Boils

Discussion

Infection of the hair follicle, much deeper than simple folliculitis and can appear in clusters. The infection is generally caused by staph bacteria. For lymphedema patients, it is important not to pick at or squeeze any carbuncles, boil or pimple. This can spread the infection and lead to serious complications such as cellulitis, lymphangitis, erysipelas.

Carbuncles are generally found on the back of the neck or thigh.

Clinical:

tender red inflamed "spots" (erythematous)

pus in the center of the boils

whitish, bloody discharge (pus) from the sore

may also include fever and fatigue (based upon the spread of the infection)

A boil, also referred to as a skin abscess, is 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 infection-fighting white blood cells that the body sends from the bloodstream to eradicate the infection. This collection of white blood cells, bacteria, and proteins is known as pus. Finally, the pus "forms a head," which can be surgically opened or spontaneously drain out through the surface of the skin.(1)

Treatment:

Antibiotics may be prescribed, based on the underlying medical condition of the patient.

Topical antibiotics

Warm compress may be used to promote drainage of the lesion.

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 can be ready to drain. Once drained, pain relief can be dramatic. Most small boils, such as those that form around hairs, drain on their own with soaking. On occasion, and especially with larger boils, the larger boil will need to be drained or "lanced" by a health-care practitioner. Frequently, these larger boils contain several pockets of pus that must be opened and drained.

Prevention

The key is prevention of boils through proper skin care. If the skin is allowed to become dry and brittle, the skin is more susceptible to cracking, developing small fissures and or small openings. We need to pay good attention to hygiene and when we wash we should use antibacterial soaps and/or antiseptic washes.

Boils

Boils are painful, pus filled firm lesions that are generally located waist area, groin, buttocks or under the arm. However, with lymphedema patients due to the localized immunodeficient limb they may even occur in any general area of the leg or arm.

Clinical:

Firm, painful and red lesions

Pus in the center of the boil (having a "core")

Whitish, bloody discharge from the sore

Treatment:

Much the same as for carbuncles.

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Boils

A boil is a skin infection that starts in a hair follicle or oil gland. At first, the skin turns red in the area of the infection, and a tender lump develops. After four to seven days, the lump starts turning white as pus collects under the skin.

The most common places for boils to appear are on the face, neck, armpits, shoulders, and buttocks. When one forms on the eyelid, it is called a sty.

If several boils appear in a group, this is a more serious type of infection called a carbuncle.

Causes of Boils

Most boils are caused by a bacteria called Staphylococcus. This germ enters the body through tiny breaks in the skin or by traveling down a hair to the follicle.

Certain health problems make people more susceptible to skin infections such as boils. Examples are

diabetes,

problems with the immune system,

poor nutrition,

poor hygiene, and

exposure to harsh chemicals that irritate the skin.

Symptoms of Boils

A boil starts as a hard, red, painful lump usually less than an inch in size. Over the next few days, the lump becomes softer, larger, and more painful. Soon a pocket of pus forms on the top of the boil. Signs of a severe infection are

the skin around the boil becomes red, painful and swollen;

more boils may appear around the original one;

a fever develops; and

the lymph nodes become swollen

When to Seek Medical Care

You start running a fever.

The skin around the boil turns red or red streaks appear.

The pain becomes severe.

The boil does not drain.

A second boil appears.

You have a heart murmur, diabetes, any problem with your immune system, or are taking medications that suppress the immune system (for example, corticosteroids or chemotherapy for cancer) and you develop a boil.
Boils usually do not need immediate emergency attention. If you are in poor health and you develop high fever and chills along with the infection, a trip to a hospital's emergency department is needed.

Exams and Tests

Your doctor can make the diagnosis of a boil with a physical exam. If you frequently get boils, your doctor may want to do a blood test to see if you have diabetes.

Boils Treatment

Self-Care at Home

Apply warm compresses, and soak the boil in warm water. This will decrease the pain and help draw the pus to the surface. Once the boil comes to a head, it will burst with repeated soakings. This usually occurs within five to seven days of its appearance. You can make a warm compress by soaking a wash cloth in warm water and squeezing out the excess moisture.

When the boil starts draining, wash it with an antibacterial soap until all the pus is gone. Apply a medicated ointment and a bandage. Continue to wash the infected area two to three times a day and to use warm compresses until the wound heals.

Do not pop the boil with a needle. This usually results in making the infection worse.

