Boils


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Boils

 

Definition

Boils and carbuncles are bacterial infections of hair follicles and surrounding skin that form pustules (small blister-like swellings containing pus) around the follicle. Boils are sometimes called furuncles. A carbuncle is formed when several furuncles merge to form a single deep abscess with several heads or drainage points.

Description

Boils and carbuncles are firm reddish swellings about 0.2-0.4in (5-10 mm) across that are slightly raised above the skin surface. They are sore to the touch. A boil usually has a visible central core of pus; a carbuncle is larger and has several visible heads. Boils occur most commonly on the face, back of the neck, buttocks, upper legs and groin area, armpits, and upper torso. Carbuncles are less common than single boils; they are most likely to form at the back of the neck. Males are more likely to develop carbuncles.
Boils and carbuncles are common problems in the general population, particularly among adolescents and adults. People who are more likely to develop these skin infections include those with:
  • diabetes, especially when treated by injected insulin
  • alcoholism or drug abuse
  • poor personal hygiene
  • crowded living arrangements
  • jobs or hobbies that expose them to greasy or oily substances, especially petroleum products
  • allergies or immune system disorders, including HIV infection.
  • family members with recurrent skin infections

Causes and symptoms

Boils and carbuncles are caused by Staphylococcus aureus, a bacterium that causes an infection in an oil gland or hair follicle. Although the surface of human skin is usually resistant to bacterial infection, S. aureus can enter through a break in the skin surface—including breaks caused by needle punctures for insulin or drug injections. Hair follicles that are blocked by greasy creams, petroleum jelly, or similar products are more vulnerable to infection. Bacterial skin infections can be spread by shared cosmetics or washcloths, close human contact, or by contact with pus from a boil or carbuncle.
As the infection develops, an area of inflamed tissue gradually forms a pus-filled swelling or pimple that is painful to touch. As the boil matures, it forms a yellowish head or point. It may either continue to swell until the point bursts open and allows the pus to drain, or it may be gradually reabsorbed into the skin. It takes between one and two weeks for a boil to heal completely after it comes to a head and discharges pus. The bacteria that cause the boil can spread into other areas of the skin or even into the bloodstream if the skin around the boil is injured by squeezing. If the infection spreads, the patient will usually develop chills and fever, swollen lymph nodes (lymphadenitis), and red lines in the skin running outward from the boil.
Furunculosis is a word that is sometimes used to refer to recurrent boils. Many patients have repeated episodes of furunculosis that are difficult to treat because their nasal passages carry colonies of S. aureus. These bacterial colonies make it easy for the patient's skin to be reinfected. They are most likely to develop in patients with diabetes, HIV infection, or other immune system disorders.
Carbuncles are formed when the bacteria infect several hair follicles that are close together. Carbunculosis is a word that is sometimes used to refer to the development of carbuncles. The abscesses spread until they merge with each other to form a single large area of infected skin with several pus-filled heads. Patients with carbuncles may also have a low-grade fever or feel generally unwell.

Diagnosis

The diagnosis of boils and carbuncles is usually made by the patient's primary care doctor on the basis of visual examination of the skin. In some cases involving recurrent boils on the face, the doctor may need to consider acne as a possible diagnosis, but for the most part boils and carbuncles are not difficult to distinguish from other skin disorders.

Treatment

Patient and family education

Patient education is an important part of the treatment of boils and carbuncles. Patients need to be warned against picking at or squeezing boils because of the danger of spreading the infection into other parts of the skin or bloodstream. It is especially important to avoid squeezing boils around the mouth or nose because infections in these areas can be carried to the brain. Patients should also be advised about keeping the skin clean, washing their hands carefully before and after touching the boil or carbuncle, avoiding the use of greasy cosmetics or creams, and keeping their towels and washcloths separate from those of other family members. Some doctors may recommend an antiseptic soap or gel for washing the infected areas.
If the patient has had several episodes of furunculosis, the doctor may examine family members or close contacts to see if they are carriers of S. aureus. In many cases they also need treatment for boils or carbuncles. Skin infections and reinfections involving small groups or clusters of people are being reported more frequently in the United States.

Medications

Boils are usually treated with application of antibiotic creams—usually clindamycin or polymyxin—following the application of hot compresses. The compresses help the infection to come to a head and drain.
Carbuncles and furunculosis are usually treated with oral antibiotics as well as antibiotic creams or ointments. The specific medications that are given are usually dicloxacillin (Dynapen) or cephalexin (Keflex). Erythromycin may be given to patients who are allergic to penicillin. The usual course of oral antibiotics is 5-10 days; however, patients with recurrent furunculosis may be given oral antibiotics for longer periods. Furunculosis is treated with a combination of dicloxacillin and rifampin (Rifadin).
Patients with bacterial colonies in their nasal passages are often given mupirocin (Bactroban) to apply directly to the lining of the nose.

Surgical treatment

Boils and carbuncles that are very large, or that are not draining, may be opened with a sterile needle or surgical knife to allow the pus to drain. The doctor will usually give the patient a local anesthetic if a knife is used; surgical treatment of boils is painful and usually leaves noticeable scars.

