Skip to main content

What is a Carbuncle ?


A carbuncle is an infective gangrenous condition affecting the subcutaneous tissue.

The infective agent is staphylococcus aureus.

Etiology

A carbuncle commonly occurs in diabetic patients, patients with reduced immunity like those undergoing radiotherapy or on a prolonged course of corticosteroids.

The common sites of occurrence of a carbuncle are the nape of the neck, followed by the back and then the shoulders. This is because the skin in these regions is coarse and has poor vascularity.

Pathology

The pathology of a carbuncle is similar to that of a boil (furuncle).
Infection of the hair follicle by staphylococci produces inflammation of the follicle and the surrounding area which is termed as perifolliculitis.
Since the patients are mostly diabetics or immunocompromised individuals, the infection spreads locally in the surrounding skin involving a larger area in a short while.
As the condition progresses, necrosis of the subcutaneous tissue and fat occurs.
This necrosis leads to the formation of pus under the surface of the skin producing abscesses.
These abscesses are multiple, intercommunicating and open to the exterior through multiple openings in the skin.
This produces a characteristic appearance known as a ‘cribriform’ appearance which is pathognomonic of a carbuncle.

Clinical features

  • Generally the patient is a diabetic or an immunocompromised individual.
  • The affected portion of the skin appears red, irritated and angry looking like red hot coal.
  • The surrounding area is indurated.
  • There is severe pain, swelling and extreme tenderness at the site.
  • Systemic symptoms like fever with chills and rigors are present and severe in nature.
  • In the later stages, the skin over the carbuncle softens and satellite vesicles appear peripherally which rupture discharging pus and giving rise to the characteristic cribriform appearance.
  • The end result is the development of a large crateriform ulcer with central sloughing.


Complications

  • In case of diabetic patients, the carbuncle may precipitate diabetic ketoacidosis.
  • The carbuncle may involve extensive necrosis of the skin and subcutaneous tissue. Hence it is included under acute infective gangrenous conditions.
  • Septicemia and toxemia –Septicemia may occur due to dissemination of infection through the blood, while toxemia occurs due to release of exotoxins produced by the bacteria, into the blood.


Treatment

  •  In case of diabetic patients, the diabetes is to be managed appropriately with the help of injectable insulin.
  • Antibiotics – Appropriate antibiotics are given parentrally till complete resolution occurs. Cloxacillin, flucoxacillin, erythromycin and cephalosporins are the drugs of choice.
  • In case of infection by Methicillin resistant Staphylococcus aureus (MRSA) where the organisms are resistant to the above mentioned drugs, vancomycin is used which is given intravenously.
  • The general health of the patient is improved with a balanced diet and adequate rest.
  • Saline dressings can be done if the cabuncle does not show softening or if it shows signs of healing. This helps relieve the edema. Alternatively, it may also be left open to the exterior if required. Complete resolution occurs within 10-15 days.
  • Surgery is the mainstay of treatment in cases where pus has developed.
    The procedure is as follows -
    A cruciate incision is preferred as this exposes the multiple sinuses and extensive necrosis the best.
    The edges of the skin flap are excised.
    Pus is drained.
    The loculi are broken down.
    Slough is carefully excised
    The cavity is irrigated with antiseptic agents.
    This facilitates wound healing as granulation tissue is formed from the depth once the necrotic slough and the pus have been removed.

Comments

Post a Comment

Popular posts from this blog

What is Cellulitis ?

Cellulitis is a diffuse inflammation of the dermal and subcutaneous layers of the skin caused by haemolytic streptococcus. Pathology Cellulitis occurs when the dermal and subcutaneous layers of the skin get infected by hemolytic streptococcus. The streptococci infect and colonize the subcutaneous layer of the skin. These streptococci produce lytic enzymes like hyaluronidase and streptokinase which breakdown the connective tissue in the subcutaneous layer of the skin. This leads to quick and diffuse spread of the inflammation over a large area. In case of cellulitis affecting areas of the body with loose skin and subcutaneous tissue like in the face, forearm or scrotum, the inflammation spreads fast. Exudation occurs as a result of this inflammation. This exudate spreads in the subcutaneous and facial layers resulting in gross swelling of the affected part. Etiology Cellulitis occurs when streptococci infect wounds in the skin. This can occur in cases of inj...
Post a Comment
Read more

What is a Colostomy ?

A colostomy is a surgical procedure which involves opening of the colon to the exterior for the drainage of faecal matter. A colostomy may be temporary or permanent. When is a Colostomy required ? A colostomy is indicated in the following conditions- Congenital conditions In cases of Hirschsprung’s disease or anorectal anomalies, a temporary colostomy is done. Carcinoma In case of rectal carcinomas where an abdomino-peritoneal resection is performed, a permanent end-sigmoid colostomy is done following the procedure. Colonic fistulae Fistulas of the colon occurring as a consequence of diverticulitis, Crohn’s disease or due to tuberculosis, requie a colostomy during their management. Colonic injuries Trauma to the colon due to stab wounds or injuries during an operative procedure like nephrectomy or a percutaneous nephrolithotomy, leads to colonic injuries which require a period of rest to heal. A colostomy is hence performed during the management. Typ...
Post a Comment
Read more

Cancer and the Environment

Cancer is caused by the uncontrolled growth and spread of abnormal cells that may affect almost any tissue of the body. Lungs, colon, rectal and stomach cancer are among the five most common cancer in the world for both men and women. Among men, lung and stomach cancer are the most common cancers worldwide. For women, the most common cancers are breast and cervical cancer. In India, oral and pharyngeal cancers form the most common type of cancers, which are related to tobacco chewing. More than 10 million people are diagnosed with cancer on the world every year. It is estimated that there will be 15 million new cases every year or 12% of the deaths worldwide. The causes of several cancers are known. Thus, the prevention of at least one third of all cancers is possible. Cancer is preventable by stopping smoking, providing healthy food and avoiding exposure to cancer causing agents (carcinogens). Early detection and effective treatment is possible for a further one third of ca...
Post a Comment
Read more