary Boils

Diagnosis and Pathophysiology

Axillary furuncles are infections of hair follicles caused primarily by Staphylococcus aureus, where suppuration extends through the dermis into subcutaneous tissue, forming a small abscess, commonly found in areas with hair follicles, moisture, friction, and proximity to lymph nodes 3, 4
Clinically, axillary furuncles present as inflammatory nodules with overlying pustules through which hair emerges 2

The Infectious Diseases Society of America recommends incision and drainage as the definitive treatment for large furuncles, involving making an incision over the fluctuant area, thorough evacuation of pus, and probing the cavity to break up loculations 1, 2, 3, 4, 5
Post-procedure wound care typically involves simply covering the surgical site with a dry dressing, as packing is not necessary and may cause more pain without improving healing 1, 2
Systemic antibiotics are usually unnecessary for uncomplicated furuncles after adequate incision and drainage, but should be added in cases of systemic inflammatory response syndrome, fever, extensive surrounding cellulitis, markedly impaired host defenses, or multiple lesions 1, 2, 3, 4
When antibiotics are indicated, they should target S. aureus, with options including oral penicillinase-resistant penicillins or first-generation cephalosporins for methicillin-susceptible S. aureus, and doxycycline, clindamycin, or trimethoprim-sulfamethoxazole for suspected MRSA 6, 7

For patients with recurrent axillary boils, evaluation for underlying causes such as hidradenitis suppurativa or foreign material is necessary, and decolonization measures including intranasal mupirocin, daily chlorhexidine washes, and daily decontamination of personal items may be beneficial 1, 2, 6
Hygiene measures such as bathing with antibacterial soaps, thorough laundering of clothing and bedding, and separate use of towels and washcloths can also help prevent recurrence 1, 5

Needle aspiration of axillary abscesses has low success rates and is not recommended 1
Culture is not routinely needed for typical, isolated furuncles, but should be obtained in recurrent cases or treatment failures 1, 7
Avoid confusing furuncles with hidradenitis suppurativa, and be aware that carbuncles require more aggressive management than simple furuncles 3, 7
Avoid antibiotic overuse for simple furuncles that have been adequately drained, as this contributes to antimicrobial resistance 7