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Boils are infected, pus-filled swellings in the skin that are often located in or near hair follicles. They are most often found on the back of the neck and in other moist areas of the body like the armpits and groin, but may be anywhere on the body. Sometimes several boils form close together in a cluster. A carbuncle is formed when several boils merge to form a single deep abscess with several heads or drainage points. An abscess may be so deep that it may not surface for a long time.
Boils and carbuncles are firm reddish swellings about 5-10mm 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.
There are several different types of boils, including: - Furuncle or carbuncle -- An abscess in the skin caused by the bacteria Staphylococcus aureus. It can have one or more openings onto the skin and may be associated with a fever or chills. They are less common than single boils; they are most likely to form at the back of the neck and in males. Carbuncles can form in the same areas as boils, and may also form on the scalp, face, and buttocks. 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 Staphylococcus aureus. These bacterial colonies make it easy for the patient's skin to be reinfected.
- Folliculitis -- A milder version of boils. This is an infection of hair follicles, usually with Staph bacteria. These often itch more than hurt. The appearance is similar to acne pustules.
- Cystic acne -- A type of abscess formed when oil ducts become clogged and infected. Cystic acne is most common in the teenage years.
- Hidradenitis suppurativa -- An uncommon illness of unknown cause in which there are multiple abscesses that form under the armpits, in the groin area, or under the breasts. These areas are a result of local inflammation of the sweat glands.
- Pilonidal cyst An type of abscess that occurs in the crease of the buttocks. These frequently form after long trips that involve sitting.
Causes & Development; Risk Factors
There are many causes of boils. Some boils can be caused by an ingrown hair. Others can form as the result of a splinter or other foreign material lodged in the skin. Others, such as those of acne, are caused by plugged sweat glands that become infected. Any break in the skin such as a cut or scrape can develop into an abscess if it becomes infected with bacteria.
Boils and carbuncles are more likely to develop in 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
Signs & Symptoms
A boil, or skin abscess, is a localized infection deep in the skin. A boil generally starts as an itchy, red, painful lump. Over time, the area becomes firm and hard. Usually within 24 hours, the lump fills with pus and takes on a round appearance with a yellow-white tip. Eventually, the center of the abscess softens; the pus forms a "head" and drains out through the skin.
There may be swelling around the boil as well as swelling of any lymph nodes near the boil.
Treatment & Prevention
Most simple boils can be treated at home. The treatment should start as soon as a boil is noticed since early treatment may prevent later problems.
Since releasing the pus in a boil can lead to more infection, puncturing it at home is not usually advised. If you do lance it, or if it bursts, make sure to sterilize the surrounding area carefully, washing hands after touching the area.
Medical treatment by a healthcare provider may include lancing or puncturing the boil to release the pressure and allow for drainage. Antibiotics may be prescribed to stop the infection.
Medications such as isotretinoin (Accutane) can be used for cystic acne; this has been helpful for some patients with hidradenitis suppurativa.
There are some measures that you can take to prevent abscesses from forming. Practicing good hygiene habits minimizes the frequency of recurring boils and prevents the spread of infection. This includes not picking at boils, using clean towels after each bath or shower, and cleaning the skin with an antiseptic / antibacterial soap such as Betadine. Antibacterial soaps may help prevent bacteria build up on the skin and therefore reduce the chance for an abscess to form.
Prognosis; Seek medical attention if
Boils may take from 10 to 25 days to heal. In most cases, a boil will not heal until it bursts and drains. This can take as long as 5 to 7 days. A single boil can usually be cared for at home and does not require a trip to the doctor.
Recurrences are common in patients with hidradenitis suppurativa.
Any boil or abscess in a patient with diabetes or a patient with an underlying illness (such as cancer, rheumatoid arthritis, etc.) should be seen by a doctor. Additionally, many medicines, especially prednisone, that suppress the immune system (the natural infection-fighting system of the body) can complicate what would be an otherwise simple boil. Patients who are on such medications should consult their doctor if they develop boils.
Any boil that is associated with a fever should receive medical attention. A pilonidal cyst is a special case and almost always requires medical treatment including drainage and packing (putting gauze in the open abscess to assure it continues to drain). Finally, any painful boil that is not rapidly improving should be seen.
