Carbuncle

Overview of Carbuncle: 

• A carbuncle is a red, swollen, and painful cluster of boils and they connectes to each other under the skin.
• 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.
• Staphylococcus aureus bacteria are cause of Most carbuncles , which inhabit the skin surface, throat, and nasal passages.
• 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 So, it’s important to practice appropriate self-care measures, like keeping the area clean and covered, until the carbuncle drains and heals. (2) 

Indian epidemiology then other

Causes of Carbuncle: 

1. Staphylococcus Aureus 

• While other bacteria are sometimes responsible,Staphylococcus aureus Causes the vast majority of carbuncles.
• Staph. is a very common bacteria found on the skin, inside of the nose, and in the genital area.
• The problem develops when the bacterium enters the skin through a broken area, There doesn’t have to be a large injury for the infection to take hold.
• In some cases, it could be a simple scratch, scrape, insect bite, or even a microtear. 
• Friction also plays a role in carbuncle development, as it can lead to irritation and inflammation of the hair follicle  that allows the infection to more easily take hold.  

2. MRSA : 

• Methicillin-resistant Staphylococcus aureus (MRSA) is becoming a fairly common cause of carbuncles, especially recurrent ones.
• These infections most commonly occur in the groin, buttocks, and upper-thigh region. (3) 

Risk factor of Carbuncle:  

  Carbuncles can affect anyone at any age and are most common in men who are middle-age or older. 

Obesity:

• Being Heavy weight  increases susceptibility to skin infections.
• This may be because bacteria thrive in moist environments such as skin folds, or that being heavy weight makes it harder to fight infection.
• The risk is highest in those with a BMI over 30.5 

Diabetes:

• Carbuncles are especially common in those with uncontrolled diabetes. 

Chronic skin conditions:

• This includes common conditions such as acne, folliculitis, eczema, and other types of dermatitis. 

Become Immunocompromised:

• Those with chronic infections, HIV, cancer, and other conditions that weaken the immune system are at greater risk for developing carbuncles.
• This is because the body has a harder time fighting off infection, allowing bacteria to rapidly grow unchecked. 

Certain medications:

• Medications that weaken the immune system also prevent body from fighting carbuncle-causing infections efficiently.
• Examples include long-term oral steroids and chemotherapy. 

Having multiple or recurrent boils:

• Certain people are more susceptible to get infected from staph.
• Those prone to recurrent cases are likely to develop more serious abscesses like carbuncles. 

Other health conditions:

• Carbuncles are also more common in those with health conditions like heart failure, liver disease, and kidney disease. (3) 

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Risk factor of Carbuncle:  

  Carbuncles can affect anyone at any age and are most common in men who are middle-age or older. 

Obesity:

• Being Heavy weight  increases susceptibility to skin infections.
• This may be because bacteria thrive in moist environments such as skin folds, or that being heavy weight makes it harder to fight infection.
• The risk is highest in those with a BMI over 30.5 

Diabetes:

• Carbuncles are especially common in those with uncontrolled diabetes. 

Chronic skin conditions:

• This includes common conditions such as acne, folliculitis, eczema, and other types of dermatitis. 

Become Immunocompromised:

• Those with chronic infections, HIV, cancer, and other conditions that weaken the immune system are at greater risk for developing carbuncles.
• This is because the body has a harder time fighting off infection, allowing bacteria to rapidly grow unchecked. 

Certain medications:

• Medications that weaken the immune system also prevent body from fighting carbuncle-causing infections efficiently.
• Examples include long-term oral steroids and chemotherapy. 

Having multiple or recurrent boils:

• Certain people are more susceptible to get infected from staph.
• Those prone to recurrent cases are likely to develop more serious abscesses like carbuncles. 

Other health conditions:

• Carbuncles are also more common in those with health conditions like heart failure, liver disease, and kidney disease. (3) 

Pathogenesis refers to the development of a disease. It’s the story of how a disease gets started and progresses.

This is the entire journey of a disease, encompassing the cause but going beyond it.

Pathophysiology of Carbuncle: 

• The initial lesion is similar to a boil in the form of hair follicle infection with peri folliculitis.
• Since majority of patients are diabetics, infection takes a virulent course and results in necrosis of subcutaneous fat which gives rise to multiple abscesses.
• These abscesses are intercommunicating, and they open to the exterior with multiple openings which can called sieve-like openings.
• This appearance described as cribriform appearance which is pathognomonic of carbuncle. (1)

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Sign & Symptoms of Carbuncle: 

• Severe pain and swelling in the nape of the neck. 
• Constitutional symptoms such as fever with chills and rigors are severe. 
• Surface is red, angry looking like RED-HOT COAL. 
• Surrounding area indurated. 
• Later, skin on the centre of carbuncle softens and peripheral satellite vesicles appear, which rupture discharging pus and giving rise to a cribriform appearance. 
• The end result is development of a large crateriform ulcer with central slough. (1) 

Investigation of Carbuncle: 

• Urine sugar and urine ketone bodies. 
• Blood sugar. 
• Discharge for C/S. (4) 

Diagnosis of Carbuncle: 

• Clinical diagnosis should confirmed after culturing the organism from the exudates.
• Phage typing employes for identifying the strains in epidemics and tracing the Carriers. (7)

Complications are what happen after you have a disease. They are the negative consequences of the disease process.

