Treatment for Small Boils on the Head
For small boils on the head, the primary treatment is incision and drainage, which should be performed for all boils that have come to a head, followed by application of topical antibiotics such as bacitracin for adults and children over 2 years of age. 1, 2
Initial Management
Step 1: Incision and Drainage
- Incision and drainage is the cornerstone of treatment for boils that have formed a head 1
- This procedure allows for the release of pus and reduces pressure and pain
- For very small boils that haven't come to a head yet, warm compresses can help bring the boil to a point where drainage is possible
Step 2: Topical Treatment
- After drainage, apply a small amount of topical antibiotic such as bacitracin 1-3 times daily 2
- For adults and children over 2 years of age, a small amount (equal to the surface area of the tip of a finger) should be applied to the affected area
- The area may be covered with a sterile bandage
- For children under 2 years of age, consult a doctor before using topical antibiotics 2
Additional Considerations
For Recurrent or Multiple Boils
- If boils are recurrent or multiple, systemic antibiotics may be necessary 1
- For outpatient treatment of skin and soft tissue infections, options include:
- Trimethoprim-sulfamethoxazole (160-320/800-1600 mg PO q12h)
- Doxycycline (100 mg PO q12h) for adults
- Minocycline (200 mg initially, then 100 mg PO q12h) for adults
- Fusidic acid (500 mg PO q8-12h or 750 mg q12h) for adults 1
Risk Factors for Recurrence
Several factors increase the risk of recurrent boils that should be addressed:
- Obesity (RR 1.3) 3
- Diabetes (RR 1.3) 3
- Smoking (RR 1.3) 3
- Age <30 years (RR 1.2) 3
- Prior antibiotic use (RR 1.4) 3
Prevention of Recurrence
- Maintain good hygiene practices
- Use antibacterial soap for bathing
- Avoid sharing personal items like towels, razors, or clothing
- Wash hands frequently, especially after touching a boil
- Wash clothing, bedding, and towels in hot water and dry on high heat cycle 4
- For those with recurrent boils, sitting on a towel during communal bathing may reduce risk 5
Special Considerations
When to Seek Further Medical Attention
- If boils are large (>5 cm), multiple, or in sensitive areas of the head
- If accompanied by fever, increasing pain, or spreading redness
- If the person has diabetes, immune suppression, or other comorbidities
- If boils recur frequently despite appropriate treatment
- For children under 2 years of age 2
Follow-up
- Most small boils resolve within 7-14 days with proper treatment
- If symptoms persist after treatment, re-evaluation is necessary
- For recurrent boils, consider evaluation for underlying conditions such as diabetes or immune disorders
The evidence suggests that simple incision and drainage followed by topical antibiotic application is the most effective approach for small boils on the head, with systemic antibiotics reserved for more complicated or recurrent cases.