Diseases

Furunculosis - symptoms, diagnosis and therapy


Occasional hair follicle ignition (boil) Having is not a bad thing in itself. Because it can happen relatively easily that a hair follicle ignites and thus creates the starting point for the development of a boil. However, boils become problematic if they appear frequently and occur at regular intervals. In this case one speaks of furunculosis. We would like to inform you about their peculiarities, causes and treatment methods in the following article.

Development of furunculosis

Each of our body hair is localized in a so-called hair follicle (also: hair follicle). The term describes the elongated depression in the skin, at the lower end of which the hair root (Radix pili) arises. The so-called hair shaft grows from it (Scapus), which forms the visible part of the body hair after exiting the hair follicle.

In addition to the hair root and hair shaft, each hair follicle is equipped with different glands. While the sebaceous glands (Glandula sebacea) The lipid glands (also known as sebum or sebum), which protect the skin from drying out, are produced by the sweat glands (Glandula suderifera) by secretion of sweat to regulate body temperature. In addition, the hair's own fragrant glands are also counted among the sweat glands. Due to the secretion of pheromones, they are responsible for sending out fragrance signals.

The excretion of secretions in the hair follicles is therefore essential both for skin protection and for skin breathing and signal transmission of the body. However, these secretions can also promote the development of inflammation, since they offer potential inflammation germs a certain nutrient basis. However, not every inflammation on the hair follicle is automatically a boil. In fact, one only speaks of boils when the entire follicle, including the surrounding tissue, has become inflamed. As the inflammation progresses, the affected hair follicle fills with pus and can even cause tissue loss (necrosis) provoke. The resulting plug of pus and dead skin tissue usually provides a hardened lump that is clearly visible from the outside, which is noticeable due to reddening, tissue swelling and severe pressure pain. From a certain size, the pus plug finally breaks through the skin surface and then spontaneously empties. What remains is a relatively large "crater" in the skin, which gradually heals through scarring.

Although boils have considerable pain potential, they are not a cause for concern if they occur only occasionally and do not exceed a certain size. The situation is different when the boils are particularly large. They can leave permanent scars that remain in the skin in the form of larger depressions. Hair follicle inflammation is even more complicated if it affects not just one but several follicles lying side by side and spreads to a deep infection. If several boils merge here, one speaks of a so-called pus bump (carbuncle). If boils repeatedly appear on different skin areas, medicine speaks of boils, which translates as “boils disease”.

Causes

Boils can occur anywhere on the body, although certain areas such as the buttocks, face, neck or the inside of the thighs are particularly susceptible to boils. Bacterial infections such as those caused by staphylococci are often responsible for the inflammation of hair follicles. Especially the bacterium Staphylococcus aureus is very often identified as the cause of inflammation. In addition, other causes of origin come into consideration, such as

  • Metabolic disorders,
  • Disorders in the secretion line of the hair follicles,
  • lack of personal hygiene
  • or immune deficiency.

Skin diseases and furunculosis

It's no secret that people with acne also suffer from boils above average. Especially when expressing boils on the face, there is the greatest risk of triggering boils. The sensitive layers of skin, as well as the deeper tissue on the face, are traversed with a particularly large number of vessels, which can quickly transport any pathogens from the original source of inflammation to other regions of the head and thus promote the spread of inflammation. If appropriate treatment is not initiated in good time, the inflammatory process can be carried over seriously. Consequences such as brain inflammation can then no longer be ruled out.

In acne, boils often arise from initial pus pimples, which ignite as the disease progresses. The process is accelerated if those affected push the pimples a lot, which further irritates the skin tissue that has already been attacked. Especially when squeezing pimples with dirty fingers, bacterial pathogens get into the pimple wounds, which ultimately sets the inflammation in motion. The situation is similar with folliculitis. This is an inflammation of the upper hair follicle, which can be caused by an abundance of germ pathogens, as if:

  • Candida mushrooms,
  • Enterobacter bacteria,
  • Escherichia coli bacteria,
  • HI viruses,
  • Klebsial,
  • Proteus bacteria,
  • Pseudomonies
  • and Staphylococcus aureus.

Without treatment or sustained tissue irritation from pushing and scratching, the inflammation initially limited to the upper part of the hair follicle can spread to the underlying follicle sections around the hair root, which in turn can lead to full hair follicle inflammation.

In addition to acne and folliculitis, there are also other skin diseases, such as Impetigo contagiosa considered as a trigger. The disease describes a highly infectious inflammatory process, which, in addition to staphylococci, also due to streptococci and here in particular Streptococcus pyogenes is triggered. As a result, vesicles filled with inflammatory liquid initially appear on the body, but these can quickly turn into tangible boils. Since impetigo contagiosa is a skin disease caused by smear infection, there is also an increased risk that the inflammation will spread and become worse as a result of pushing the affected tissue. This is particularly important to mention because the disease manifests itself primarily in infancy and childhood. Parents of sick children should therefore take special care to prevent their children from pushing or scratching at the blisters caused by the disease.

