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Carbuncle

Dr Ganesh Ramalingam

Specialist in General Surgery

Condition

What Is A Carbuncle?

“A carbuncle is a painful cluster of red, swollen boils that are connected under the skin. They are tender and painful and cause a severe infection which could lead to a scar”.

– Dr Ganesh Ramalingam

Boils are bacterial infections under your skin, typically located at a hair follicle; it has a small collection of pus, called an abscess. A carbuncle is a cluster of boils that appears to have multiple pus “heads”. A carbuncle is also known as a staph skin infection.

Table of Contents

Carbuncle

What Causes A Carbuncle?

“A carbuncle tends to develop when Staphylococcus aureus bacteria or ‘staph’ enter the hair follicles. Scrapes or broken skin make it easy for bacteria to enter your body and cause an infection. This can result in boils or carbuncles filled with fluid and pus.”

– Dr Ganesh Ramalingam

Carbuncles are typically found on the back of the neck, shoulders, or thigh. They can also appear over any area where you sweat or experience friction. Moist areas of your body are particularly susceptible to this type of infection because bacteria thrive in these areas.

What Are The Characteristics Of A Carbuncle?

A carbuncle’s most obvious symptom is that of a red, irritated lump under your skin. It may be painful to the touch. The size of the lump may range from the size of a lentil to a medium-sized mushroom, and it may increase over the next few days as it quickly becomes filled with pus. You may eventually observe a yellow-white tip or “head” developing on the surface. The tip will rupture and drain the pus. Swelling may also be experienced in the areas surrounding the carbuncle. Pus usually appears within one day of the carbuncle forming.

Other symptoms may include:

  • Itching before the lump appears
  • Bodily aches
  • Fatigue
  • Fever and chills
  • Skin crustiness or oozing

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How Are Carbuncles Diagnosed?

Our doctor can usually diagnose a carbuncle by looking at the area of the skin. A pus sample may be collected for lab analysis to better determine the type of infection. A tendency to develop carbuncles may indicate other health issues, such as diabetes. Our doctor may order urine or blood tests to check your overall health.

Such was the case of Caroline Moore, an athlete. After summiting Mount Denali in 2013, she contracted a staph infection in her knee during surgery. While cases like Caroline’s battle with a staph skin infection may be rare, large untreated carbuncles can cause serious issues.

Do Carbuncles Go Away On Their Own?

Carbuncles, like skin abscesses, are usually not dangerous and disappear on their own with time. A small boil will form a white tip and drain within five to seven days. However, very large boils or carbuncles can last longer and may not drain on their own. Carbuncles may need to be drained by a doctor, and you may need to take antibiotics.

How Can I Prevent My Skin From Developing Carbuncles?

One may not always be able to prevent the development of carbuncles on your skin. However, maintaining good personal hygiene minimises your chance of acquiring the staph infection that commonly leads to developing a carbuncle. To reduce your risk, start by:

  • Washing your hands regularly.
  • Showering frequently to prevent your skin from coming into constant contact with bacteria.
  • Avoid squeezing boils or rubbing any broken skins as it might cause the infection to spread.
  • Washing your clothes, bedsheets and towels regularly in hot water.

Steer clear of sharing personal items such as towels, sheets, razors, athletic equipment, makeup, and clothing. If you have a cut or sore, wash and clean your bedding and towels in hot water with detergent and bleach regularly, and dry them on the hot setting.

As the infection is bacterial, carbuncles can be spread through contact with another infected person, as with the case of a nail salon in California, which left as many as 37 women contracting boils after they visited the salon. The infection came from a microbe growing in a footbath used for pedicures.

Are Carbuncles Considered An Emergency?

A carbuncle refers to a cluster of boils that form a connected area of infection. Compared with single abscesses, carbuncles cause a deeper and more severe infection, and they are more likely to leave a scar.

If you suffer from a carbuncle, you may often feel unwell and experience a fever and chills. Moreover, an active boil or carbuncle is contagious and can spread to other parts of the person’s body or other people through skin-to-skin contact or personal items.

“My recommendation would be to seek medical advice when you notice that the carbuncle or clusters of boils on your skin remain for more than a week and are starting to affect your daily life. Never attempt to pop your boil on your own as it can cause a spread of the infection.”