Alternative treatment

Naturopathic therapy

Naturopathic practitioners usually recommend changes in the patient's diet as well as applying herbal poultices to the infected area. The addition of zinc supplements and vitamin A to the diet is reported to be effective in treating boils. The application of a paste or poultice containing goldenseal (Hydrastis canadensis) root is recommended by naturopaths on the grounds that goldenseal helps to kill bacteria and reduce inflammation.

Key terms

Abscess — A localized collection of pus in the skin or other body tissue.
Carbuncle — A large, deep skin abscess formed by a group or cluster of boils.
Follicle — The small sac at the base of a hair shaft. The follicle lies below the skin surface.
Furunculosis — A condition in which the patient suffers from recurrent episodes of boils.
Pustule — A small raised pimple or blister-like swelling of the skin that contains pus.

Homeopathy

Homeopaths maintain that taking the proper homeopathic medication in the first stages of a boil or carbuncle will bring about early resolution of the infection and prevent pus formation. The most likely choices are Belladonna or Hepar sulphuris. If the boil has already formed, Mercurius vivus or Silica may be recommended to bring the pus to a head.

Western herbal therapies

A variety of herbal remedies can be applied topically to boils to fight infection. These include essential oils of bergamot (Citrus bergamia), chamomile (Matricaria recutita), lavender (Lavandula officinalis), and sage (Salvia officinalis), as well as tea tree oil (Melaleuca spp.). Herbalists also recommend washing the skin with a mixture of goldenseal and witch hazel. To fight the inflammation associated with boils, herbalists suggest marsh mallow (Althaea officinalis) ointment, tinctures (herbal solutions made with alcohol) of blue flag (Iris versicolor) or myrrh (Commiphora molmol), and slippery elm (Ulmus fulva) made into a poultice.

Prognosis

The prognosis for most boils is excellent. Some patients, however, suffer from recurrent carbuncles or furunculosis. In addition, although the spread of infection from boils is relatively unusual, there have been deaths reported from brain infections caused by squeezing boils on the upper lip or in the tissue folds at the base of the nose.

Prevention

There are some precautions that people can take to minimize the risk of developing bacterial skin infections:
  • cleanse skin properly with soap and water, and take showers rather than tub baths
  • do not share washcloths, towels, or facial cosmetics with others
  • cut down on greasy or fatty foods and snacks
  • always wash hands before touching the face
  • consider using antiseptic soaps and shower gels
  • consult a doctor if furunculosis is a persistent problem—it may indicate an underlying disease such as diabetes

Resources

Books

Hacker, Steven M. "Common Bacterial and Fungal Infections of the Integument." In Current Diagnosis, edited by Rex B. Conn, et al. Vol 9. Philadelphia: W. B. Saunders Co., 1997.

Patient discussion about Boils

Q. how do i get rid of boils I have been plagued by boils for about 3 to 4 years now, i get a boil, go to the doctor, get antibiotics, take them for 10 days, and about a week later the boils are back. I came accoss this site a week ago and learned about (turmeric) i purchased some, i've been taking it and i still manage to get more boils, i have one existing boil right now and a new one is forming please help because i don't have health insurance and it cost to much to keep going to the doctor and getting medicine for boils only to have the boils occur back in a weeks time please help, demario y

A. Have you ever consulted a dermatologist (a doctor that specialize in skin problems)? He or she may diagnose the problem more accurately and address it better. What you describe may be acne or other disease that are treated by such doctors.

Anyway, you can find several suggestions about preventing boils here (http://www.medicinenet.com/boils/article.htm) and here (http://www.nlm.nih.gov/medlineplus/ency/article/001474.htm)

Q. hey how about having brown rice in place of white or boiled rice…….?

A. Brown rice is a good carb, plus I personally think it tastes delicious.

Q. what should i do if i got burned from boiling water? how should i take care of my self? will i get a scar?

A. ooooOOOooo! i hope you are asking a hypothetic question... a friend wife of mine still got scars from a boiling water accident a few years back. anyway, here is a site that gives instructions on how to react after burns. boiling water is probably second degree burns:
http://familydoctor.org/online/famdocen/home/healthy/firstaid/after-injury/638.html

More discussions about Boils
References in periodicals archive ?
That's like saying you can't boil water to make a cup of tea.
A cluster of connected boils is called a carbuncle.
Far be it from me to teach my Michelin-starred grandchefs to boil eggs, but the rule should not be to leave it for six minutes after the water boils but to apply the formula: W=7-B/2 giving W, the minutes the egg should be left in the water, in terms of B, which is the minutes it takes to boil.
Of course, we all know that water boils at +100[degrees]C.
It poaches a single egg or boils up to four, soft, medium or hard.
Hums annoyingly in use but it's very quick: 300ml (a large mug's worth) boils in just 45 seconds.
As the new technology fully boils hops before mixing them with wort, it shortens the time for the total boiling process and thus improves the efficiency in the use of gas and electricity, Asahi said.
When water boils, add rice, stir and reduce the heat to low.
As the syrup boils water is driven off as steam, the sugar concentration increases, and the temperature of the syrup rises to well beyond the boiling point of water.
Since water boils at lower temperatures at higher altitudes (approximately 90[degrees]C at 3 kin), boiling times must also compensate for decreased atmospheric pressure conditions (1,2).
Boils seemed to be the main worry for us, and my mother would slap a boiling hot piece of bread on the offending lump, to screams of agony.
We discussed Sunday dinners and how a watched pot never boils.