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Skin abscesses, furuncles, and carbuncles

Larry M Baddour, MD, FIDSA
Section Editors
Daniel J Sexton, MD
Morven S Edwards, MD
Deputy Editor
Elinor L Baron, MD, DTMH


Skin abscesses are collections of pus within the dermis and deeper skin tissues. A furuncle (or "boil") is an infection of the hair follicle in which purulent material extends through the dermis into the subcutaneous tissue, where a small abscess forms. A carbuncle is a coalescence of several inflamed follicles into a single inflammatory mass with purulent drainage from multiple follicles (picture 1) [1].

Most abscesses are caused by infection. However, sterile abscesses can occur in the setting of injected irritants. Examples include injected drugs (particularly oil-based ones) that may not be fully absorbed and so remain at the site of injection, causing local irritation. Sterile abscesses can turn into hard, solid lesions as they scar.

The epidemiology, clinical manifestations, microbiology, and treatment of skin abscesses, furuncles, and carbuncles due to infection will be reviewed here. Issues related to dental, breast, vulvovaginal, and perianal abscesses are discussed separately. (See "Complications, diagnosis, and treatment of odontogenic infections" and "Primary breast abscess" and "Perianal abscess: Clinical manifestations, diagnosis, treatment" and "Bartholin gland masses: Diagnosis and management".)


Skin abscesses, furuncles, and carbuncles can develop in healthy individuals with no predisposing conditions other than skin or nasal carriage of Staphylococcus aureus; spontaneous infection due to community-acquired methicillin-resistant S. aureus (CA-MRSA) may occur with greater frequency than abscesses due to other pathogens [2]. Rectal colonization of S. aureus, including CA-MRSA of the USA300 clone, was strongly associated with skin abscess formation in one pediatric investigation [3].

Individuals in close contact with others who have active infection with skin abscesses, furuncles, and carbuncles are at increased risk [4,5]. Individuals exposed to whirlpool footbaths at nail salons are at risk for mycobacterial furunculosis [6,7]. Additional risk factors include diabetes mellitus and immunologic abnormalities [6,8]. (See "Approach to the adult with recurrent infections" and "Approach to the child with recurrent infections" and "Methicillin-resistant Staphylococcus aureus (MRSA) in adults: Epidemiology" and "Methicillin-resistant Staphylococcus aureus infections in children: Epidemiology and clinical spectrum", section on 'Epidemiology and risk factors'.)