You should also see a doctor if:- a boil develops in a child or a sick or elderly person
- a boil develops on the face near the eyes or nose
- a boil becomes extremely large or painful
- a cluster of boils form or you have an abscess
- boils become increasingly common
- red lines spread out from the center of the boil
- the boil is extremely tender
- fever and chills develop
- lymph nodes begin to swell that are located in other areas of the body from where the original lymph node swelling occurred.
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Conditions that suggest Boils, Abscesses, Carbuncles:
Risk factors for Boils, Abscesses, Carbuncles:
Recommendations and treatments for Boils, Abscesses, Carbuncles: | | | | | Botanical |  Goldenseal | The application of a paste or poultice containing goldenseal root is sometimes recommended on the grounds that goldenseal helps to kill bacteria and reduce inflammation. |
Castor Oil |
Drug |
 Antibiotics| | Boils often resolve by themselves, but severe or recurring cases require medical treatment. Options include lancing and draining the boil, or antibiotics. If there is an infection of the surrounding skin, a doctor may decide to prescribe antibiotics. However, antibiotics are not needed in every case and, in fact, do not enter an abscess well and will not cure an abscess. For acne and hidradenitis suppurativa, antibiotics may be required on a long-term basis to prevent abscess formation. In cases of multiple or recurrent boils, antibiotics are taken by mouth for 10 or 14 days. Stubborn cases may require two oral antibiotics plus topical antibiotic ointments to eliminate the bacteria. |
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Homeopathy |
Calcarea sulfuricum Cell Salt
Homeopathic Remedies| | Boils, carbuncles and other septic conditions can be effectively treated through homoeopathy. Suggested remedies include:- Arsenicum album: Deeply infected boils with intensely burning pain and offensive discharge. Warmth and hot applications usually are soothing. The person may feel exhausted and ill, yet anxiety and discomfort also make them restless.
- Belladonna: Used in the early stages of inflammation, before much pus has formed. The area is red, hot, throbbing, and tender, often with intense or stabbing pains. Jarring or touch may increase discomfort. The person may also feel excitable or feverish.
- Calendula: Used as a topical application for boils and infected sores. It can be used in herbal form or in low dilution as a tincture, ointment, or compress. Taken internally, Calendula can help the body overcome infection.
- Echinacea angustifolia: People who need this remedy typically feel sickly, lethargic, achy, and chilly.
- Hepar sulphuris calcareum: When a boil is extremely tender and sensitive to touch, this remedy can be helpful. A splinter-like sticking pain is often felt. The boil may produce deep pockets of offensive pus or be slow to heal. This remedy is also indicated when boils seem to be spreading. A person who needs this remedy usually is vulnerable and touchy, with extreme sensitivity to cold.
- Mercurius solubilis: When boils are very sensitive with advanced development of pus. The person may have moist or greasy-looking skin, with swollen lymph nodes and offensive breath, and be very sensitive to changes in temperature. Warmth may aggravate the pain.
- Silica: Boils that form hard lumps and are slow to come to a head and slow to heal. If many boils form at once, or boils frequently recur, it is often very useful. People who need this remedy are sensitive and nervous, inclined toward colds and swollen glands, and easily fatigued.
- Tarentula cubensis: When a boil is sore and swollen with stinging, burning pain, and purplish or bluish discoloration of surrounding tissues. A person who needs this remedy may also have restless feet and difficulty sleeping.
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Mineral |
Iron| | Recurrent boils are sometimes associated with low iron levels. |
Zinc
Colloidal Silver |
Physical Medicine |
 Hot Applications (Thermotherapy)| | The main treatment for most boils is heat application, usually with hot soaks or hot packs. Heat application increases the circulation to the area and allows the body to better fight off the infection. As long as the boil is small and firm, opening the area and draining the boil is not helpful, even if the area is painful. However, once the boil becomes soft or "forms a head" (that is, a small pustule is noted in the boil), it is ready to drain. Once drained, pain relief can be dramatic. Most small abscesses, such as those that form around hairs, drain on their own with soaking. On occasion, and especially with larger boils, these will need to be drained or "lanced" by a healthcare practitioner. Frequently, these larger boils contain several pockets of pus that must be opened and drained.
