Furuncles, or boils, represent a progression of bacterial folliculitis. An abscess extends out from an infected follicle, forming a painful, red, firm nodule. Carbuncles are conglomerations of coalescing furuncles. Systemic symptoms may occur with carbuncles but not furuncles. S. aureus is the most common pathogen, but anatomically localized microflorae also play a role. For example, perianal abscesses can be caused by fecal flora and head-neck abscess may be due to anaerobes.

Furuncles and carbuncles are self-limited. With time, the lesions become fluctuant and will either point to the surface and open or be reabsorbed. Warm compresses are the mainstay of treatment. Topical antibiotics are of no use. Systemic antistaphylococcal antibiotics can be helpful in early cases before furuncles have pointed. Many clinicians reserve antibiotics for carbuncles or for patients with fever or secondary cellulitis. Once lesions have pointed and become fluctuant, incision and drainage hastens recovery. It is harmful to incise deeper lesions. Patients with recurrent furuncles or carbuncles can be treated to eradicate S. aureus carriage. This can be accomplished with nasal mupirocin ointment for 5 days or oral penicillinase-resistant penicillin for 14 days.

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