Medical Treatment

If the boil is large, your health-care provider may need to open it up and drain the pus. This is done with a scalpel after the area of the boil is numbed with a local anesthetic.

If the infection is deep, your doctor may put some gauze in the incision to keep it open and draining. The gauze is usually removed in two days.

If there are concerns about the seriousness of the infection, blood tests may be needed. The doctor may prescribe antibiotics if the infection is severe. If the boil is drained, a culture may be done to determine the type of bacteria causing the infection and to assess if an appropriate antibiotic was given.

Next Steps

Follow-up

Whether the boil is drained at home or is lanced by a doctor, you will need to clean the infected area two to three times a day until the wound is healed. Apply an antibiotic ointment after washing and cover with a bandage. If the area turns red or looks as if it is getting infected again, contact your doctor.

Prevention

Help prevent boils by following these guidelines:

Carefully wash clothes, bed linen, and towels of a family member who is infected with boils.

Clean and treat minor skin wounds.

Practice good personal hygiene.

Stay as healthy as possible
Outlook

Most boils will disappear with simple home treatment.

Synonyms and Keywords

infected hair, abscess, ingrown hair, infected gland, furuncle, carbuncle, sty, skin infection, boils

Authors and Editors

Author: Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Assumption Community Hospital.

Editor: Melissa Conrad Stöppler, MD, Chief Medical Editor, eMedicineHealth.com

Previous contributing editors:

Editors: Scott H Plantz, MD, FAAEM, Research Director, Assistant Professor, Department of Emergency Medicine, Mount Sinai School of Medicine; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; Jeter (Jay) Pritchard Taylor III, MD, Vice-Chief, Compliance Officer, Attending Physician Emergency Medicine Residency, Department of Emergency Medicine, Palmetto Richland Memorial Hospital, University of South Carolina.

eMedicineHealth

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Boils and Carbuncles

What are boils and carbuncles?

A boil is a type of infected sore on the skin. The sore is raised, red, painful, and filled with pus. A carbuncle is a large severe boil or group of boils that develop close together due to the spread of the infection.

How do they occur?

Boils commonly develop because bacteria have infected hair follicles (the small openings out of which hair grows).

Staphylococcus aureus ("staph") is the name of the bacteria that usually infect hair follicles. The bacteria normally live on the skin, particularly on certain parts of the body (rectum, nose, mouth, and genitals). The bacteria cause an infection only if they penetrate the skin through a scrape, irritation, or injury of some kind. Sometimes friction (from clothing, for example) will cause a hair follicle to swell up. The opening becomes closed, trapping the bacteria inside and starting an infection.

Boils and carbuncles often form in moist areas of the body such as the back of the neck, buttocks, thighs, groin, and armpits.

If you have a chronic illness, such as diabetes or kidney or liver disease, you may be more likely to have boils and carbuncles.

What are the symptoms?

A boil starts out suddenly as a red, painful lump. Usually within 24 hours, the lump fills with pus and takes on a round appearance with a yellow-white tip. There may be swelling around the boil as well as swelling of any lymph nodes near the boil. (You are most likely to notice swollen lymph nodes in the neck, armpit, or groin area.) The boil may be tender to touch or quite painful.

Symptoms of carbuncles are similar but more severe than those of boils.

How are they diagnosed?

Your health care provider will examine the infected area. Tell your provider if you have had a boil or carbuncle longer than 2 weeks or you if you have boils often.

If you have boils often, you may have lab tests of your blood or urine. These tests can check for conditions that might cause the sores, such as diabetes mellitus or kidney or liver disease.

How is it treated?

A boil can sometimes be treated at home, but a carbuncle often needs medical treatment.

For treatment at home you can:

Put warm, moist compresses on the boil or carbuncle for 10 to 15 minutes at least 3 times a day. For example, you can use a washcloth soaked in warm water. Be careful not to burn yourself.
Clean the sore with antiseptic soap and protect it with a loose gauze dressing until it has healed.
Take acetaminophen or another pain reliever.

These steps will help relieve the pain, reduce the risk of spreading the infection, and help boils to heal.

See your health care provider if:

A boil does not drain and heal with treatment at home.
The boil lasts longer than 1 week.
The boil becomes very large or painful.
You are elderly or you have diabetes.
You have a boil on your face or near your eyes or nose.
You have a cluster of boils or they become increasingly more common.