Furunculosis due to metabolic disorders

In most cases, disorders of the metabolism or even chronic metabolic diseases are responsible for both furunculosis itself and numerous skin diseases that act as triggers for hair follicle inflammation. For example, it is suspected in the medical community that there is excessive sebum production in the hair follicles in many forms of acne. This makes the skin extremely oily and the hair follicles can no longer keep up with the emptying of the sebum glands. The result is clogged follicles, which, due to the persistent non-emptying, become a pool for bacteria, which ultimately provokes not only pimples but also inflammation in the follicles. Metabolic disorders that cause increased secretion of sebum are often behind the increased sebum production.

An increase in secretion is conceivable, for example, through very fatty or sugar-rich foods, the ingredients of which the body tries to remove through the sebum. Hormonal reasons for metabolic disorders are also not absurd, which is often the reason for skin problems in adolescents with extreme acne and / or furunculosis. In this sensitive phase of physical development, the metabolism gets out of balance relatively easily due to the constant hormone fluctuations, which can also affect the secretion production of the sebaceous glands.

But metabolic disorders of a completely different kind can also promote furunculosis. Diabetes mellitus in particular is always associated with the chronic variant of hair follicle inflammation. Similar to long-term diets containing a lot of sugar, the body tries to break down excess sugar deposits through the skin, because it lacks the necessary insulin to break down the body.

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When it comes to the sweat glands of the hair follicle, the sweat secretion can also promote the development of boils. Especially if you already have acne and increased sweat production (Hyperhidrosis), there is a risk that boils will quickly develop from acne pimples. Because sweat contributes to further constipation of the follicles and thus also makes inflammation more likely. Of course, sweat-related boils are particularly affected by sweating parts of the body such as the buttocks and armpits, which have a particularly large number of sweat glands. The causes of a corresponding hyperhidrosis can often also be found in hormonal and metabolic problems. Diseases such as thyroid dysfunction, menopausal symptoms, diabetes mellitus and obesity are considered to be some of the main triggers for increased sweat flow.

Boils with poor hygiene

Men, in particular, sometimes complain about boils caused by daily bar shaving on the chin and cheek area. Shaving wounds are the originators into which infectious agents have migrated due to the wound not being sterile. In general, poor hygiene often plays an important role in the development of boils. This applies not only to the face, but also to the rest of the body. Above all, people who have proven to have oily skin should take regular cleaning measures to prevent constipation of the hair follicles and the associated inflammation.

Important: A lack of hygiene precautions does not necessarily refer to inadequate personal hygiene with regard to boils. Simply touching or pressing on purulent pimples with unwashed hands can have a devastating effect on the tissue. The slightest migration of germs into the skin can be enough to trigger a boil.

Immunodeficiency and boil formation

Another important factor in the development of furunculosis is a weakened immune system, because infectious agents are known to have an easy time with existing immune deficiencies. Of importance are not only immune-debilitating diseases, but also an unhealthy diet, which not only reduces the immune system, but also worsens the complexion and can impair the protective function of the skin barrier.

Symptoms

Furunculosis is characterized by repeated or chronic inflammation of one or more hair follicles. Accordingly, the cardinal symptoms can be described as typical symptoms of a local inflammatory reaction in the body. It occurs in the affected skin area:

  • Redness,
  • Swelling,
  • inflammation-related pain
  • and overheating.

At the beginning, the boil appears as a small red pustule that appears to be above the skin level. As the bacteria multiply and the immune reaction of the body's immune system is triggered, a number of other skin reactions occur. The inflamed tissue fills with pus and the surrounding blood vessels become permeable, causing additional water in the skin to flow with the defense cells it contains. A cavity is created in the affected hair follicle that is filled with various inflammatory secretions, but also with sebum and sweat. The hair follicle is expanded due to the secretion accumulation and its diameter can swell up to a multiple of its original size.

With the opening of the boil, which happens all by itself from a certain internal pressure in the tissue, the pus and the tissue fluid drain. Now both the pain and the swelling subside significantly and the boil heals itself, usually with scarring.

Danger: At the opening stage, the boil is particularly susceptible to secondary infections and should therefore be treated with special care. It is therefore important to keep the affected skin area sterile.

If boils do not occur in frequent succession and those affected are otherwise in good health, furunculosis is painful and, if it occurs in the face area, is also associated with a high level of suffering, but is not dangerous to health. The situation is different for those with a weakened immune system. In this case, the invaded bacteria do not remain locally confined to the hair follicle, but can penetrate the blood and lymphatic system and cause generalized symptoms. Those affected then feel beaten and uncomfortable, can develop a fever and the surrounding lymph nodes can swell. In the case of particularly severe courses, furunculosis can ultimately even grow into sepsis or meningitis.

