Doc: Staph skin infection: from carbuncle to furuncle
Dear Dr. Roach: I’ve been having trouble with boils for a couple of years. Last year, my doctor told me that it was a staph infection. After about a week on the antibiotics he prescribed, I started to develop an allergic reaction: a rash all over my body. I was told by a local clinic to discontinue what I was taking; they gave me a different antibiotic. Again, a few days later, the same reaction happened, so my mom told me to stop taking it. I’m a teenager, and my mom hasn’t done anything else about it except to suggest that I soak in the tub and keep the area dry. While sometimes it helps, it never completely gets rid of it.
I try to shave the area or at least trim the area, and I shower daily. The boils appeared before I began shaving it, and even when I started shaving they still appeared. I had used an antibacterial ointment, but my mom said that it’d be too oily and wouldn’t help, so I haven’t used it since. I usually just clean it and pat it with a cloth with peroxide on it and place a bandage over it.
I’d appreciate any suggestions — things that I could do or bring up if I get it checked again.
Dear C.F.: There are several types of skin infections, and if that’s what you have, yours may have started off as folliculitis, an infection of the hair follicle. It’s most commonly infected by Staphylococcus aureus, the well-known cause of various “staph” infections. Several infected follicles can coalesce together to form a carbuncle. Also, an infection of the hair follicle can extend deeper into the skin, becoming a furuncle (boil).
For mild cases, the infection can be treated locally, with warm compresses and topical antibiotics. (Tell Mom to get a cream, not an oily ointment.) I prefer using mupirocin, a prescription topical antibiotic that is effective against even most resistant strains, such as MRSA (methicillin-resistant Staphylococcus aureus). I don’t normally prescribe oral antibiotics, as they usually aren’t necessary and can cause problems (such as your allergic reaction). However, very deep infections may need to be drained by your doctor or sometimes even by a surgeon.
Shaving can create breaks in the skin that allow the Staphylococci that normally live on the skin to enter and cause infection. This is very common in younger people who shave, especially in the groin, but also the axillae (armpits). If you shave, use a new razor every time and an astringent to protect your skin after shaving. Or just trim the hair. You shouldn’t shave when the skin is irritated or infected. You also should avoid hydrogen peroxide — it is too harsh to use on any kind of open wound.
However, you have had this problem for years, which would make me consider the diagnosis of hidradenitis suppurativa, which can commonly be misdiagnosed as boils. I think it is worth your getting evaluated by a dermatologist to be sure.
Email questions to ToYourGoodHealth@med.cornell.edu.