Carbuncle

# Overview
A carbuncle is an abscess, larger than a boil, usually with one or more openings draining pus onto the skin. It is usually caused by bacterial infection.

# Pathophysiology
Carbuncles may develop anywhere, but they are most common on the back and the nape of the neck. Men get carbuncles more often than women. Because the condition is contagious, family members may develop carbuncles at the same time. Often, the direct cause of a carbuncle cannot be determined. Things that make carbuncle infections more likely include friction from clothing or shaving, generally poor hygiene and weakening of immunity. For example, persons with diabetes and immune system diseases are more likely to develop staphylococcal infections.

# Causes
Most carbuncles are caused by the bacteria staphylococcus aureus. The infection is contagious and may spread to other areas of the body or other people.

# Natural History, Complications and Prognosis
Carbuncles may heal on their own. Others usually respond well to treatment. However, a carbuncle can return again and again for months or years following the first infection. Call a doctor if a carbuncle does not heal with home treatment within 2 weeks or is located on the face, neck or spine. The same if you have a fever or a lot of swelling around the carbuncle, or pain that gets worse. Also consult a professional if carbuncles come back often.

# Diagnosis

## Physical Examination
A carbuncle is made up of several skin boils. The infected mass is filled with fluid, pus, and dead tissue. Fluid may drain out of the carbuncle, but sometimes the mass is so deep that it cannot drain on its own.
The carbuncle may be the size of a pea or as large as a golf ball. It may be red and irritated and might hurt when you touch it. It may also grow very fast and have a white or yellow center. It may crust or spread to other skin areas. Sometimes, other symptoms may occur. These may include fatigue, fever and general discomfort or a sick feeling. Sometimes an itchy sensation occurs before the carbuncle develops.

# Treatment
Carbuncles usually must drain before they will heal. This most often occurs on its own in less than 2 weeks. Placing a warm moist cloth on the carbuncle helps it to drain, which speeds healing. The affected area should be soaked with a warm, moist cloth several times each day. The carbuncle should not be squeezed, or cut open without medical supervision, as this can spread and worsen the infection.
Treatment is needed if the carbuncle lasts longer than 2 weeks, returns frequently, is located on the spine or the middle of the face, or occurs along with a fever or other symptoms. Treatment helps reduce complications related to an infection. A doctor may prescribe antibacterial soaps and antibiotics applied to the skin or taken by mouth. Deep or large lesions may need to be drained by a health professional.
Proper hygiene is very important to prevent the spread of infection. Hands should always be washed thoroughly after touching a carbuncle. Washcloths and towels should not be shared or reused.  Clothing, washcloths, towels, and sheets or other items that contact infected areas should be washed in very hot (preferably boiling) water. Bandages should be changed frequently and thrown away in a tightly-closed bag.

## Medical Therapy
- Carbuncle
- Mild
- Preferred treatment: Incision and Drainage
- Moderate
- Empiric treatment: TMP-SMX OR Doxycycline
- Culture directed treatment
- MSSA: TMP-SMX
- MRSA: Dicloxacillin OR Cephalexin
- Severe
- Empiric treatment: Vancomycin OR Daptomycin OR Linezolid OR Televancin OR Ceftaroline
- Culture directed treatment
- MSSA: Nafcillin OR Cefazolin OR Clindamycin
- MRSA: Vancomycin OR Daptomycin OR Linezolid OR Televancin OR Ceftaroline