Another peculiarity occurs when the boil is caused by colonization with strains of the multi-resistant Staphylococcus aureus (MRSA). These bacterial strains have developed a particularly good resistance to the common antibiotics and can therefore only be treated with very few antibiotic preparations. Especially for those with a weakened immune system and for patients in hospitals and care facilities, this bacterial strain, also known as hospital germ, has a special status and requires meticulous hygiene measures.

Diagnosis

The confirmed diagnosis of furunculosis is usually made by a dermatologist. First of all, it is important to differentiate chronic hair follicle inflammation from other skin diseases such as acne or folliculitis. However, this can usually be accomplished by gaze diagnosis based on the typical appearance and symptoms of furunculosis (red and solid pus). If it is a common form of furunculosis, no further diagnosis is required before starting therapy.

The situation is different for certain risk groups, in which the attending physician has to observe a few things and, if necessary, initiate further diagnostic steps. These risk groups include:

  • Chronically ill people (for example with diabetes mellitus, COPD),
  • People with weak immune systems (e.g. with leukemia, with an immune deficiency, after organ transplantation, HIV-infected people),
  • Affected, whose boils do not heal despite therapy
  • and people who have struggled with MRSA colonization before.

In these cases, the medical professional should identify the pathogen strain of furunculosis by taking a smear from the secreted secretion from the boil. In addition to identifying the pathogen, the result evaluated by the laboratory also provides an indication of which antibiotic preparations can be used effectively for the treatment. The inflammation parameters (CRP, blood count, blood sedimentation rate) can also be determined in order to detect that the pathogen has entered the bloodstream. If fever occurs in those affected, cultivated blood cultures can unmask the causative agent.

Therapy

The therapy of furunculosis depends very much on the degree of its expression. For many sufferers, treatment with home remedies, naturopathic preparations and, above all, taking some behavior or precautionary measures is sufficient to cure furunculosis. In severe cases, systemic drug therapy or even surgery may need to be considered.

Home remedies

A boil can heal without medical treatment. In this case, however, those affected must closely monitor the healing process and, if the healing and general condition deteriorate, they must definitely go to the doctor. In general, those affected should refrain from fiddling with the fingers of the boil or even expressing it. In addition to the risk of potential secondary infections from dirty hands, the increased pressure applied from outside can also push the pathogens in the boil into the bloodstream. In the face area in particular, this procedure increases the risk of complications in the form of possible meningitis or blood poisoning.

In order to achieve a faster maturation of the boil and thus promote spontaneous self-emptying, you can instead apply local heat, for example using a red light lamp or warm, moist envelopes. The traction ointment available over the counter in the pharmacy can also accelerate the ripening process and cause the pus to be drawn to the surface of the skin. If severe pain occurs in the area of ​​the boil, additional cooling pads can be used. Here, sufferers have to decide for themselves what gets them better - warming envelopes to promote pus formation or cooling pads to relieve the pain.

If the boil has already opened, the exuding secretion should be carefully dabbed off with a lint-free, clean cloth. Avoid direct manipulation of the wound opening with your fingers. In general, the boil should be exposed to as little environmental impact as possible when it is open. Especially if it is in the facial area, it is advisable to provide it with a clean wound covering during working hours. The herpes patches available in pharmacies and drugstores can be quickly converted for this purpose. Boils that are under the skin should also be treated appropriately to reduce additional irritation from rubbing clothes. A normal wound plaster is usually sufficient here.

In addition, there are many other tips for home remedies for boils.

Hygiene measures

When it comes to cosmetics, skin areas affected by furunculosis should under no circumstances be contaminated with makeup or powder. The cosmetics are usually only a source of further impurities for the skin and hair follicles. Especially for people who attach great importance to their external appearance and who have furunculosis on the face, it is therefore important to devote themselves to the natural appearance of their facial skin gentle care and acceptance.

Aggressive cleaning agents should also be avoided under all circumstances if furunculosis is present. The ingredients of the cosmetics mean a further irritation to the skin tissue and may only fuel an existing inflammation even more. Skin cleaning with bare water, if necessary using special natural care products, is definitely preferable here. There are now very good special products for diabetes-related furunculosis that can also help people with normal hair follicle ignition.

An important additive that everyone concerned should pay attention to when choosing care products is urea, better known as uric acid. The natural substance is considered a secret weapon, which can alleviate even the most serious skin diseases such as neurodermatitis or psoriasis. Urea also works wonders against boils thanks to its anti-inflammatory and antibacterial properties.

Nutritional measures

When it comes to nutrition, it is advisable to avoid high-fat and sugary foods and foods with artificial additives in the case of furunculosis. The products mentioned could adversely affect the sebum secretion and thus worsen the clinical picture. On the other hand, skin-friendly foods are recommended.

