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What is a Diabetic Carbuncle & How is it Treated?

There are many types of boils that affect us at some time or the other in our lives. One such type of boil is known as a carbuncle. A carbuncle is a painful, red, and swollen cluster of boils that are connected to one another underneath the skin. A carbuncle usually occurs on a hairy part of the body, such as the nape or back of the neck, though, of course, it can develop in other parts of the body as well, including the groin, thighs, buttocks, and armpits. People with diabetes are known to be more prone to getting carbuncles. Read on to find out about diabetic carbuncles.

What are Carbuncles?

Carbuncles are basically a form of deep infection in the skin tissue, which causes red, inflamed, and painful bumps to come up underneath the skin. They tend to vary in size and can be as tiny as a lentil or as big as a medium-sized apple even. Carbuncles are typically caused by Staphylococcus aureus bacteria, which commonly inhabit the surface of our skin, throat, and even the nasal passages. While these bacteria are commonly present in the body, they can sometimes cause infection when they enter the skin through a small scrape, puncture, or hair follicle. In some cases, there is no visible point of entry.(1234)

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Carbuncle is also known as infective gangrene of skin and subcutaneous tissue, and it usually starts out as a boil or furuncle developing at the root of a hair follicle.(5)

What is important to know is that an active carbuncle can be contagious, and the infection can easily spread to other parts of the body or even to other people through sharing of personal items or skin-to-skin contact. If the carbuncle is filled with pus, it is necessary to drain them before it can heal. As compared to boils, carbuncles are highly likely to leave scars.

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When you have a carbuncle, it is essential to practice proper hygiene and self-care measures, such as keeping the area of the carbuncle clean and covered until it drains out and heals. If you have a carbuncle, you need medical treatment to manage or prevent any complications, boost the healing process, and also reduce scarring.

What is a Diabetic Carbuncle?

People who have diabetes are more prone to getting skin infections like carbuncles. This is because their bodies have a more challenging time fighting off infections, including infections caused by bacteria like Staphylococcus aureus. This is why it is quite common to find boils on various parts of the body in diabetes patients. Carbuncles are usually filled with pus, and it is likely that it develops a yellowish or white tip that leaks, radiates or scabs over.(6)

Over a few days, if left untreated, the carbuncles may rupture, leading to a discharge of fluids present inside. If you have uncontrolled diabetes or you are immunocompromised, this infection may even spread to the subcutaneous plane and start to move upwards. This can lead to the formation of multiple sinuses or multiple pus points in the carbuncle.(7)

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Some of the common symptoms of a diabetic carbuncle include:(8)

  • It is a painful and reddish-colored bump that is around the size of a pea.
  • The skin around the bump becomes red, and the area swells up
  • The size of the bump increases over the next few days, and it starts to fill with pus. In some cases, the bump may even get as big as a baseball.
  • The yellowish-white tip starts to develop slowly, leading to the eventual rupture of the carbuncle to allow the pus to drain out.

Over the next few days, you will find that many of the untreated carbuncles will rupture, again discharging the pus inside. Some of the other symptoms of a diabetic carbuncle can also include fatigue, fever, and a general sense of being unwell. Swelling may also occur in the nearby tissues and lymph nodes. The commonly affected lymph nodes are the ones in your armpit, groin, or neck.

Treatment of Diabetic Carbuncle

If you notice a carbuncle developing under your skin, the most important thing to remember is to avoid squeezing, popping, or irritating the carbuncle. Doing this will only increase the risk of severe scarring as well as complications.

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You can apply warm compresses to the area to promote the drainage of pus. The faster the carbuncle drains out, the sooner the healing process will begin. To do warm compresses, you can either gently soak the carbuncle in lukewarm water, or you can apply a warm, moist cloth for 20 minutes to the affected area several times a day. Make sure that the cloth you use is clean. You can also consider keeping the carbuncle covered with a clean and dry cloth and applying a hot water bottle or any kind of heating pad to it for at least 15 to 20 minutes a few times a day. After every use, make sure to wash the clothes in hot water and dry them at a high temperature to kill any remaining bacteria.

