A. Specific Measures
Incision and drainage is recommended for all locilated suppurations and is the mainstay of therapy.
Systemic antibiotics are indicated (chosen on the basis of cultures and sensitivity tests, if possible). Sodium dicloxacillin or cephalexin 1.5 gm daily in divided doses by mouth for 10 days, is usually effective. Erythromycin in similar doses may be used in penicillin allergic individuals in communities with low populations of erythromycin-resistant staphylococci or if the particular isolate is sensitive. Ciprofloxacin 500 mg twice daily, is effective against strains of staphylococci resistant to other antibiotics.
Recurrent furunculosis may be effectively treated with a combination of dicloxacillin, 250-500 mg four times daily for 2-4 weeks and rifampicin 300 mg twice daily for 5 days during the period. Clindamycin 150-300 mg daily for 1-2 months, may also cure recurrent furunculosis.
Family members and intimate contacts may need evaluation for staphylococcal carrier state and perhaps concomitant treatment. Applications of topical 2% mupirocin to the nares, axillae, and anogenital area twice daily for 5 days eliminates the staphylococcal carrier state.
B. Local Measures
Immobilize the part and avoid over manipulation of inflamed areas. Use moist heat to help “larger” lesions localize. Use surgical incision and debridement AFTER the lesions are “ripe”. It is not necessary to incise and drain an acute staphylococcal paronychia. Inserting a flat metal spatula and sharpened hardwood stick into the nail fold where it adjoins the nail will release pus from a mature lesion.
Inflamed epidermal cysts may be treated in the initial stages with intralesional injections of triamcinolone acetonide into the borders of the lesions, attempting not to puncture the cyst itself. Drainage of fluctuant lesions results in rapid resolution and reduction of pain.
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