Boils are the result of a deep infection in one or more hair follicles, a condition known as folliculitis. As the infection develops, the area accumulates dead tissue, which causes swelling at the infection site. It’s a painful process, and one that can last for an extended period of time. Some people even develop chronic boils, where reinfection occurs several times every year. Although the condition first presents as a dermatological condition, it can progress and may eventually damage other organs in the body. In rare cases, the bacteria responsible for the boil can enter the bloodstream and present an immediate danger to the patient. Fortunately, boils can be easily managed.

What are the signs that a boil is present?

At first, a boil presents with general symptoms, including reddening of the infected area, inflammation and tenderness. It can be quite painful when touched, especially once the swelling starts. Most boils are between pea-sized and the size of a golf ball. Within a week, the swollen area will develop a white or yellow point, which is a sign that the boil will soon discharge pus. If the infection persists for a long time, or if the infection is aggressive, the patient may feel fatigued or feverish, and their lymph nodes may swell as well.

Boils can appear almost anywhere on the body, but the face, neck, shoulders, buttocks and armpits are the areas most often infected. They can even develop in the mouth, around the eyes or in the ear canal.

If several boils develop in close proximity, this is called a carbuncle. Carbuncles are the same size as individual boils and are usually found on the back or neck, and though they very unpleasant, they are a sign that the body is fighting the infection. Inside a carbuncle is the same kind of mix of dead tissues and pus that are found in individual boils. Carbuncles can present with fatigue, fever or malaise if the infection is particularly severe.

The overwhelming majority of cases are the result of a Staphylococcus aureus infection. Staph is an extremely prevalent bacteria that lives on the skin, and people differ in how much Staph they are carrying around. It’s noted for its propensity to develop antibiotic resistance, and strains of the bacteria have become so hardy against antibiotics that some cases have required surgery to defeat the infection. Fortunately, that is rarely needed. However Staph is still dangerous even if it is not antibiotic-resistant, as it can quickly spread to other parts of the body, and even into deeper organ systems, where it can eventually cause abscesses to form.

What are some of the risk factors that can increase the chances of boils developing?

  1. Family history – Boils appear to run in families, suggesting a genetic factor being involved in the development of boils. As every person has a varying amount of Staph on their skin, genetics may play a part in what an individual’s collection of skin bacteria will look like.
  2. Skin injury – Insect bites, cuts, burns and the like provide a possible vehicle for Staph to enter the skin and cause infection.
  3. Weakened immune system – Chronic conditions that suppress immune system function, like HIV/AIDS or diabetes, make folliculitis more of a threat. Likewise, poor nutrition and drug use can also make it tough for the immune system to operate properly and fend off infection.
  4. Poor hygiene – A noted link between proper hygiene and lower incidence rate of folliculitis has been found.

Treating a Boil

Boils seem innocuous and incapable of real harm, but don’t be fooled. It’s true that very small boils can typically be treated at home, but larger boils and carbuncles cannot be drained safely without the assistance of a healthcare provider. As boils and their discharge are readily capable of passing on the infection, careful drainage is essential to limiting the condition and ensuring no one else is infected. Attempts to drain a boil without help can cause them to spread to other parts of the body, taxing the immune system further and increasing the chances of developing serious complications.

Most complications are typically minor, with scarring representing the worst. However, Staph is nomad in the body, potentially migrating to other organs and doing damage there. This danger is multiplied if the Staph is of the MRSA variety (methicillin-resistant Staphylococcus aureus), as the bacteria may be antibiotic-resistant.

If a patient is first diagnosed with MRSA and then develops a boil, they should contact their healthcare provider immediately. Other signs that a boil needs medical attention include:

  1. There are other medical conditions present that are weakening the immune system. Diabetes and HIV are two examples.
  2. The boil is presenting with a fever or malaise.
  3. Pain associated with the boil becomes severe or constant.
  4. The boil does not discharge on its own or becomes soft.
  5. Additional boils appear, either close to the initial boil or elsewhere on the body.

Boils rarely require more than basic treatment to manage, but that treatment should be handled by a healthcare professional to ensure the boil does not spread or worsen. After an initial examination, the healthcare provider may instruct the patient to apply a warm compress to the boil in order to open it up and cause drainage. However, if the boil is large, causing severe pain or presenting with fever or malaise, the healthcare provider may perform an incision and drainage (I&D) procedure. During I&D, the doctor numbs the area with a local anesthetic and lances the boil to produce immediate drainage. In some cases, gauze may be placed in the lanced boil to keep it open and draining. The gauze is typically removed after a couple days.

Antibiotics may be prescribed for severe infections. If an abscess forms, surgical intervention may be indicated. This is usually only reserved for cases where the infection is extremely deep or if the infection is caused by a stubborn case of MRSA.

While boils aren’t typically a medical emergency, they shouldn’t be ignored either. Fortunately, a healthcare provider can comprehensively treat boils and provide insight to avoiding them in the future.