Washing and covering the area with a sterile bandage can also help hasten the process of drainage and healing. It will also help prevent the infection from spreading to other parts of the body or to other people. To get relief from the pain of a swollen carbuncle, you can use over-the-counter medications like ibuprofen or acetaminophen.(9)

Remember to always wash your hands thoroughly after you touch the carbuncle. At the same time, you must clean any clothing, bedding, towel, or any personal items that have touched the carbuncle.

If you have diabetes and you find that even after a couple of days of home treatment, there is no improvement in the carbuncle, you should see your doctor. You should always consult a doctor if you have a carbuncle on your face, on the spine, or near the eyes or nose. A very large or painful carbuncle should also be shown to the doctor.

Depending on the severity of the carbuncle, your doctor may end up cutting and draining the carbuncle to ensure that all the pus gets removed. The area will be washed with a sterile solution to ensure that there is no pus remaining. If needed, your doctor may collect some of the pus and send it to a laboratory to determine the exact bacteria causing the infection and also check if it is susceptible to antibiotics.

You usually do not need to take any antibiotics if the carbuncle is correctly drained and it is completely free from pus. However, in some cases, you might need to be treated with antibiotics. This includes:

  • When the surrounding soft tissue also becomes infected.
  • If you have a weakened immune system or you are immunocompromised.
  • If the infection spreads to other parts of the body.
  • If the carbuncle is caused by methicillin-resistant Staphylococcus aureus (MRSA) bacteria.(101112)

Depending on the severity of the carbuncle, it should heal within two to three weeks after treatment.

Conclusion

While diabetes does not directly cause carbuncles, it does make you more susceptible to developing skin infections like carbuncles. Diabetes weakens the body’s ability to fight against all types of infections. If you have diabetes and you develop a carbuncle, the first thing to do is to avoid squeezing or irritating the affected area. Keep an eye on the carbuncle, and depending on the severity, location, and other factors, talk to your doctor about it, especially if you notice any unexpected changes or issues with the carbuncle.

You should definitely consult a doctor if the size of the carbuncle becomes too big or the pain is too much.

References:

  1. Stulberg, D.L., Penrod, M.A. and Blatny, R.A., 2002. Common bacterial skin infections. American family physician, 66(1), p.119.
  2. Sharma, S. and Verma, K.K., 2001. Skin and soft tissue infection. Indian journal of pediatrics, 68, pp.S46-50.
  3. Hacker, S.M., 1994. Common infections of the skin: characteristics, causes, and cures. Postgraduate medicine, 96(2), pp.43-52.
  4. Moore, T.D., 1931. Renal carbuncle. Journal of the American Medical Association, 96(10), pp.754-759.
  5. Shah, A.M., Supe, A.N. and Samsi, A.B., 1987. Carbuncle―a conservative approach. Journal of Postgraduate Medicine (Bombay), 33(2), pp.55-57.
  6. Venkatesan, R., Baskaran, R., Asirvatham, A.R. and Mahadevan, S., 2017. ‘Carbuncle in diabetes’: a problem even today!. Case Reports, 2017, pp.bcr-2017.
  7. Troxell, T. and Hall, C.A., 2020. Carbuncle.
  8. Badwe, Y., Shinde, J., Mugave, B., Naikwade, P., Khobragade, S. and Moje, P., 2022. DIABETIC CARBUNCLE A COMPLICATION OF INTRA-ARTICULAR STEROIDAL INJECTION: A CASE STUDY.
  9. Rabbets, W., 2021. Treating skin infections in the pharmacy. SA Pharmacist’s Assistant, 21(3), pp.13-14.
  10. Ioannides, D. and Lazaridou, E., 2015. Furuncles and carbuncles. In European Handbook of Dermatological Treatments (pp. 313-317). Springer, Berlin, Heidelberg.
  11. Docekal, J., Hall, J., Reese, B., Jones, J. and Ferguson, T., 2013. A rare presentation of community acquired methicillin resistant Staphylococcus aureus. Case Reports in Infectious Diseases, 2013.
  12. Hadfield, M.J., Kota, S.V., Siragusa, S.M. and Pettitt, R.M., 2019. Skin & Soft Tissue Infections: It’s More Than Just MRSA. Osteopathic Family Physician, 11(1), pp.28-32.
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