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Literature review current through: Dec 2016. | This topic last updated: Thu Jun 30 00:00:00 GMT+00:00 2016.
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  1. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. Clin Infect Dis 2014; 59:147.
  2. Singer AJ, Talan DA. Management of skin abscesses in the era of methicillin-resistant Staphylococcus aureus. N Engl J Med 2014; 370:1039.
  3. Faden H, Lesse AJ, Trask J, et al. Importance of colonization site in the current epidemic of staphylococcal skin abscesses. Pediatrics 2010; 125:e618.
  4. Sosin DM, Gunn RA, Ford WL, Skaggs JW. An outbreak of furunculosis among high school athletes. Am J Sports Med 1989; 17:828.
  5. Zimakoff J, Rosdahl VT, Petersen W, Scheibel J. Recurrent staphylococcal furunculosis in families. Scand J Infect Dis 1988; 20:403.
  6. Gira AK, Reisenauer AH, Hammock L, et al. Furunculosis due to Mycobacterium mageritense associated with footbaths at a nail salon. J Clin Microbiol 2004; 42:1813.
  7. Vugia DJ, Jang Y, Zizek C, et al. Mycobacteria in nail salon whirlpool footbaths, California. Emerg Infect Dis 2005; 11:616.
  8. Kars M, van Dijk H, Salimans MM, et al. Association of furunculosis and familial deficiency of mannose-binding lectin. Eur J Clin Invest 2005; 35:531.
  9. Gordon RJ, Lowy FD. Bacterial infections in drug users. N Engl J Med 2005; 353:1945.
  10. Binswanger IA, Kral AH, Bluthenthal RN, et al. High prevalence of abscesses and cellulitis among community-recruited injection drug users in San Francisco. Clin Infect Dis 2000; 30:579.
  11. Begier EM, Frenette K, Barrett NL, et al. A high-morbidity outbreak of methicillin-resistant Staphylococcus aureus among players on a college football team, facilitated by cosmetic body shaving and turf burns. Clin Infect Dis 2004; 39:1446.
  12. Summanen PH, Talan DA, Strong C, et al. Bacteriology of skin and soft-tissue infections: comparison of infections in intravenous drug users and individuals with no history of intravenous drug use. Clin Infect Dis 1995; 20 Suppl 2:S279.
  13. Squire BT, Fox JC, Anderson C. ABSCESS: applied bedside sonography for convenient evaluation of superficial soft tissue infections. Acad Emerg Med 2005; 12:601.
  14. Meislin HW, Lerner SA, Graves MH, et al. Cutaneous abscesses. Anaerobic and aerobic bacteriology and outpatient management. Ann Intern Med 1977; 87:145.
  15. Ghoneim AT, McGoldrick J, Blick PW, et al. Aerobic and anaerobic bacteriology of subcutaneous abscesses. Br J Surg 1981; 68:498.
  16. Brook I, Frazier EH. Aerobic and anaerobic bacteriology of wounds and cutaneous abscesses. Arch Surg 1990; 125:1445.
  17. Rajendran PM, Young D, Maurer T, et al. Randomized, double-blind, placebo-controlled trial of cephalexin for treatment of uncomplicated skin abscesses in a population at risk for community-acquired methicillin-resistant Staphylococcus aureus infection. Antimicrob Agents Chemother 2007; 51:4044.
  18. Ruhe JJ, Smith N, Bradsher RW, Menon A. Community-onset methicillin-resistant Staphylococcus aureus skin and soft-tissue infections: impact of antimicrobial therapy on outcome. Clin Infect Dis 2007; 44:777.
  19. Moran GJ, Krishnadasan A, Gorwitz RJ, et al. Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med 2006; 355:666.
  20. Demos M, McLeod MP, Nouri K. Recurrent furunculosis: a review of the literature. Br J Dermatol 2012; 167:725.
  21. Naimi TS, LeDell KH, Como-Sabetti K, et al. Comparison of community- and health care-associated methicillin-resistant Staphylococcus aureus infection. JAMA 2003; 290:2976.
  22. Baggett HC, Hennessy TW, Rudolph K, et al. Community-onset methicillin-resistant Staphylococcus aureus associated with antibiotic use and the cytotoxin Panton-Valentine leukocidin during a furunculosis outbreak in rural Alaska. J Infect Dis 2004; 189:1565.
  23. Fridkin SK, Hageman JC, Morrison M, et al. Methicillin-resistant Staphylococcus aureus disease in three communities. N Engl J Med 2005; 352:1436.
  24. Miller LG, Quan C, Shay A, et al. A prospective investigation of outcomes after hospital discharge for endemic, community-acquired methicillin-resistant and -susceptible Staphylococcus aureus skin infection. Clin Infect Dis 2007; 44:483.
  25. Bobrow BJ, Pollack CV Jr, Gamble S, Seligson RA. Incision and drainage of cutaneous abscesses is not associated with bacteremia in afebrile adults. Ann Emerg Med 1997; 29:404.
  26. Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 2007; 116:1736.
  27. Gorwitz RJ. The role of ancillary antimicrobial therapy for treatment of uncomplicated skin infections in the era of community-associated methicillin-resistant Staphylococcus aureus. Clin Infect Dis 2007; 44:785.
  28. Liu C, Bayer A, Cosgrove SE, et al. Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis 2011; 52:e18.
  29. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis 2014; 59:e10.
  30. Talan DA, Mower WR, Krishnadasan A, et al. Trimethoprim-Sulfamethoxazole versus Placebo for Uncomplicated Skin Abscess. N Engl J Med 2016; 374:823.
  31. Duong M, Markwell S, Peter J, Barenkamp S. Randomized, controlled trial of antibiotics in the management of community-acquired skin abscesses in the pediatric patient. Ann Emerg Med 2010; 55:401.
  32. Schmitz GR, Bruner D, Pitotti R, et al. Randomized controlled trial of trimethoprim-sulfamethoxazole for uncomplicated skin abscesses in patients at risk for community-associated methicillin-resistant Staphylococcus aureus infection. Ann Emerg Med 2010; 56:283.
  33. Spellberg B, Boucher H, Bradley J, et al. To treat or not to treat: adjunctive antibiotics for uncomplicated abscesses. Ann Emerg Med 2011; 57:183.
  34. Duong M, Markwell S, Peter J, Barenkamp S. Randomized, controlled trial of antibiotics in the management of community-acquired skin abscesses in the pediatric patient. Ann Emerg Med 2010; 55:401.