My daughter (20) after living away from home for 2 years returned with
a very painful abscess on the base of her spine which had to be
operated on immediately. During her period of recovery (some three
months), she has continued to suffer from the development of more
external abscesses, mostly on the buttocks and some on the back.
Although they seem to clear up when treated with antibiotics, more
continue to develop. There seems to be no end. Her diet is good and
she now gets plenty of rest and little or no stress. What is she
suffering from and how can it be best treated and brought to an end?

Hello chrisb123-ga,

You say your daughter eats a healthy diet and has little stress. Poor
diet and stress can certainly aggravate skin conditions. Without
causing alarm, has she been checked for diabetes? Diabetics are very
prone to skin abcesses and boils, as does anemia and insufficient
vitamin C intake.

The first abcess you mention certainly sounds like a pilonidal cyst.
("Pilo" meaning hair, "nidal' meaning nest -- a nest of hair, so to
speak)
These abcesses are usually triggered  by skin and perianal bacteria,
such as  Staphylococcus aureus  and/or Bacteroides species, with the
average age of presentaion being 21. Pilonidal cysts are 2 times more
common in men, but not rare in women. Some consider pilonidal cysts to
be a minor birth defect, since  the hair follicle is buried within the
dermis, As this cyst is disturbed  (by bacteria, pressure from sitting
too long, a weak immune system are some causes) the dead hair
entrapped within the skin becomes infected. (and the skin on the
buttocks.
http://www.gihealth.com/html/education/pilonidal.html

"These theories suggest that pilonidal sinuses are vestigial
structures, cystic remnants of the medullary canal or the result of
dermal inclusions caused by faulty development of the median coccygeal
raphe."
http://www.emedicine.com/emerg/topic771.htm

"A pilonidal cyst or sinus is an abscess (localized collection of pus)
or a chronic draining sinus (canal or passage). These cysts develop
when a dead hair or hairs are pushed into the skin forming a canal or
passage. This sinus then becomes infected as more debris collects in
the sinus. The most common place for a pilonidal cyst to develop is in
the skin over the tailbone, just over the cleft in the buttocks.
Friction and pressure on the area aggravate the condition along with
the presence of bacteria. People are not born with this condition but
develop it in the late teens, twenties or thirties."
http://pediatric.um-surgery.org/new_070198/new/Library/Pilonidal%20Cyst.htm

You can see an illustration of one form of a pilonidal cyst.
http://www.bodybuilding.com/fun/randy28abig.jpg

A more graphic photo:
http://www.proctosite.com/imagens/doenca_piloni/grandes/piloni9.jpg

The rest of your daughter's "bumps" seem to be boils, carbuncles,
furuncles, or  folliculitis. "Folliculitis is the inflammation of hair
follicles due to an infection, injury, or irritation. It is
characterized by tender, swollen areas that form around hair
follicles, often on the neck, breasts, buttocks, and face. Boils are
pus-filled lesions that are painful and usually firm. Boils are
usually located in the waist area, groin, buttocks, and under the arm.
Carbuncles are clusters of boils. These are usually found in the back
of the neck or thigh." An overuse of topical steroids (hydrocortisone)
can trigger folliculitis.
http://www.mountcarmelhealth.com/healthinfo/Adult/derm/fbc.shtml


Folliculitis:
See a photo here:
http://www.dermnetnz.org/acne/folliculitis.html


Risk factors for all of the above are:
    * Diabetes
    * Poor nutrition
    * Poor hygiene
    * Weakened immune system
    * Exposure to harsh chemicals

http://www.emoryhealthcare.org/HealthGate/12009.html



Treatment:
==========
Most medical providers caution against lancing a boil yourself.
Sterile conditions must prevail, and this is best left to a health
care provider.

Dermnet NZ recommends:
#  Use an antiseptic cleanser in your daily bath or shower for a week
then twice weekly for several weeks. The cleanser may cause a little
dryness.
# Your doctor may recommend an antiseptic or antibiotic ointment or
gel to apply to the inside of the nostrils.
# Wipe the entire skin surface daily for a week with 70% isopropyl
alcohol in water (this will make the skin dry).
# Apply a topical antiseptic such as povidone iodine or chlorhexidine
cream to the boils and cover with a square of gauze.
# Your doctor may prescribe an oral antibiotic (usually the penicillin
antibiotic flucloxacillin), sometimes for several weeks.
# Other members of the family with boils should also follow the Skin
Cleansing Regime for a week. All members of the family should apply
topical antibiotic on a cotton bud twice a day to their nostrils for a
week in case they are Staph. aureus carriers as well.
# If the boils fail to clear up, a swab should be taken for
microbiological culture, in case you are infected with methicillin
resistant staphylococci.
# Sometimes, special antibiotics may be prescribed on the
recommendation of a specialist, including fucidin, clindamycin,
rifampicin and cephalosporins.
http://www.dermnetnz.org/bacterial/boils.html


"Most simple boils can be treated at home. Ideally, the treatment
should begin as soon as a boil is noticed since early treatment may
prevent later complications.