Apply warm, moist compresses for 20 minutes, 4 times a day to encourage circulation and resolution. Take showers instead of baths (baths can spread infection) and keep the boil covered with a clean bandage. |
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Surgery/Invasive |
Surgery| | Surgery may occasionally be needed, especially in cases of pilonidal cysts that recur, but also for hidradenitis suppurativa. For pilonidal cysts, surgically removing the cyst lining is important. The procedure is typically performed in the operating room. For hidradenitis suppurativa, extensive involvement can require plastics surgical repair. |
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KEY | | Strong or generally accepted link |  | | Proven definite or direct link | | | May do some good | | | Likely to help | | | Highly recommended |
GLOSSARY
Acne
A chronic skin disorder due to inflammation of hair follicles and sebaceous glands (secretion glands in the skin).
Allergy (Allergies)
Hypersensitivity caused by exposure to a particular antigen (allergen), resulting in an increased reactivity to that antigen on subsequent exposure, sometimes with harmful immunologic consequences.
Antiseptic
Inhibiting growth of infectious organisms.
Anxiety
Apprehension of danger, or dread, accompanied by nervous restlessness, tension, increased heart rate, and shortness of breath unrelated to a clearly identifiable stimulus.
Bacteria (Bacterial, Bacterium)
Microscopic germs. Some bacteria are "harmful" and can cause disease, while other "friendly" bacteria protect the body from harmful invading organisms.
Boil (Abscess, Abscesses, Boils, Carbuncle, Carbuncles, Cystic Acne, Furuncle, Furuncles, Hidradenitis Suppurativa, Pilonidal Cyst, Pilonidal Cysts)
A localized infection deep in the skin. A boil generally starts as a reddened, tender area. Over time, the area becomes firm and hard. Eventually, the center of the abscess softens and becomes filled with white cells that the body sends to fight the infection (pus). Finally, the pus forms a "head" and drains out through the skin. A furuncle or carbuncle is an abscess in the skin caused by the bacteria Staphylococcus aureus. It can have one or more openings onto the skin and may be associated with a fever or chills. Cystic acne is a type of abscess formed when oil ducts become clogged and infected. Cystic acne is most common in the teenage years. Hidradenitis suppurativa is an illness in which there are multiple abscesses that form under the arm pits and in the groin area. These areas are a result of local inflammation of the sweat glands. A pilonidal cyst is a special kind of abscess that occurs in the crease of the buttocks. These frequently form after long trips that involve sitting.
Cancer
Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.
Chronic Renal Failure (Chronic Renal Insufficiency, Kidney Failure, Renal Insufficiency)
(CRF) Irreversible, progressive impaired kidney function. The early stage, when the kidneys no longer function properly but do not yet require dialysis, is known as Chronic Renal Insufficiency (CRI). CRI can be difficult to diagnose, as symptoms are not usually apparent until kidney disease has progressed significantly. Common symptoms include a frequent need to urinate and swelling, as well as possible anemia, fatigue, weakness, headaches and loss of appetite. As the disease progresses, other symptoms such as nausea, vomiting, bad breath and itchy skin may develop as toxic metabolites, normally filtered out of the blood by the kidneys, build up to harmful levels. Over time (up to 10 or 20 years), CRF generally progresses from CRI to End-Stage Renal Disease (ESRD, also known as Kidney Failure). Patients with ESRD no longer have kidney function adequate to sustain life and require dialysis or kidney transplantation. Without proper treatment, ESRD is fatal.
Cysts (Cyst)
A closed pocket or pouch of tissue; a cyst may form within any tissue in the body and can be filled with air, fluid, pus, or other material. Cysts within the lung generally are air-filled, while cysts involving the lymph system or kidneys are fluid filled. Cysts under the skin are benign, extremely common, movable lumps. These may develop as a result of infection, clogging of sebaceous glands, developmental abnormalities or around foreign bodies.
Diabetes Mellitus (Diabetes, Diabetic, Diabetics)
A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.
Discharge (Discharges)
A secretion, of pus for example, from a wound or bodily orifice.
Furunculosis
Localized skin infection.
Gland (Glands)
The glandular system is one of the most important and complicated systems of the body. Gland tissue can be either an organ or general tissue that secretes chemicals and there are two types of gland: exocrine and endocrine. Those glands which secrete chemicals through tubules or ducts are called exocrine and include sweat, tear and salivary glands. Ductless glands - part of the endocrine system - secrete special chemicals (hormones) directly into the blood.
Herbs (Herb, Herbal)
Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with one teaspoon herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Tinctures may be used singly or in combination as noted. The high doses of single herbs suggested may be best taken as dried extracts (in capsules), although tinctures (60 drops four times per day) and teas (4 to 6 cups per day) may also be used.