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Treatment of Carbuncle: 

• Diabetes control, preferably with injectable insulin. 
• Appropriate parenteral antibiotics are given till complete resolution occurs.
• Most strains of Staphylococcal aureus are sensitive to cloxacillin, flucloxacillin, erythromycin and some of the cephalosporins.
• However, methicillin-resistant Staphylococcal aureus (MRSA) bacteria are resistant to the drugs mentioned above.
• They are sensitive only to expensive drug vancomycin which must be given intravenously. 
• Improve general health of the patient. 
•  If carbuncle does not show any softening or if it shows evidence of healing, it is not incised.
• It can be left open to the exterior or saline dressings may be applied to reduce oedema.
• Complete resolution may take place within 10-15 days. 
• Surgery is required when there is pus.
• Cruciate incision is preferred because of multiple abscesses and extensive subcutaneous necrosis.
• Edges of the skin flap are excised, pus is drained, loculi are broken down, slough is excised, and cavity is irrigated with antiseptic agents.
• Like pyogenic abscess, wound heals with granulation tissue from the depth excision of carbuncle. (1)

Prevention of Carbuncle: 

Follow this prevention tips:

• Proper hygiene reduces your risk of developing a carbuncle. 
• 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. 
• Wash clothes, sheets, and towels regularly in hot water. (6) 

Homoeopathic Treatment of Carbuncle: 

Homeopathic Medicines for Carbuncles: 

• The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition.
• The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy, potency and repetition of dose by Homeopathic doctor. 
• So, here we describe homeopathic medicine only for reference and education purpose.
• Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath).  

1. ANTHRACINUM 

• Violent burning pain in carbuncle, not relieved by Ars., cerebral symptoms; sloughing, abundant discharge of ichorous, terribly smelling pus and poisoning of blood by absorption of pus; excessive sensitiveness of parts affected; dusky appearance of parts surrounding the gangrenous spots. 

2. ARSENICUM 

• Intense burning in the seat of the carbuncle and some distance around the tumor, or sensation of swelling as though boiling water were running beneath the skin; restlessness thirst, debility; (<) nights, (>) from warmth. 

3. BELLADONNA  

• Bright redness; throbbing pains; drowsiness with inability to sleep; erysipelatous inflammation around carbuncle; cerebral irritation.

4. CARBO VEG 

• Dark, blackish appearance with burning pain and discharging offensive matter even after gangrene has set in; blood-poisoning; collapse. 

5. CHINA 

• Asthenic character, with symptoms of putrid fever, where patient is leuco-phlegmatic and much reduced, or where the carbuncle developed itself from malarious causes.  

6. HEPAR 

• Carbuncle surrounded by indurated spots; pain intense, sleeplessness; stinging burning of edges of ulcer with corroding discharge. 

7. LACHESIS 

• Slow progress, the skin over the dead cellular tissue shows little disposition to ulcerate; dark bluish appearance; after perforation scanty discharge of thin, sometimes bloody sanics; cerebral symptoms; prostration; inability to bear any bandage over the sore. 

8. RHUS TOX 

• Burning, itching around carbuncle, with vertigo stupor, the face; great restlessness; feels somewhat relieved of violent pain as long as he is in motion; more indicated in the beginning, when the pains are intense, and the affected parts are dark red.
• Orbital cellulitis. 

9. SILICEA  

• During process of ulceration, it clears the wound of its decaying masses and promotes healthy granulation; want of viral warmth; slow progress of the disease; furuncles appearing in drops; carbuncle between the shoulder and nape of the neck; indurations after boils or carbuncles. (4) 

Homeopathic Treatment of Carbuncles: 

• Homeopathy treats the person as a whole.
• It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition.
• The homeopathic medicines selected after a full individualizing examination and case-analysis. 

Which includes 

• The medical history of the patient, 
• Physical and mental constitution, 
• Family history, 
• Presenting symptoms, 
• Underlying pathology, 
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions. 

What Homoeopathic doctors do? 

• A homeopathy doctor tries to treat more than just the presenting symptoms.
• The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’? 
• The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses.
• Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. Now a days, even modern medicine also considers a large number of diseases as psychosomatic.
• The correct homeopathy remedy tries to correct this disease predisposition. 
• The focus is not on curing the disease but to cure the person who is sick, to restore the health.
• If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improve with homeopathic medicines.

Diet and Regiment for Carbuncle: 

• Avoid food items which produce  imbalance like cold, acrid, sour and dry food, hard to digest. Because  imbalance aggravates the symptoms. 
• Intake of proper amounts of fluids.
• Combs and towels are not shared with others (8) 

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References of Carbuncles: 

1. Manipal Manual Of Surgery Fourth Edition Chapter 2 
2. Carbuncles: Causes, Symptoms, and Treatments (webmd.com) 
3. Carbuncles: Causes and Risk Factors (verywellhealth.com) 
4. Homoeopathic Therapeutics By Lilienthal 
5. SRB’S MANUAL OF SURGERY 3RD EDITION 
6. Diagnosis, Causes, and Treatments of Carbuncles (healthline.com) 
7. KV Krishna Das – Textbook of Medicine, 5th Edition 
8. CARBUNCLE- Ayurvedic Treatment, Diet, Exercises, Yoga & Pranayama – Ayurveda Blogs, Services and Consultation (ayurvedapc.blog) 

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