Boil differential diagnosis

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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) must be differentiated from other common diseases that cause tender swelling or a reddened lump filled with pus such as cystic acne, hydradrenitis suppurativa and pilonidal cyst.

Differentiating Boil(furuncle) from Other Diseases

Boil(furuncle) must be differentiated from:

Disease	Findings
Cystic acne	Presents with tender cystic pustules usually confined to the face and trunk, where there are higher concentration of sebaceous glands.
Hydradrenitis suppurativa	Presents as painful suppurative lesions in the axillary, genital and perianal areas, where there are higher concentration of apocrine glands. Chronic disease may cause irregular sinus tracts and scarring. Diagnosis is primarily clinical based on distribution, characteristic lesions and recurrence.
Pilonidal cyst	The cyst usually contains skin and hair debris, which if gets infected results in painful pus filled nodule at the bottom of tail bone (coccyx).Diagnosis is based on physical examination.
Yellow fever and other Flaviviridae	Present with hemorrhagic complications. Epidemiological investigation may reveal a pattern of disease transmission by an insect vector. Virus isolation and serological investigation serves to distinguish these viruses. Confirmed history of previous yellow fever vaccination will rule out yellow fever.
Shigellosis & other bacterial enteric infections	Presents with diarrhea, possibly bloody, accompanied by fever, nausea, and toxemia, vomiting, cramps, and tenesmus. Stools contain blood and mucous in a typical case. A search for possible sites of bacterial infection, together with cultures and blood smears, should be made. Presence of leukocytosis distinguishes bacterial infections from viral infections.
Ebola	Presents with fever, chills vomiting, diarrhea, generalized pain or malaise, and internal and external bleeding, that follow an incubation period of 2-21 days.
Others	Scarlet fever, leptospirosis, viral hepatitis, typhus, and mononucleosis can produce signs and symptoms that may be confused with rheumatic fever in early stages of infection.

Differential Diagnosis

• Cystic acne
• Hidradenitis suppurativa
• Herpetic whitlow
• Pilonidal cyst
• Anthrax
• Cellulitis
• Furuncular myasis
• Impetigo herpitiformis
• SAPHO syndrome
• Interleukin 1 receptor antagonist deficiency
• Eosinophilic pustular folliculitis

References

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