Human Immunodeficiency Virus (HIV)
A retrovirus associated with onset of advanced immunodeficiency syndrome (AIDS).
Immune System (Immune Response, Immunity)
A complex that protects the body from disease organisms and other foreign bodies. The system includes the humoral immune response and the cell-mediated response. The immune system also protects the body from invasion by making local barriers and inflammation. The process may involve acquired immunity (the ability to learn and remember a specific infectious agent), or innate immunity (the genetically programmed system of responses that attack, digest, remove, and initiate inflammation and tissue healing).
Insulin
A hormone secreted by the pancreas in response to elevated blood glucose levels. Insulin stimulates the liver, muscles, and fat cells to remove glucose from the blood for use or storage.
Iron
An essential mineral. Prevents anemia: as a constituent of hemoglobin, transports oxygen throughout the body. Virtually all of the oxygen used by cells in the life process are brought to the cells by the hemoglobin of red blood cells. Iron is a small but most vital, component of the hemoglobin in 20,000 billion red blood cells, of which 115 million are formed every minute. Heme iron (from meat) is absorbed 10 times more readily than the ferrous or ferric form.
Lymph Nodes (Axillary Nodes, Inguinal Nodes, Lymph Gland, Lymph Glands, Lymph Node, Lymphatic)
Small, bean-shaped nodes at various points throughout the body that function to filter the lymph fluid and attempt to destroy the microorganisms and abnormal cells which collect there. The most common locations are the neck (both sides and front), armpit (axillary) and groin (inguinal), but also under the jaw and behind the ears. Swollen or painful lymph nodes generally result from localized or systemic infection, abscess formation, or malignancy. Other causes of enlarged lymph nodes are extremely rare. Physical examination for lymph nodes includes pressing on them to check for size, texture, warmth, tenderness and mobility. Most lymph nodes can not be felt until they become swollen, and then will only be tender when pressed or massaged. A lymph node that is painful even without touching indicates greater swelling. Lymph nodes can usually be distinguished from other growths because they generally feel small, smooth, round or oval-shaped and somewhat mobile when attempts are made to push them sideways. Because less fat covers the lymph nodes in children, they are easier to feel, even when they are not busy filtering germs or making antibodies. Childrens' nodes enlarge faster, get bigger in response to an infection and stay swollen longer than an adult's. Also known (incorrectly) as lymph glands.
Millimeter (Millimeters, mm)
A metric unit of length equaling one thousandth of a meter, or one tenth of a centimeter. There are 25.4 millimeters in one inch.
Poultice
Soft mass prepared by moistening botanicals or other absorbent substances with oil or water, usually applied hot to the skin.
Pus
White cells that the body sends to fight an infection.
Pustule
Small elevation of the skin containing pus.
Rheumatoid Arthritis
A long-term, destructive connective tissue disease that results from the body rejecting its own tissue cells (autoimmune reaction).
Staphylococcus (Staph, Staphylococcal)
A genus of micrococci bacteria with many members that can cause disease. They are gram-positive, nonmotile bacteria
that are aerobic-(unless they need to be anaerobic). Staph of various types are responsible for boils and carbuncles; they may be involved in impetigo, toxic shock syndrome, endocarditis, osteomyelitis, and urinary tract infections, as well as some food poisoning. They stay around hospitals and veterinary clinics waiting to get you. They are also a normal part of the mouth, throat, and skin flora in a third to a half of all of us, causing no problems, but just waiting. Staph has always been with us. Some even eat our antibiotics for breakfast.
Tincture
An alcohol or water-alcohol solution, usually referring to a preparation from herbal materials.
Topical
Most commonly 'topical application': Administration to the skin.
Zinc
An essential trace mineral. The functions of zinc are enzymatic. There are over 70 metalloenzymes known to require zinc for their functions. The main biochemicals in which zinc has been found to be necessary include: enzymes and enzymatic function, protein synthesis and carbohydrate metabolism. Zinc is a constituent of insulin and male reproductive fluid. Zinc is necessary for the proper metabolism of alcohol, to get rid of the lactic acid that builds up in working muscles and to transfer it to the lungs. Zinc is involved in the health of the immune system, assists vitamin A utilization and is involved in the formation of bone and teeth.
Last updated: Feb 02, 2009
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