Definition

A carbuncle is an infection of the skin that affects a cluster of hair follicles, the skin around them, and the deeper tissues beneath the surface. Under the skin's surface, a group of related furuncles (infection of hair follicles) assemble to create a carbuncle. An abscess or collection of pus beneath the skin is indicative of a furuncle.

Carbuncles are most frequently seen on hairy parts of the body, such as the back, legs, and nape of the neck, but they can also be found in body areas with thick skin. Nevertheless, carbuncles can also develop in other body parts like the armpits, vaginal area, thighs, buttocks, and thigh folds.

Carbuncles look like swollen lumps that resemble inflamed masses and frequently contain pus. Carbuncles are predominantly present in adults and infrequently in children. Carbuncles are more common in men than in women.

Causes

Carbuncles are typically the result of a bacterial infection caused by Staphylococcus aureus that resides on the skin, throat, and nasal passages. This bacteria can sometimes be resistant or untreatable to methicillin antibiotics, leading to the development of MRSA (Methicillin-resistant Staphylococcus aureus). If the carbuncle is caused by MRSA, the required antibiotic therapy will be more targeted. Recurrent carbuncles affecting the vaginal area and anus may be caused by different microorganisms.

Bacteria that cause infections can enter the skin through hair follicles, small scratches, puncture marks, and other tiny lesions, often not visible to the naked eye. The infection might spread if the individual scrapes the lesions and touches other parts of the body. Fluid, pus, and dead tissue accumulate in the affected area. An active, inflammatory carbuncle is contagious, and other family members living in the same space might simultaneously develop carbuncles.

Risk factor

Factors that could elevate the likelihood of developing a carbuncle include:

• Old age
• Obesity
• Poor personal hygiene
• Poor overall health 
• A chronic skin disorder that impairs the skin's protective barrier
• Diabetes
• Kidney disease
• Alcohol consumption can lead to liver damage and liver disease
• Anemia (a condition characterized by a deficiency of red blood cells in the body)
• Individuals with compromised immune systems, such as those with HIV/AIDS or undergoing immunosuppressive treatments (e.g., cancer chemotherapy or post-organ transplant patient)

Carbuncles can impact healthy young individuals, particularly those residing in crowded environments like dorms and sharing personal goods such as bed linens, towels, and clothes. Carbuncles can develop due to skin irritation and friction caused by wearing tight clothes, shaving, or insect bites, particularly in body parts that perspire heavily.

Symptoms

Carbuncles can originate from folliculitis, which, if not treated, can progress into a furuncle. A group of contiguous furuncles is referred to as a carbuncle.

A carbuncle typically begins as a red, pimple-like protrusion that gradually increases in size and causes pain. Pus will arise from a mixture of germs, dead skin cells, red blood cells, and white blood cells. Several yellowish-white pustules will be present on the carbuncle's surface, gradually oozing fluid. Within a short while, the carbuncle typically ruptures and discharges a hazy white or pinkish liquid known as pus. Occasionally, the lump develops deep under the skin, preventing the pus from naturally draining out. Complete drainage of the pus is necessary for the carbuncle to heal. After the pus discharge drains, a scab-like crust will develop on the surface.

Carbuncles situated more superficially with an opening on the skin's surface are less likely to leave scars than those lying deeper. Additional symptoms of carbuncles include fever, tiredness, and weakness. Edema of the adjacent tissues and lymph nodes, particularly in the neck, armpits, and groin, may also occur.

Diagnosis

The diagnosis of carbuncles is usually based on patient symptoms and signs found from physical examinations performed by a doctor. Usually, lumps have appeared for several days to several weeks. They look like they are about to burst and are getting bigger and more painful. Laboratory tests are rarely requested but could be done to grow the bacteria in the carbuncle pus. This procedure determines the type of bacteria that infects so that patients can be treated with the right antibiotics.

Management

Medical therapy is necessary for carbuncles to prevent complications, speed up healing, and reduce scarring. The doctor will drain the pus from the carbuncle and treat the scar with a sterile solution, typically performed under local anesthetic. After cleaning the lesion, it will typically be covered with a specific gauze to remove any remaining pus, which will be taken out within the next 1-2 days.

The doctor will prescribe antibiotics to the patient. The prescribed antibiotics can be pills or topical creams and ointments. Carbuncles often heal within 2-3 weeks after receiving medical treatment, depending on the seriousness of the symptoms. The doctor may prescribe painkillers like acetaminophen and ibuprofen to alleviate the pain.

Due to the contagious nature of carbuncles, it is crucial to maintain good personal hygiene. Home remedies for treating carbuncles include:

• Do not compress or irritate the carbuncle as this can heighten the chances of infection, significant scarring, and further issues
• Cleaning the carbuncle and applying a sterile bandage helps accelerate pus drainage and healing, as well as inhibit the spread of infection
• After contacting the carbuncle, wash your hands and also launder clothes, bed linen, and towels that have been in contact with the carbuncle. Avoid sharing personal belongings with others
• Applying warm compresses can accelerate the process of pus drainage and promote the healing of carbuncles

To apply a compress to the carbuncle, immerse it in warm water or apply a clean, warm, damp towel to it for 20 minutes. The compress can be applied 3 to 4 times daily. To treat the carbuncle, you can also cover it with a clean, dry towel and use a heat pad or hot water bottle for 20 minutes, 3 to 4 times daily. After each usage, the fabric should be washed with hot water and dried at a high temperature.

Complications

Complications may arise if germs that cause carbuncle enter the bloodstream and cause sepsis, a serious illness considered as a medical emergency that can result in multiple organ failure. Untreated sepsis can be fatal. Signs of sepsis include elevated body temperature, shivering, fast heart rate, and altered mental status. The infection might also spread to other regions of the body.

Prevention

Good hygiene practices can lower the likelihood of getting carbuncles, these are the examples:

• Handwashing before meals and after using the restroom
• Showering frequently
• Avoid squeezing pimples or touching skin lesions
• Regularly launder clothes, bed linens, and towels in hot water

When to See a Doctor?

If you have a warm, tender skin lump discharging pus, it is recommended that you seek medical advice. Adhere to the doctor's treatment suggestions to prevent the carbuncle from recurring in the future.

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