– Dr Ganesh Ramalingam

What Happens When The Infection From A Carbuncle Spreads?

The bacteria within a boil or carbuncle may sometimes spread to other parts of the body, triggering a secondary infection. Cellulitis is the most common secondary infection that is associated with both boils and carbuncles.

Some less common secondary infections associated with boils and carbuncles include:

  • Impetigo
  • Septic arthritis
  • Osteomyelitis
  • Endocarditis
  • Septicaemia
  • Brain abscess

Some of these infections need to be treated with injections of antibiotics. For septicaemia and brain abscess, admission to an intensive care unit (ICU) may be required.

Complications From Boils And Carbuncles

While most carbuncles do not pose serious health problems or are life-threatening, carbuncles may cause severe complications in rare cases. These may include:

  • Abscess of the brain, skin, spinal cord, or organs such as the kidneys
  • Endocarditis
  • Osteomyelitis
  • Permanent scarring of the skin
  • Sepsis
  • Spread of infection to other areas

Methicillin-resistant Staphylococcus aureus (MRSA) is another potential complication. MRSA is a drug-resistant strain of bacteria that commonly causes skin abscesses. While there are alternative antibiotics to treat this strain, they may not be effective all the time.

How Is A Carbuncle Treated?

A carbuncle is treated based on its size and area of infection. Depending on these factors, our doctor may use one or more of the following medical treatments:

  • Antibiotics. These are taken either orally or applied to the skin.
  • Antibacterial soaps. To be added to your daily cleaning regimen.
  • Pain relievers. Over-the-counter medications are typically sufficient.
  • Surgery. Our doctor may need to drain deep or large carbuncles with a scalpel or needle.

“A carbuncle is infectious. You should never attempt to drain a carbuncle yourself as you risk spreading the infection and, in the worst scenario, infecting your bloodstream.”

– Dr Ganesh Ramalingam

What Happens During Treatment For A Carbuncle?

If surgery or drainage is required, our doctor may cut and drain the carbuncle. Additionally, our doctor will need to ensure that all the pus has been removed by washing the area with a sterile solution.

Two Procedures may be conducted: Saucerisation or Incision & Drainage (I&D).

Saucerisation is the surgical excavation of tissue, resulting in a shallow depression to facilitate drainage from the infected area of a wound.

As with the case of a 71-year-old man who developed a painful carbuncle on his back, he had diabetes mellitus, which was treated with oral hypoglycemic medications. On arrival at the hospital, his carbuncle measured 10cm x 12cm. Saucerisation of the carbuncle was performed, and he was discharged one week after treatment.

Surgical incision and drainage is a standard procedure performed by a trained clinician to drain a collection of pus from an infected region. The procedure involves both sharp and blunt surgical dissection, irrigation, possible placement of a drainage tube and suturing.

After Treatment Of A Carbuncle

After surgery, a sample of the pus may be sent to a lab to identify the bacteria causing the infection and check its susceptibility to antibiotics and medication. Typically, once the carbuncle is completely drained, antibiotics are usually unnecessary.

However, treatment with antibiotics may be necessary if:

  • When MRSA is involved
  • If drainage is incomplete and the infection has spread to other parts of the body.
  • A person has a weakened immune system
  • There is surrounding soft-tissue infection (cellulitis)

Depending on the severity, most carbuncles heal within two to three weeks after medical treatment.

How Long Does It Take For The Carbuncle To Heal?

A carbuncle often requires treatment by a healthcare provider. Depending on its severity, the carbuncle should heal within 2 to 3 weeks after treatment.

Why Do Carbuncles Come Back?

Boils and carbuncles that keep returning may need further treatment. Most patients with recurrent abscesses are carriers of Staphylococcus aureus bacteria (staph bacteria), a common cause of boils and carbuncles.

In the case of recurrent carbuncles, treatment may be necessary to kill the bacteria. Our doctor will determine the best course of treatment based on where the staph bacteria are found on your body. Additionally, bacteria on the skin can be treated with an antiseptic soap. Staph bacteria are also commonly found in the nose. Doctors may prescribe an antiseptic nasal cream to apply several times a day for five to 10 days.

Our doctor will also advise you on how you can prevent boils, such as regularly washing and cleaning cuts and grazes.

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