PENGENALAN

A carbuncle is a cluster of boils caused by bacterial infection, most commonly with

Staphylococcus aureus or Streptococcus pyogenes. The presence of a carbuncle is a sign that
the immune system is active and fighting the infection. The infection is contagious and may
spread to other areas of the body, or other people; those living in the same residence may
develop carbuncles at the same time. In the early 21st century, infection involving
methicillin-resistant staphylococcus aureus (MRSA) has become more common.
A carbuncle is a red, swollen, and painful cluster of boils that are connected to each
other under the skin. A boil (or furuncle) is an infection of a hair follicle that has a small
collection of pus (called an abscess) under the skin. Usually single, a carbuncle is most likely
to occur on a hairy area of the body such as the back or nape of the neck. But a carbuncle also
can develop in other areas of the body such as the buttocks, thighs, groin, and armpits.
These bacteria can cause infection by entering the skin through a hair follicle, small
scrape, or puncture, although sometimes there is no obvious point of entry. Filled with pus --
a mixture of old and white blood cells, bacteria, and dead skin cells -- carbuncles must drain
before they're able to heal. Carbuncles are more likely than boils to leave scars. An active boil
or carbuncle is contagious: the infection can spread to other parts of the person's body or to
other people through skin-to-skin contact or the sharing of personal items. it's important to
practice appropriate self-care measures, like keeping the area clean and covered, until the
carbuncle drains and heals.
Older age, obesity, poor hygiene, and poor overall health are associated with
carbuncles. Other risk factors for carbuncles include Chronic skin conditions, which damage
the skin's protective barrier, diabetes, kidney disease, Liver disease and any condition or
treatment that weakens the immune system. Also known as boils. Furuncle is small abscess
exuding purulent material, involving skin and subcutis in areas with hair follicles. Carbuncle
is aggregate of connected furuncles, involves multiple hair follicles
 RUJUKAN
1. https://www.pathologyoutlines.com/topic/skinnontumorcarbuncle.html
2. https://www.healthline.com/health/carbuncle#treatments
3. https://www.webmd.com/skin-problems-and-treatments/guide/carbuncles-causes-
treatments#1
4. https://en.wikipedia.org/wiki/Carbuncle
 PENYATAAN MASALAH
A man of age 50 years old complain of having carbuncle on his right upper back. The
carbuncle started to appear since 3 weeks ago. Patient also have diabetes since 6 years ago.
Patient have been taking medication ever since. The patient started to realise the carbuncle
since he start having problem of laying on his back cause of so much pain.
 PENCARIAN LITERATURE
A carbuncle is a cluster of boils caused by bacterial infection, most commonly with
Staphylococcus aureus or Streptococcus pyogenes. The presence of a carbuncle is a sign that
the immune system is active and fighting the infection. The infection is contagious and may
spread to other areas of the body, or other people; those living in the same residence may
develop carbuncles at the same time. In the early 21st century, infection involving
methicillin-resistant staphylococcus aureus (MRSA) has become more common.
The word is believed to have originated from the Latin: carbunculus, originally a small
coal; diminutive of carbon-, carbo: charcoal or ember, but also a carbuncle stone, "precious
stones of a red or fiery colour", usually garnets. In 1984 Charles, Prince of Wales, described
the proposed Sainsbury Wing extension to the National Gallery in London as a "monstrous
carbuncle on the face of a much-loved and elegant friend", a term he has used since to
describe other pieces of architecture.
The initial cause of a carbuncle can often not be determined. Triggers that make
carbuncle infections more likely include recent incidence of folliculitis; friction from clothing
or shaving; having hair pulled out, such as sites where clothing or furniture grab at hairs;
generally poor hygiene; poor nutrition; or weakened immunity. Poor health may be a
predisposing factor – for example, persons with diabetes and immune system diseases are
more likely to develop infections (especially bacterial infections of the leg or foot).
A carbuncle usually develops when Staphylococcus aureus bacteria enter your hair
follicles. These bacteria are also referred to as “staph.” Scrapes and other broken skin make it
easy for bacteria to enter your body and cause an infection. This can result in boils or
carbuncles (a cluster of boils) filled with fluid and pus. The moist parts of your body are
particularly susceptible to this infection because bacteria thrive in these areas. Carbuncles are
usually found on the back of the neck, shoulders, or thigh. They can also appear on your face,
neck, armpits, or buttocks; or any area you sweat or experience friction.
In rare cases, bacteria from a carbuncle can escape into the bloodstream and cause
serious complications, including sepsis and infections in other parts of the body such as the
lung, bones, joints, heart, blood, and central nervous system. Sepsis is an overwhelming
infection of the body that is a medical emergency and can be fatal if left untreated. Symptoms
include chills, a spiking fever, rapid heart rate, and a feeling of being extremely ill. Carbuncle
can be treated using antibiotic such as erythromycin, dicloxacillin and clindamycin.
A carbuncle is palpable and can range in size to be as small as a pea or as large as a
golf ball. Surface is red, looking like hot red coal. The surrounding area is indurated. Later,
skin on the centre of the carbuncle softens and peripheral satellite vesicles appear, which
rupture discharging pus and give rise to cribriform appearance. As the impending infection
develops, itching may occur. There may be localized erythema, skin irritation, and the area
may be painful when touched. Sometimes more severe symptoms may occur, such as fatigue,
fever, chills, and general malaise as the body fights the infection.
