Everything you need to know about abscesses and boils

A boil is a painful, pus-filled bump that forms under your skin when your hair follicles become infected by bacteria and get inflamed. A carbuncle is a cluster of boils (furuncles) that form a connected area of infection under the skin.

Boils usually start as red or purple and painful bumps. The bumps quickly fill with pus, growing larger and more painful until they rupture and drain.

Areas most likely to be affected are the face, back of the neck, armpits, thighs and buttocks. Pricking and squeezing boils is not advisable, as it usually leads to the spread of the infection.

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When are boils serious?

Urgently see your doctor if:

• You have more than one boil at a time.
• It is found on your face or affects your vision.
• Worsens rapidly or is extremely painful.
• Gets bigger despite self-care
• Causes high temperature or fever.
• Has not healed in two weeks.
• It recurs.

Causes

Most boils are caused by Staphylococcus aureus, a type of bacteria commonly found on the skin and inside the nose. Boils sometimes develop at sites where the skin has been broken by a small injury or an insect bite, which gives the bacteria easy entry.

Symptoms

Boils can occur anywhere on your skin, but appear mainly on the face, back of the neck, armpits, thighs and buttocks. These are the hairy areas where you’re most likely to sweat or experience friction.

Signs and symptoms of a boil usually include:

• A painful, red bump that starts out small and can enlarge to more than five centimetres.
• Reddish or purplish, swollen skin around the bump.
• An increase in the size of the bump over a few days as it fills with pus.
• Development of a yellow-white tip that eventually ruptures and allows the pus to drain out.

A carbuncle is a cluster of boils that form a connected area of infection. Compared with single boils, carbuncles cause a deeper and more severe infection and are more likely to leave a scar.

People who have a carbuncle often feel unwell in general and may experience a fever and chills.

Risk factors

Anyone is at risk of developing boils. Even the people who seem healthy can develop boils or carbuncles.

The following factors, however, will increase your risk of developing these:

• Close contact with a person who has a staph infection. You’re more likely to develop an infection if you live with someone who has a boil or carbuncle.
• Diabetes. This disease can make it more difficult for your body to fight infection, including bacterial infections of your skin.
• Other skin conditions. Because they damage your skin’s protective barrier, skin problems, such as acne and eczema, make you more susceptible to boils and carbuncles.
• A compromised immune system. If your immune system is weakened for any reason, you’re more susceptible to boils and carbuncles. Commonly HIV.

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Complications

Rarely, bacteria from a boil or carbuncle can enter your bloodstream and travel to other parts of your body. The spreading infection, commonly known as blood poisoning (sepsis), can lead to infections deep within your body, such as your heart (endocarditis) and bone (osteomyelitis).

Prevention

It’s not always possible to prevent boils, especially if you have a weakened immune system. But the following measures may help you avoid staph infections:

• Wash your hands regularly with soap and water. Or use an alcohol-based hand rub often. Careful hand-washing is your best defence against germs.
• Keep wounds covered. Keep cuts and abrasions clean and covered with sterile, dry bandages until they heal.
• Avoid sharing personal items, such as towels, sheets, razors, clothing, athletic equipment and other personal items. Staphylococcus aureus infections can spread via objects, as well as from person to person.
• If you have a cut or sore, wash your towels and linens using detergent and hot water with added bleach, and dry them in a hot dryer.

Diagnosis

From a good history, physical examination, your doctor will be able to diagnose a boil or carbuncle simply by looking at it. A sample of the pus may be sent to the lab for testing. This may be useful if you have recurring infections or an infection that hasn’t responded to standard treatment.

Many varieties of the bacteria that cause boils have become resistant to certain types of antibiotics. So laboratory testing can help determine what type of antibiotic would work best.

Treatment

You can generally treat small boils at home by applying warm compresses to relieve pain and promote natural drainage.

For larger boils and carbuncles, treatment may include:

• Incision and drainage. Your doctor may drain a large boil or carbuncle by making an incision in it. Deep infections that can’t be completely drained may be packed with sterile gauze to help soak up and remove additional pus.
• Antibiotics. Sometimes your doctor may prescribe antibiotics to help heal severe or recurrent infections.

Self-treatment at home

For small boils, these measures may help the infection heal more quickly and stop it from spreading:

• Warm compresses. Apply a warm washcloth or compress to the affected area several times a day, for about 10 minutes each time. This helps the boil rupture and drain more quickly.
• Never squeeze or lance a boil yourself. This can spread the infection.
• Prevent contamination. Wash your hands thoroughly after treating a boil. Launder clothing, towels or compresses that have touched the infected area, especially if you have recurrent infections.

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