The primary treatment for most boils is heat application, usually with
hot soaks or hot packs. Heat application increases the circulation to
the area and allows the body to better fight off the infection by
bringing antibodies and white blood cells to the site of infection.

As long as the boil is small and firm, opening the area and draining
the boil is not helpful, even if the area is painful. However, once
the boil becomes soft or "forms a head" (that is, a small pustule is
noted in the boil), it can be ready to drain. Once drained, pain
relief can be dramatic. Most small boils, such as those that form
around hairs, drain on their own with soaking. On occasion, and
especially with larger boils, the the larger boil will need to be
drained or "lanced" by a healthcare practitioner. Frequently, these
larger boils contain several pockets of pus that must be opened and
drained.

Antibiotics are often used to eliminate the accompanying bacterial
infection. Especially if there is an infection of the surrounding
skin, the doctor often prescribes antibiotics. However, antibiotics
are not needed in every situation. In fact, antibiotics have difficult
penetrating the outer wall of an abscess well and often will not cure
an abscess without additional surgical drainage. "

"Small boils can be treated with moist heat (usually a warm, wet
washcloth) applied for 20 to 30 minutes, three or four times a day.
This will help the boil drain on its own. Once the boil drains, cover
it with a clean bandage to protect the skin and absorb draining pus.
Wash the affected area daily with antibacterial soap to prevent the
infection from spreading. Anyone who helps care for the infected area
should also wash his or her hands thoroughly with antibacterial soap.

Carbuncles and large boils may be treated with antibiotics. In many
cases, the doctor will drain the infected area through a small
incision. This will relieve pain, speed recovery and limit scar
formation. If the infection is completely drained, antibiotics may not
be necessary. If the infection is deep, your doctor may cover it with
a piece of sterile gauze to keep the incision open and allow pus to
continue to drain. You may need to return to the doctor a few times to
have the gauze and dressing changed and to make sure the infection
drains completely."
http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/9562.html

http://www.medicinenet.com/boils/article.htm

http://www.emedicinehealth.com/articles/20077-2.asp

Photo of boils
http://www.dermnetnz.org/bacterial/boils.html



Prevention
==========

    * Practice good hygiene. Wash boil-prone areas with soap and water
or an antibacterial soap. Dry thoroughly.
    * Clean and treat any minor skin wounds.
    * Avoid clothing that is too tight.
http://www.emoryhealthcare.org/HealthGate/12009.html


"If you have an area of skin that is prone to boils or carbuncles,
keep the area clean and dry, and avoid wearing tight clothing that
doesn't allow the skin to breathe. Washing daily with an antibacterial
soap also can help. At the earliest sign of irritation or a bump at a
hair follicle, use warm compresses to open up the blocked pore and
drain any early infection. If you develop signs of inflammation or
infection at a hair follicle (folliculitis) as a result of shaving,
you should avoid shaving in that area to prevent bacteria from being
spread from this area to other parts of the skin."
http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/9562.html


Untill all boils/abcesses are healed, wash your daughter's laundry in
a very mild soap, such as Ivory Snow using very hot water.Consider
omitting fabric softener untill healed. Change bedding daily or every
other day, and use fresh towels and washcloths. Try using an
antibacterial body wash such as Dial Antibacterial Body Wash. Sleeping
in the nude, or at least with no undergarments will allow more air
flow to the affected skin. If the doctor has not given you any
ointments, you can apply a triple antibiotic ointment (Neosporin) to
the area once or twice a day. Have your daughter take a multi-vitamin
with iron, and include plenty of fresh fruit and veggies in her diet.
Try substituting water for some of her  soda pop, if she drinks a lot
of soda.

There you go. Hope this clears things up for your daughter!(No pun
intended!) If any part of my answer is unclear, please request an
Answer Clarification, before rating, This will enable me to assist you
further, if possible.

Regards,
crabcakes

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