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Bacterial Infections of the Skin - Impetigo, Folliculitis, and AIDS

Furuncles and Carbuncles

A furuncle, or boil, is an acute perifollicular staphylococcal abscess of the skin and subcutaneous tissue. Lesions appear as an indurated, dull, red nodule with a central purulent core, usually beginning around a hair follicle or a sebaceous gland. Furuncles occur most commonly on the nape, face, buttocks, thighs, perineum, breast, and

A carbuncle is a coalescence of interconnected furuncles that drain through a number of points on the

The most common cause of furuncles and carbuncles is coagulase-positive S aureus. Cultures should be obtained from all

Treatment of Furuncles and Carbuncles

Warm compresses and cleansing.

Dicloxacillin (Pathocil) 500 mg PO qid for 2 weeks.

Manipulation and surgical incision of skin infections, cellulitis, superficial folliculitis, impetigo early lesions should be avoided, because these maneuvers may cause local or systemic skin infections, cellulitis, superficial folliculitis, impetigo extension. However, when the lesions begin to suppurate and become fluctuant, drainage may skin infections, cellulitis, superficial folliculitis, impetigo be performed by "nicking" the lesion with a

Draining lesions should be covered with skin infections, cellulitis, superficial folliculitis, impetigo topical Skin Infections Skin Infections antibiotics and loose infantigo infintigo, infentigo

Superficial Folliculitis    Impetigo

Superficial folliculitis is characterized by small dome-shaped pustules at the ostium of hair follicles. It is caused by

Multiple or single lesions appear on the scalp, back, and extremities. In children, the scalp is the

Gram stain and bacterial culture supports

Treatment. Local cleansing and erythromycin 2% solution applied topically bid to


Impetigo consists of small superficial vesicles, which eventually formpustules and develop a honey-colored crust. A halo of erythema often surrounds the

Impetigo occurs most commonly on exposed surfaces such as the extremities and face, where minor trauma, insect bites, contact dermatitis, or abrasions may have occurred.

Gram stain of an early lesion or the base of a crust often reveals gram-positive cocci. Bacterial culture yields S aureus, group A beta-hemolytic streptococci, or both.

Treatment of Impetigo

A combination of systemic and topical therapy is recommended for moderate to severe cases of impetigo for a 7- to 10-day course:

Dicloxacillin 250-500 mg PO qid. Dicloxacillin should be the initial treatment because erythromycin-resistant strains of S aureus are prevalent.

Cephalexin (Keflex) 500 mg PO qid.

Erythromycin 250-500 mg PO qid is used in penicillin allergic patients.

Mupirocin (Bactroban): Highly effective against staphylococci and Streptococcus pyogenes. Applied bid-tid for 2-3 weeks or until 1 week after lesions heal. Bacitracin (neomycin, polymyxin B) ointment tid may also be used.


Acute glomerulonephritis is a serious complication of impetigo, with an incidence of 2-5%. It is most commonly seen in children under the age of 6 years old. Treatment of impetigo does not alter the risk of acute glomerulonephritis.

Rheumatic fever has not been reported after impetigo.


Cellulitis is a diffuse suppurative bacterial inflammation of the subcutaneous tissue. It is characterized by localized erythema, warmth, and tenderness. Cutaneous erythema is poorly demarcated from uninvolved skin. Cellulitis may be accompanied by malaise, fever, and chills.

The most common causes are beta-hemolytic streptococcal and S aureus. Complications include gangrene, metastatic abscesses, and sepsis.


Dicloxacillin or cephalexin provide adequate coverage for either streptococci and staphylococci. Penicillin may be added to in