Cutaneous Abscesses and Furuncles

Definitions and Clinical Presentation

Furuncles are infections of a single hair follicle caused by Staphylococcus aureus, where suppuration extends through the dermis into the subcutaneous tissue, forming a small abscess, and can occur anywhere on hairy skin 1, 2, 3
Carbuncles occur when infection extends to involve several adjacent hair follicles, producing a coalescent inflammatory mass, typically developing on the back of the neck, and are more common in people with diabetes 2, 4
Abscesses are collections of pus within the dermis and deeper skin tissues, usually presenting as painful, tender, and fluctuant red nodules often surrounded by erythematous swelling, and are typically polymicrobial 1, 2
S. aureus is present as a single pathogen in only about 25% of cutaneous abscesses 2

For small furuncles, moist heat application to promote spontaneous drainage is often sufficient, while larger furuncles and all carbuncles require incision and drainage 2, 3
For cutaneous abscesses, incision, thorough evacuation of pus, and probing the cavity to break up loculations is necessary 2
Systemic antibiotics are usually unnecessary for uncomplicated lesions unless there is extensive surrounding cellulitis, fever, or other systemic manifestations 2, 3

Decolonization with intranasal mupirocin twice daily for 5 days each month can reduce recurrences by ~50% 3
Daily chlorhexidine washes may help reduce recurrences 3
Thorough laundering of clothing, towels, and bedding, and use of separate towels and washcloths can also help prevent recurrence 3