 PERBINCANGAN
A carbuncle is a cluster of boils caused by bacterial infection, most commonly with
Staphylococcus aureus or Streptococcus pyogenes. The presence of a carbuncle is a sign that
the immune system is active and fighting the infection. A carbuncle is palpable and can range
in size to be as small as a pea or as large as a golf ball. Surface is red, looking like hot red
coal. The surrounding area is indurated. Later, skin on the centre of the carbuncle softens and
peripheral satellite vesicles appear, which rupture discharging pus and give rise to cribriform
appearance. As the impending infection develops, itching may occur. There may be localized
erythema, skin irritation, and the area may be painful when touched. Sometimes more severe
symptoms may occur, such as fatigue, fever, chills, and general malaise as the body fights the
infection.
Staphylococcus aureus is most commonly found in intertriginous regions (where two
skin areas may touch or rub together) of nostrils, armpits, groin and intergluteal cleft.
Staphylococcus aureus is present in patients in intertriginous regions, but may be transferred
to other sites by scratching. Tiny nicks or scratches in the skin can inoculate the bacteria into
the wall of a hair follicle, a weak point in the skin. Once innoculated, bacteria cause a boil,
which runs its usual infectious course in about 10 days.
Carbuncle can be prevent by doing proper hygiene such as wash your hands before
eating and after using the bathroom, shower often to keep your skin free of bacteria, avoid
squeezing boils or rubbing any broken skin and wash clothes, sheets, and towels regularly in
hot water. Older age, obesity, poor hygiene, and poor overall health are associated with
carbuncles. Other risk factors for carbuncles include Chronic skin conditions, which damage
the skin's protective barrier, diabetes, kidney disease, Liver disease and any condition or
treatment that weakens the immune system. Also known as boils. Furuncle is small abscess
exuding purulent material, involving skin and subcutis in areas with hair follicles. Carbuncle
is aggregate of connected furuncles, involves multiple hair follicles.
In rare cases, bacteria from a carbuncle can escape into the bloodstream and cause
serious complications, including sepsis and infections in other parts of the body such as the
lung, bones, joints, heart, blood, and central nervous system. Sepsis is an overwhelming
infection of the body that is a medical emergency and can be fatal if left untreated. Symptoms
include chills, a spiking fever, rapid heart rate, and a feeling of being extremely ill. Carbuncle
can be treated using antibiotic such as erythromycin, dicloxacillin and clindamycin.
 RAWATAN
The treatment of carbuncle is antiseptic cleanser, like povidone-iodine or chlorhexidine is
used daily for several weeks to clean carbuncle. Topical antibiotics include erythromycin
BID and clindamycin BID to affected area until clear
Oral antibiotics include:
1. Cephalexin (adult) 1 - 4 g/day divided BID or QID x 10 - 14 days; (children) 25 - 50
mg/kg/day PO divided q6H for mild to moderate infection; 50 - 100 mg/kg/day
divided q6H for severe infection; not to exceed 4g/day for any age
2. Dicloxacillin (adult or children > 40 kg) 125 - 500 mg q6h x 10 - 14 days; (children <
40 kg): 12.5 - 50 mg/kg/d PO divided q6h
3. Erythromycin (adult) 500 mg BID or 330mg q8hr x 10 - 14 days
4. Clindamycin (adult) 150 - 450 mg q6 - 8h x 10 - 14 days; (children) 10 - 30
mg/kg/day q6 - 8h
5. Minocycline (adult) 100 mg BID x 10 - 14 days
6. Rifampicin (adult) 600 mg qD x 10 days; (children) 15 mg/kg/day divided BID x 10
days
7. Ciprofloxacin (adult): 250 - 750 mg BID x 10 - 14 days
In recurrent cases, obtain nasal culture of patient and family members to look for
Staphylococcus aureus colonization. If patient is Staphylococcus aureus nasal carrier,
consider applying topical antibiotic like mupirocin ointment to nostrils twice daily for 5 days.
If family members are nasal carriers, consider mupirocin ointment or rifampin 600 mg daily
for 10 days. Consider checking nasal swab for MRSA or culture for sensitivity for treatment
failure
Prevention:
1. Good hygiene including bathing, hand-washing, keeping nails short and clean
2. Avoid close shaving until lesions are completely resolved
3. Change disposable razors daily or clean electric razor heads daily
4. Wear loose-fitting clothes (tight-fitting clothes may cause occlusion); change clothes
daily
5. In obese patients, weight reduction will be beneficial
For home care:
1. Place a clean, warm, moist cloth on your carbuncle several times a day. Leave it on
for 15 minutes. This will help it drain faster.
2. Keep your skin clean with antibacterial soap.
3. Change your bandages often if you’ve had surgery.
4. Wash your hands after touching your carbuncle.
5. acetaminophen or ibuprofen can help relieve the pain of an inflamed carbuncle.
6. Launder any clothing, bedding, and towels that have touched a carbuncle and avoid
sharing bedding, clothing, or other personal items.
 RUMUSAN
Carbuncle can occur to people who neglecting hygiene. But the most common is the
carbuncle happen to people who have diabetes. Carbuncle can be dangerous and let to sepsis
if not be treat properly. This especially to the people that have diabetes cause even the
smallest wound can cause them problem. This is because the people that have diabetes is
having difficulty of healing the wound without proper treatment. Carbuncle can be treat using
antibiotic such as erythromycin and rifampicin.
If carbuncle left untreated it can cause mortality to the patient and sometimes carbuncle
can also recurrent.