How are boils treated?

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.

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 infection 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.

Boils usually don't need any further treatment, but sometimes other measures are necessary – for instance, if the boil is on the face or if several boils have merged, forming a carbuncle.

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.

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.

Antibiotics are 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 may be done

• 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.