Boil pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Yamuna Kondapally, M.B.B.S[2]

Overview

Boil (furuncle) is the tender, deep, dome shaped skin infection of the hair follicle.

Pathophysiology

Pathogenesis

• Furuncle is a localized, deep, suppurative, necrotizing form of folliculitis which involves dermis and subcutaneous tissue. Staphylococcus aureus is the most common causative agent.
• Following abrasion or cut the pathogen uses the entry site to invade and colonize the hair follicle leading to the formation of tender, red, perifollicular nodule.
• It later becomes painful and fluctuant terminating in the discharge of pus and necrotic plug which may leave a scar.

• Furunculosis is the acute or chronic appearance of a number of furuncles at multiple skin sites. Recurrent furunculosis is defined as three or more attacks within 12 month period.
• It is a contagious condition which usually develops in moist or sweaty areas such as the scalp, face, buttocks, axillae and areas which are subject to friction and perspiration.

• Group of furuncles coalesce to form carbuncle.

Associated Conditions

• Folliculitis
• Carbuncle

Gross Pathology

On gross pathology, the following are characteristic findings of boil(furuncle):

• It begins as a firm, tender, red, dome shaped nodule
• It later becomes fluctuant (Pus filled) and painful
• They vary in size

Microscopic histopathological analysis

On microscopic histopathological analysis, the following are characteristic findings of boil(furuncle):

• Infiltrate predominantly consists of neutrophils with in the wall and ostia of hair follicle which later becomes more mixed with lymphocytes and macrophages creating a central focus of necrosis.
• Inflammation of hair follicle can either be:

• Superficial(primarily involving the infandibulum)
• Deep

Images

The following are the images associated with boil(furuncle)

• 
  Boil(furuncle) on Anterior leg: Dome shaped pus filled boil(furuncle) with erythema of skin]]
• 
  Boil(furuncle): pathogenesis

References

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