Staphylococcal folliculitis–furunculosis that recurs when treatment is ceased can be challenging to manage.
A non-obese 54-year-old man had an 18-month history of recurrent boils, particularly on his lower trunk, buttocks, groin, axillae and thighs. The boils usually started with a painful or itchy red papule or pustule. Some of these lesions spontaneously involuted, but most progressed to painful nodules that later drained significant quantities of pus, with relief to the pain. Boils occurring in skin folds were the most painful. Sometimes, when multiple boils occurred, the patient felt unwell with a mild fever but no sweats. Bad flares could take up to two months to settle but treatment with cephalexin 500 mg three times daily hastened recovery. Most of the boils left red marks that were slow to settle, and some left unsightly permanent atrophic scars. The patient also had episodes of superficial folliculitis, mostly on the upper trunk and proximal limbs, often linked to the flares of his boils. His fasting blood glucose level was repeatedly normal. Swabs taken from the boils grew Staphylococcus aureus that was resistant to tetracycline, penicillin and erythromycin but sensitive to other tested antibiotics.