Staph Infections: Folliculitis, Furuncles, and Carbuncles (Boils)

Staphylococcus aureus or just plain staph (pronounced like "staff") is the name of the bacteria that causes a variety of problems including the following:

Folliculitis	Definition: red bumps with or without very small collections of pus fluid at the top red bump. These red bumps are always centered around individual hair follicles and can be located anywhere there is hair on the body including the nose, eyelids, genital organs, and anus.
Furuncles	Definition: collections of several hair follicles that are inflamed, red, and infected. Simply stated this is the next step of progression of staph infection from folliculitis where several areas of folliculitis occur close together.
Carbuncles	Definition: collections of many, many infected hair follicles that combine together to form a large skin abscess that is commonly referred to as a boil. Many times these abscesses are mistaken as spider bites even by physicians. There is a tendency for carbuncles to form on near the genitals or near the anus.

All of these staph infections may drain liquid pus or dead white cells mixed with the germ or bacteria. Pus is usually white, brown, or yellow/green, and it may have blood mixed in with it. Most of these infections are due to staph bacteria that is resistant to penicillin and methicillin. Therefore, these staph strains are known as "methicillin resistant Staphylococcus aureus" or MRSA.

Drainage of the liquid yellow material or "pus" is the most important treatment for staph infections. Folliculitis, furunculosis, and carbuncles usually respond to repeated application of warm, moist compresses or soaking/showering which will help to bring them "to a head" or soften, liquefy, and drain on their own. When these staph infections do not drain on their own, drainage may be performed with either a syringe/needle or with some other surgical instrument by a healthcare provider. An antibiotic like sulfamethoxazole (Bactrim, Septra or others,) doxycycline, or cephalexin (Keflex or others) may be necessary at times also. However, the emphasis is not on an antibiotic with staph disease; the correct emphasis should be on drainage (either spontaneous or surgical), wound care, and decontamination which prevents spread of the staph and recurrences.

Recurrent folliculitis, furuncles or boils may be due to auto-infection or a vicious cycle where drainage of the bacteria from one area on the body is spread to another area of the body via touching, clothes, bed linens, or towels. Staph can also be passed easily between persons, and staph can be acquired from animal contact. Healthcare facilities (including clinics and hospitals,) team/contact sports, hot tubs, whirlpools, and gymnasiums have also been implicated.

If recurrent staph infections are a problem for you, it may be well worth your time to try the following hygienic strategies:

1	Bathe, or even better, shower at least twice a day. Studies have clearly shown that showering at least 14 times per week decreases the chances of staph infections. Use an antibacterial soap such as Dial, Safeguard, or any of the green soaps like Irish Spring. Plain soap such as Ivory is also very good. If your skin is excessively dry after using this type of soap, try using a moisturizing soap afterwards or apply a lotion after you bathe or shower. Special antibacterial soaps such as Hibiclens may be used, but they are usually not necessary, and they may be quite expensive. Apply whatever soap you use to your entire body from the top of your head to the bottom of your feet, rinse, and repeat. Make sure you wash the area around your genitals and anus very well. Do not share wash clothes or towels with other people. If you only do one thing to decrease staph problems, showering with lots of soap is the KEY!
2	Wear clothes for one day at a time only. Wash clothes in warm water with detergent (and a small amount of bleach if possible.) Repeated washings, large amounts of bleach, the use of hot water, or the addition of other disinfectants is NOT necessary.
3	Change and wash your bath towel several times per week.
4	Change and wash your bed linens several times per week.
5	Cover all draining wounds with a bandage or dressing, and change the dressing as often as necessary to prevent saturation of the dressing or at least once a day.
6	Wash your hands frequently or use an antibacterial liquid (Purell and others) on your hands several times per day, particularly after you touch your wounds, your bandages, your clothes, your towels, or your bed linens.
7	Avoid shaving while you have staph infections or at least keep shaving to a minimum. Similarly avoid "picking" at scabs, wounds, or skin bumps.
8	If your pet has crusty or oozing wounds, you may need to seek treatment for your pet from a veterinarian.
9	Avoid contact with other persons who do not practice good hygiene and with persons who have folliculitis/furuncles/carbuncles.
10	Wash your hands and take a shower after using public exercise/recreational facilities and after you engage in any contact sports such as football, soccer, rugby, or basketball.
11	Wash your hands and take a shower after all sexual intercourse.
12	Avoid sharing soap or other hygiene products with other people.
13	For best results, everyone in your household should follow these same guidelines. Please make copies of this information sheet and pass it along to friends and family.

Although it is a lot of work, it will probably be necessary to continue these activities until all of your staph infections are completely healed and then for some time.

If despite these strategies, you continue to develop problems with staph infections, special lab tests may need to be done to determine if staph is "colonizing" or hiding on your body especially in the nose or mouth without causing any symptoms there. If so this colonizing condition may be treated under the supervision of your healthcare provider with nasal ointments or other medications. Let your healthcare provider know.

Notify your healthcare provider or go to an emergency department if your immune system is impaired (HIV/AIDS, cancer, liver disease, etc.,) if you have fever over 100.5 degrees, shaking chills, severe pain, involvement of the head or neck, involvement of the area between the genital organs and rectum, rapidly enlarging abscesses, involvement of multiple areas at the same time, or involvement of an area greater than 4-6 inches in diameter.