Definition. An acute circumscribed inflammation of a cutaneous gland of hair- follicle, characterized by nodular infiltration and followed by suppuration, necrosis, discharge and a resulting scar.
Furunculosis is a condition in which boils appear singly or in crops for a varying period of weeks, months or even years.
Symptoms. The initial lesion appears as a reddish point or papule generally pierced by a rudimentary hair and accompanied by some slight itching or burning. Slight induration can be felt which, in a day or two, becomes nodular and elevated and the center is marked by a small vesicle or pustule often surrounded by a red areola. If the process is arrested at this stage, the pustule dries up and resolution takes place in the nodular mass (blind boil). Ordinarily, the process increases in intensity, extends until the nodule becomes pea to cherry sized, well imbedded in or under the skin and projecting more or less above the surface, and the area of redness enlarges and assumes a dark reddish or purplish color. The parts affected and the surrounding skin become sensitive to pressure, and heat, throbbing and tension are frequently felt of a painful degree. A few drops of blood and pus escape if the central pustule is prematurely opened but, if left to itself, at the end of a week spontaneous rupture occurs followed by a free discharge of pus, leaving a ragged opening in the skin and exposing beneath the central necrotic mass called the core. This is firmly attached at first but after a few days becomes loosened by a further necrosis; then is expelled spontaneously or can be easily removed. the core may be entirely absent and a free discharge of pus completes the evolution of the furuncle. Either form of evacuation give an equal amount of relief. Healing is by granulation as the drainage is completed and the skin presents a purplish or violaceous color which fades away in a few weeks or months, leaving a small permanent scar.
Boils may occur in any part of the body but they are more commonly located on the back of the neck, face, buttocks, axillae and less often on the forearms and legs. Neighboring lymphatic glands are often swollen and in chronic furunculus constitutional symptoms such as anemia, pyrexia, nervous depression, loss of appetite and rarely cachexia may appear. The duration of a single furuncle will vary from one to four weeks although the process may be completed in a shorter period; while the duration of an attack is equally elastic, often persisting for months, depending upon the number and variety of the lesions.
Etiology and Pathology. The infection of the skin with pyogenic bacteria, frequently the staphylococcus aureus, is the exciting cause. It is the well to remember that this germ and similar ones are found upon normal skin, so there must be some condition predisposing to the furuncular state, such as the lithemic, neurasthenic, anemic, diabetic or septicemic. Furuncles may occur with or after chronic dental abscesses, iodid dosing, miliaria, eczema, scabies, pediculosis and variola. Cooperating with these systemic abnormalities may be any one of the numerous local agents which may inflict injury on the skin such as excoriations rom the itching dermatoses, continued friction, pressure, occupations which necessitate the handling of irritating or poisonous substances such as may happen to dyers, tanners, butchers, etc., vesicant application, poultices and ointments which separated and soften the epidermis and open the follicles. It is possible for any of these agents to cause boils without the presence of predisposing factors. Both sexes and all ages may be affected, but males between twenty and forty years of age are most liable.
The pathological conditions are not peculiar to this disease except in the seat of the process. It usually develops i or about a hairfollicle, oil or sweat gland. Unna maintains that most furuncles begin as a follicular impetigo which meets with such resistance outwardly from the horny layer of from rapid pus formation as to force an extension downward until it penetrates beneath the epidermis, or the cocci penetrate deeper into a lanugo hair-follicle which runs through the pustule. Whatever the mode of entrance, the soil being favourable, a suppurative perifolliculitis and folliculitis is established.
Diagnosis is usually made by the patient. The location of suppurating buboes and their antecedent history should make the diagnosis easy. Acne varioliformis begins by the formation of one or more painless, subcutaneous, shot-like papules which slowly reach their acme and exhibit only slight inflammation, elevation and tenderness. A carbuncle would only be mistaken for a furuncle in its early stage because the more extensive infiltration and the appearance of multiple points in its latter development, are characteristic.
Prognosis. The single uncomplicated furuncle should run a short course under proper treatment. As a complication or sequele of other affections, the process would relate chiefly to the primary disease. The possibility of the removal of the cause of furunculosis determines the element of rapid recovery.
Treatment. As every furuncle may be a possible source of further infection and is likely to produce a permanent scarring, the object of local treatment is to minimize the chance of infection and the degree of scarring. When the eruption appears to be due to the general condition of the patient, anything that will establish a more physiological existence is to be employed whether it affects the diet, clothing, exercise or any other mode of living. It is in this particular that the causal treatment plays such an important part. From their inception furuncles should be carefully protected from further irritation, any central hair should be extracted, and iodin tincture or guaiacol applied on or about the lesion. After this application dries, some antiseptic powder like aristol or boric acid may applied. On the first appearance of suppuration, the boil should be incised, the contents evacuated, thoroughly cleansed with hot boric acid, hydrogen dioxid, or mercuric chlorid solution (1:4000) and iodex ointment applied.
A most effective method in most cases is the continuous application of 2 to 6 per cent. solution of creolin in glycerin, applied on several layers of gauze, or in conspicuous locations it can be applied only at night, and an antiseptic powder dusted on the lesions during the day. Even rubbing the solution on or about a furuncle four or five times during a day tends to arrest its development. Poulticing, early incision and the injection or application of such abortive substances as carbolic acid or nitrate of silver cannot be recommended for the average case. Squeezing or forcible pressing of the lesions and he surrounding tissue should never be allowed. Localized furuncles can often be successfully treated with the X-ray. The technique is the same as given under the treatment of acne. The opsonic treatment, consisting of injection of sterilized emulsions of organisms (usually staphylococci) cultivated from he lesions, has given splendid results and, although by no means a panacea, should be carefully considered in all persistent cases.
For internal medication see Anthrac., Apis, Arnica, Belladonna, Calcarea sulph., Crotal., Hepar, Kali brom., Ledum, Lycopodium, Nat. mur., Phosphorus acid, Phyto., Pic. acid, Rhus, Secale, Silicea, Sul., Vespa, Vipera.