Your health care provider may recommend that you take antibiotic drugs to heal the infection. Your provider may drain the boil or carbuncle by opening it with a sterile needle or scalpel. After the sore has been opened, it should be covered with a loose, gauze dressing until it heals. (Do not try to open a boil at home. This may cause harmful spread of the infection.)

If you have an underlying illness, such as diabetes, your health care provider will want you to schedule regular appointments so your condition can be monitored. If your boil or carbuncle does not heal properly or if new symptoms develop, contact your provider.

How long will the effects last?

Boils may take from 1 to 3 weeks to heal. In most cases, a boil will not heal until it opens and drains. This can take up to a week.

A carbuncle often requires treatment by your health care provider. Depending on the severity of the problem and its treatment, the carbuncle should heal in 2 to 3 weeks after treatment.

Your health care provider may want to see you for a follow-up visit if he or she prescribes medicine to treat the infection, such as antibiotics, or treats it by opening the boil.

How can I take care of myself?

Be sure to follow the instructions your health care provider gives you. Take any prescribed medicine as directed.

What can I do to help prevent boils and carbuncles?

To help prevent boils and carbuncles from spreading and recurring:

Do not open or squeeze the boil yourself. This can cause the infection to spread.
If the boil does open or drain, clean it with an antiseptic soap. Cover it with a loose, gauze dressing.
Wash clothes that touch the infected area in hot, soapy water on a daily basis. Dry clothes on the hot setting if you use an automatic dryer.
Practice good personal hygiene. Bathe or shower daily.
Wash your hands often. Always wash them after caring for the boil, after using the bathroom, and especially before touching any food. (The bacteria that cause boils can also cause food poisoning.)
Get treatment for any underlying illness.

Developed by McKesson Health Solutions LLC.

Published by McKesson Health Solutions LLC.

link no longer valid

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Boils

People refer to tender, red lumps that may ooze pus as boils. A single "boil" may be a ruptured cyst or a small abscess. Most boils can be treated by "incision and drainage", a minor surgical procedure to open the boil and to drain the pus. Oral antibiotics are usually not needed.

Some people have multiple or recurrent boils. These boils are usually Staph infections (furuncles or carbuncles). The bacteria are picked up somewhere and then live on the skin, crowding out the normal, harmless bacteria we all carry. The source may be a family member, a pet or just appear "out of the blue."

In these cases antibiotics are taken by mouth for 10 or 14 days. In stubborn cases two oral antibiotics plus topical antibiotic ointments are usually required to eliminate the bacteria.

Gentle heat, provided by a moist, warm washcloth held over the area for 20 minutes three times a day, speeds up the healing process. Putting antibiotic ointment (Neosporin, Bacitracin, Iodine or Polysporin) on the boil will not cure it because the medicine does not penetrate into the infected skin. Covering the boil with a Band-Aid will keep the germs from spreading.

A milder version of boils is folliculitis. This is an infection of hair follicles, usually with Staph bacteria. These often itch more than hurt. The appearance is similar to acne pustules.

http://www.aocd.org/skin/dermatologic_diseases/boils.html

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External Links

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Carbuncles

A cluster of furuncles with subcutaneous spread of staphylococcal infection,
resulting in deep suppuration, often extensive local sloughing, slow
healing, and a large scar

http://www.merck.com/mrkshared/mmanual/section10/chapter112/112l.jsp

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Boils and Carbuncles

http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/9671.html

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Boils and carbuncles From Mayo Clinic

http://www.mayoclinic.com/health/boils-and-carbuncles/DS00466

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Boils

http://www.medicinenet.com/boils/article.htm

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Carbuncles

http://www.nlm.nih.gov/medlineplus/ency/article/000825.htm

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ICD-10

L02.

ICD-9

2008 ICD-9-CM Diagnosis 680.9

Carbuncle and furuncle of unspecified site

680.9 is a specific code that can be used to specify a diagnosis
680.9 contains 11 index entries
View the ICD-9-CM Volume 1 680.* hierarchy

680.9 also known as:

Boil NOS
Carbuncle NOS
Furuncle NOS

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Related Lymphedema People Medical Blogs and Pages:

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http://bacteriainfections.blogspot.com

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http://antibioticinformation.blogspot.com/

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MRSA Information

http://mrsainformation.blogspot.com/

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http://www.lymphedemapeople.com/phpBB2/viewforum.php?f=34

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