How are boils treated?

Photo of a man with a painful boil at the back of his neck (PantherMedia / Wavebreakmedia ltd)

Boils are generally treated by a doctor. When the boil is “ready,” the doctor can make a small cut to allow the pus to drain and the wound to heal. Antibiotics are used in certain situations, for instance if the person has a weakened immune system or a fever. People who try to squeeze boils themselves increase the risk of the infection spreading inside their body and leading to complications.

A boil (furuncle) is a bacterial skin infection that looks a bit like a very big pus-filled pimple. It starts off as a noticeable swelling that then becomes filled with pus. Boils are often very painful.

Sometimes they drain on their own, and go away without causing any problems. But medical treatment may be needed, particularly for big boils.

If someone gets boils often, it could be a sign that they have a medical condition that has weakened their immune system, increasing the risk of infections. It is then important to find out what that medical condition is, and treat both the underlying condition and the boils.

 

Illustration: Different types of hair follicle infections – as described in the articleDifferent types of hair follicle infections

Compresses and ointments

When a boil first appears, the pus-filled space inside the swollen bump (abscess) hasn’t yet fully developed. In this phase, doctors usually recommend applying a warm, moist, antiseptic compress (a cloth pad held in place by a bandage) or a special ointment that draws (pulls) pus out of the boil. This kind of ointment is also known as “drawing salve.” It typically contains a drug called ammonium bituminosulfonate, also known as Ichthyol. The compress and ointment are meant to speed up the development of the abscess inside the boil, so that it can drain and heal on its own later on – or be cut open and drained by a doctor.

Cutting and draining

The cutting and draining of boils is a standard treatment, particularly for large boils. It is usually an outpatient procedure (no need to stay overnight in a hospital). Before piercing the skin covering the boil, the doctor numbs the area around the inflammation with a local anesthetic or by cooling it.

Sometimes one or more strips of gauze or silicone are placed inside the open wound. These help to remove any remaining pus and fluid from the wound, keeping it clean and allowing the tissue to gradually recover. The strips are usually replaced every day, for instance by a family doctor.

In many cases, the wound is also cleansed with a sterile saline (salt) solution. Doctors sometimes use antiseptic solutions, ointments or dressings too. The wound generally isn’t sewn shut – it gradually closes up on its own. This is known as open wound healing or healing by secondary intention. While the wound is still open, a compress or plaster are used to protect it from dirt and germs.

Treatment for more severe cases

The above-mentioned treatments are usually enough, but sometimes other measures are needed – for instance, if the boil is on the face or if several boils have merged, forming a carbuncle.

Keeping still

If you have a boil on your face, it’s important to keep the infected area still. This is because movement and pressure can increase the risk of bacteria spreading to the brain through the bloodstream. So you should try to avoid using your face muscles. In other words: Don’t talk, and only eat liquid or mushy food that doesn’t have to be chewed, if possible. Bed rest is also recommended.

Antibiotics

If complications arise or are likely, antibiotics are taken as tablets or a liquid, or given in the form of an infusion (IV drip) or injection. When used in this way, they travel around the whole body in the bloodstream. This type of treatment is called systemic antibiotic therapy. It is usually only needed

  • if the boil is on your face, particularly on your nose or upper lip,
  • if you have several boils (furunculosis) or a carbuncle,
  • if the infection starts spreading through the lymph vessels,
  • if you have symptoms such as a fever, high pulse rate, low blood pressure and rapid breathing – or if blood tests suggest that the infection is spreading in the body.

Doctors usually prescribe an antibiotic that is effective in the treatment of boils, which are nearly always caused by the same type of bacteria.

In rare cases, samples of pus are taken and analyzed in a laboratory to find out exactly which type of bacteria is causing the infection. This is done, for instance, if the normal treatment approach doesn’t seem to be working, if it’s thought that the person may have blood poisoning (sepsis), or if there’s a risk that the bacteria are resistant to a lot of antibiotics. Once doctors know which strain of bacteria is causing the infection, they can use the type of antibiotic that is most likely to work.

Labels: Abscess, Boil, Carbuncle, L02, Skin abscess, Skin and hair