These include above all berry fruits, which provide the skin with important antioxidants to fight free radicals. This is because they are responsible for a number of harmful dermal processes, including an impure complexion. In general, fruits and vegetables offer a wonderful opportunity to improve skin protection through vitamins, minerals and trace elements. In the area of ​​minerals, silicon and zinc are particularly important for the skin. You can find them in cabbage and root vegetables such as:

  • Broccoli,
  • Cauliflower,
  • Kale,
  • Brussels sprouts,
  • White cabbage,
  • Red cabbage,
  • radish
  • and radish.

Vitamins that are important for the skin, such as vitamin C and vitamin B, can be found in

  • Carrots,
  • Spinach,
  • Paprika,
  • Currants,
  • Sea buckthorn
  • and rose hips.

In addition to the right choice of food, the right drinking behavior is also important for furunculosis in order to positively influence the natural cleaning and emptying of the skin pores. It should be at least two liters of liquid a day, which are supplied to the body through drinks. Mineral water can also be used as an additional source of minerals. Alternatively, fruit teas from nutritious berries such as sea buckthorn or rose hip are recommended, which contain important skin vitamins. The teas should not be sweetened too much to keep the supply of sugar to the skin as low as possible. You should avoid high-sugar soft drinks and juices.

A good alternative to harmful table sugar as a sweetener is stevia or honey herb.

Naturopathy

In naturopathy you will definitely find what you are looking for in treatment options for furunculosis. In the closed stage, larch turpentine, when applied locally, achieves an effect similar to that of traction ointment. Extracts from chamomile, calendula or arnica can be added to the above-mentioned moist-warm envelopes, since these promote wound healing. Other healing skin herbs for boils are:

  • Ackerhell herb,
  • Arnica,
  • Fenugreek,
  • Nettle,
  • Marshmallow,
  • Marigold,
  • Tea tree
  • and wound clover.

The medicinal plants can be used, for example, as an additive for a healing envelope or for the production of a nourishing cleaning water.

Medical therapy

If furunculosis is very pronounced and frequently recurring or if the affected person belongs to one of the risk groups, antibiotic therapy is often considered for treatment. Mostly penicillin is used for this, in the case of intolerance an antibiotic with the active ingredient clindamycin. It can be applied locally to the affected areas or administered systemically as a tablet or even a solution for infusion. If fever and severe pain occur, pain relievers with antipyretic active components (e.g. ibuprofen, paracetamol, novalgin) are used to treat the symptoms.

Surgical therapy

In some cases, for example if the boil is located in an area that is not favorable for wound healing (armpit area, genital area, anal area), surgical rehabilitation of the boil is also an option. Here, usually in an outpatient procedure, the skin area is generously disinfected and opened under sterile conditions, the wound cavity is peeled and cleaned and then tamped with disinfectant wound dressings. A type of mini-drainage is often inserted, which should facilitate the drainage of further wound secretions. During wound healing, the dressing must be changed regularly in accordance with the manufacturer's specifications and the wound must be cleaned. Post-operative care can be taken over by the family doctor.

More options

The homeopathic preparations Silicea and Myristica, applied internally or externally, can help to accelerate the production of pus and thus the release of toxins. Once the boil has opened, propolis tinctures and Schuessler Salt No. 12 (Calcium sulfuricum) be applied. Both internally and externally through local application to the wound area (not into the wound opening), these two preparations can support wound healing. (ma)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Swell:

  • German Dermatological Society (DDG): S2k + IDA Guideline: Diagnostics and Therapy Staphylococcus aureus-related infections of the skin and mucous membranes, as of April 2011, To the guideline
  • Altmeyer's encyclopedia: furunculosis L02.93 (access: June 24, 2019), enzyklopaedie-dermatologie.de
  • Institute for Quality and Efficiency in Health Care (IQWiG): Boils and carbuncles (accessed: June 24, 2019), gesundheitsinformation.de
  • Robert Koch Institute (RKI): Staphylococcal diseases, especially infections caused by MRSA (accessed: June 24, 2019), rki.de
  • Sterry, Wolfram (ed.): Short Textbook Dermatology, Thieme, 2nd updated edition, 2018
  • Stevens, Dennis L. / Bisno, Alan L. / Chambers, Henry F. / ua: Executive Summary: Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections, Clinical Infectious Diseases, Volume 59, Issue 2, 2014, Executive Summary
  • Merck & Co., Inc .: Boils and Carbuncles (accessed: June 24, 2019), msdmanuals.com
  • Mayo Clinic: Boils and carbuncles (accessed: June 24, 2019), mayoclinic.org

ICD codes for this disease: L02ICD codes are internationally valid encryption codes for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.


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