Boils

A boil is a skin infection that starts in a hair follicle or oil gland. At first, the skin turns red in the area of the infection, and a tender lump develops. After 4-7 days, the lump starts turning white as pus collects under the skin.

• The most common places for boils to appear are on the face, neck, armpits, shoulders, and buttocks. When one forms on the eyelid, it is called a sty.

• If several boils appear in a group, this is a more serious type of infection called a carbuncle.

Most boils are caused by a germ (staphylococcal bacteria). This germ enters the body through tiny nicks or cuts in the skin or can travel down the hair to the follicle.

These health problems make people more susceptible to skin infections:

• Diabetes

• Problems with the immune system

• Poor nutrition

• Poor hygiene

• Exposure to harsh chemicals that irritate the skin

A boil starts as a hard, red, painful lump usually less than an inch in size. Over the next few days, the lump becomes softer, larger, and more painful. Soon a pocket of pus forms on the top of the boil. These are the signs of a severe infection:

• The skin around the boil becomes infected. It turns red, painful, warm, and swollen.

• More boils may appear around the original one.

• A fever develops.

• Lymph nodes become swollen.

• You start running a fever.

• The skin around the boil turns red or red streaks appear.

• The pain becomes severe.

• The boil does not drain.

• A second boil appears.

• You have a heart murmur, diabetes, any problem with your immune system, or use immune suppressing drugs (for example, corticosteroids or chemotherapy) and you develop a boil.
   
  
• Boils usually do not need immediate emergency attention. If you are in poor health and you develop high fever and chills along with the infection, a trip to a hospital's Emergency Department is needed.

Your doctor can make the diagnosis with a physical exam. Many parts of your body may be affected by this infection on your skin, so some of the questions or exam may be about other parts of your body.

|Self-Care at Home|

• Apply warm compresses and soak the boil in warm water. This will decrease the pain and help draw the pus to the surface. Once the boil comes to a head, it will burst with repeated soakings. This usually occurs within 10 days of its appearance. You can make a warm compress by soaking a wash cloth in warm water and squeezing out the excess moisture.

• When the boil starts draining, wash it with an antibacterial soap until all the pus is gone. Apply a medicated ointment and a bandage. Continue to wash the infected area 2-3 times a day and to use warm compresses until the wound heals.

• Do not pop the boil with a needle. This usually results in making the infection worse.

|Medical Treatment|

If there are concerns about the seriousness of the infection, additional blood tests will be performed. The doctor may prescribe antibiotics to take if the infection is severe. If the boil is drained, a culture may be done to determine the type of bacteria causing the infection and to assess if an appropriate antibiotic was given.

|Follow-up|

Whether the boil is drained at home or is lanced by a doctor, you will need to clean the infected area 2-3 times a day until the wound is healed. Apply an antibiotic ointment after washing and cover with a bandage. If the area turns red or looks as if it is getting infected again, contact your doctor.

|Prevention|

Help prevent boils by following these guidelines:

• Carefully wash clothes, bed linen, and towels of a family member who is infected with boils.

• Clean and treat minor skin wounds.

• Practice good personal hygiene.

• Stay as healthy as possible.

|Outlook|

Most boils will disappear with simple home treatment.

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Author: Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Assumption Community Hospital.

Editors: Scott H Plantz, MD, FAAEM, Research Director, Assistant Professor, Department of Emergency Medicine, Mount Sinai School of Medicine; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, ; Jeter (Jay) Pritchard Taylor III, MD, Vice-Chief, Compliance Officer, Attending Physician Emergency Medicine Residency, Department of Emergency Medicine, Palmetto Richland Memorial Hospital, University of South Carolina.