Carbuncle is an acute inflammation of several adjacent hair follicles with the formation of an extensive necrosis focus in the skin. After the departure of necrotic masses, a deep ulcer forms in place of the carbuncle, in some cases reaching the muscles. In emaciated patients, diabetics and the elderly, the course of the carbuncle can be malignant and complicated by sepsis or bleeding. The treatment shows antibiotic therapy, local use of antiseptics, some types of physiotherapy. When a necrotic focus is formed, surgical treatment is performed.
The carbuncle got its name due to the dark color of the purulent-necrotic masses formed with it. After all, “carbo” means “coal” in Greek. Carbuncles occur at different ages, but most often in young people. At the same time, men get sick about 1.5 times more often than women. About 40% of carbuncle cases occur in the summer.
The causative agent of carbuncle in the vast majority of cases is staphylococcus, sometimes a mixed staphylococcal and streptococcal infection. In some cases, carbuncle can be caused by E. coli, non-clostridial anaerobes, proteus or enterococci. Favorable conditions for infection of hair follicles are created with increased sweating, increased secretion of sebaceous glands, contamination of the skin with dust particles of sand, cement, lime, coal, etc. The pathogen can penetrate through microtrauma and scuffs on the skin. A decrease in the body’s resistance, metabolic disorders in diabetes mellitus and obesity, exhaustion of the body and severe diseases contribute to the appearance of carbuncle.
As a rule, carbuncles are single. They are more often localized on the back of the neck, on the face, between the shoulder blades, on the buttocks and lower back, the skin of the extremities is affected much less often. At the beginning of its development, the carbuncle consists of several dense tubercles-infiltrates, representing separate inflamed hair follicles.
As the inflammation increases, these tubercles merge and form a single hemispherical infiltrate raised above the skin level. It can reach the size of a child’s palm. The skin in the center of the infiltrate has a bluish color and is hot to the touch. The tension of the skin in the infiltrate area gradually increases, which is accompanied by increased soreness. This is the stage of carbuncle maturation, which takes an average of 8-12 days. It is often accompanied by an increase in body temperature (sometimes up to 40 degrees), general weakness, decreased appetite, headache, nausea and vomiting may occur.
The maturation of the carbuncle ends with the formation of several pustules on its surface. Opening, the pustules form holes through which necrotic masses and pus are released. The discharge has a green color and may be mixed with blood. Gradually, more and more carbuncle tissues undergo necrosis and a deep ulcer forms at the site of the infiltration. In some cases, it can reach the muscles. The stage of suppuration and necrosis lasts 14-20 days. The process of carbuncle development ends with the gradual healing of the resulting skin defect. In its place, a rough scar is formed, soldered to the surrounding tissues.
Complications arising from carbuncle are associated with the spread of infection deep into the tissues, along the course of blood vessels and its entry into the blood. They usually develop in weakened patients or in the absence of adequate treatment.
The spread of infection deep into the soft tissues can lead to the formation of a soft tissue abscess or the appearance of phlegmon, infection of the bone leads to the development of osteomyelitis. When the infection passes to the venous vessels, phlebitis and thrombophlebitis develop. Bleeding from the affected vessels is possible. With the involvement of lymphatic vessels and nodes, serous-purulent lymphadenitis, lymphangitis, periadenitis and adenophlegmon may occur. In some cases, there is an attachment of erysipelas.
The most dangerous carbuncles are located on the face. Infection from them can pass to the meninges with the development of purulent meningitis. When carbuncle pathogens enter the blood and spread them throughout the body, sepsis develops, which can lead to death. With the rapid appearance of such serious complications as sepsis, meningitis or bleeding, they talk about the malignant course of the carbuncle.
The specific clinical picture and appearance of the carbuncle, as a rule, do not cause the dermatologist any difficulties in its diagnosis. However, an important diagnostic point is the differential diagnosis of an ordinary carbuncle from a carbuncle in anthrax, which is characterized by the appearance of a black scab in the pustule area. Seeding of the separated carbuncle makes it possible to exclude the presence of anthrax bacillus and determine the sensitivity of the isolated microflora (usually staphylococci) to antibiotics.
Small carbuncles without pronounced intoxication and disorders of general well-being are subject to outpatient treatment. If treatment is started at the stage of carbuncle maturation, then it is carried out by conservative methods and may result in its reverse development with the resorption of the inflammatory infiltrate. The patient is prescribed broad-spectrum antibiotics for oral administration: ampicillin, gentamicin, carbenicillin, etc. In parallel, carbuncle is punctured with antibiotics. Analgesics are used to relieve pain. The surface of the carbuncle is treated with 70% ethyl alcohol, then an aseptic dressing is applied. It is possible to use a syntomycin or streptomycin emulsion.
The transition of the carbuncle to the necrotic stage is an indication for surgical treatment. It is carried out against the background of antibiotic therapy. The operation is performed under local anesthesia. The opening of the carbuncle includes a wide dissection, removal of all necrotic and non-viable tissues. After surgery, a tampon with proteolytic enzymes and a hypertonic sodium chloride solution is injected into the wound. In the postoperative period, for the final rejection of necrotic masses and cleansing of the postoperative wound, a daily change of dressings with a hypertonic solution and proteolytic enzymes is carried out. In some cases, there is a need for additional staged necrectomies. The large area and depth of tissue damage in carbuncle leads to the fact that the postoperative wound heals with the formation of a noticeable and rough scar.
Of the physiotherapeutic methods of treatment at the stage of carbuncle maturation and in the postoperative period, local UVI and UHF therapy are used. If necessary, ultraviolet blood irradiation (UBI) and intravenous laser blood irradiation (ILBI) are carried out to stimulate the body’s defenses. Indications for treatment in the hospital are: severe intoxication, large size of the carbuncle, its localization on the face, the presence of uncompensated diabetes mellitus and other serious diseases in the patient.