What are the non-pharmacological (non-pharma) management options for boils?

Non-Pharmacological Management of Boils

Incision and drainage is the primary treatment for boils (furuncles) and carbuncles, with systemic antibiotics typically unnecessary unless fever or other evidence of systemic infection is present. 1

Understanding Boils

• Boils (furuncles) are infections of the hair follicle, usually caused by Staphylococcus aureus, where suppuration extends through the dermis into the subcutaneous tissue, forming a small abscess 1
• Carbuncles develop when infection involves several adjacent follicles, producing a coalescent inflammatory mass with pus draining from multiple follicular orifices, commonly on the back of the neck, especially in individuals with diabetes 1
• The incidence of first consultation for a boil or abscess is approximately 512 per 100,000 person-years in females and 387 per 100,000 person-years in males 2

Primary Non-Pharmacological Management

Incision and Drainage

• Incision and drainage is the recommended treatment for large furuncles and all carbuncles 1
• The procedure involves:
  • Making an incision to access the abscess
  • Thorough evacuation of pus
  • Probing the cavity to break up loculations 1
  • Simply covering the surgical site with a dry dressing is usually the easiest and most effective treatment of the wound 1

Moist Heat Application

• For small furuncles, application of moist heat is satisfactory and may promote spontaneous drainage 1
• Warm compresses can help bring the boil to a head, allowing it to drain naturally 1

Management of Recurrent Boils

Approximately 10% of patients with a boil or abscess develop a repeat boil or abscess within 12 months 2. For recurrent furunculosis, consider:

• Daily chlorhexidine washes to reduce bacterial colonization 1
• Daily decontamination of personal items such as towels, sheets, and clothes 1
• Thorough laundering of clothing, towels, and bed wear 1
• Separate use of towels and washcloths 1
• Sitting on towels when using shared seating (such as in steam baths, which have been associated with outbreaks) 3

Risk Factors for Recurrence

Several factors increase the risk of recurrent boils that should be addressed:

• Obesity (relative risk 1.3) 2
• Diabetes (relative risk 1.3) 2
• Smoking (relative risk 1.3) 2
• Age under 30 years (relative risk 1.2) 2
• Prior antibiotic use (relative risk 1.4) 2

When to Consider Antibiotics

Non-pharmacological management alone is usually sufficient, but consider antibiotics in these situations:

• Presence of systemic inflammatory response syndrome (SIRS) such as temperature >38°C or <36°C, tachypnea >24 breaths per minute, tachycardia >90 beats per minute, or white blood cell count >12,000 or <400 cells/μL 1
• Markedly impaired host defenses 1
• Extensive surrounding cellulitis 1
• Severe systemic manifestations of infection, such as high fever 1

Special Considerations

• For recurrent abscesses at the same site, search for local causes such as a pilonidal cyst, hidradenitis suppurativa, or foreign material 1
• Adult patients with recurrent abscesses that began in early childhood should be evaluated for neutrophil disorders 1
• Gram stain and culture of pus from carbuncles and abscesses are recommended, but treatment without these studies is reasonable in typical cases 1

Common Pitfalls to Avoid

• Packing the wound with gauze has been found to cause more pain and did not improve healing compared to simply covering the incision site with sterile gauze 1
• Ultrasonographically guided needle aspiration has been shown to be successful in only 25% of cases overall and <10% with MRSA infections, and is therefore not recommended 1
• Failure to address underlying risk factors may lead to recurrence 2
• Overuse of antibiotics for uncomplicated boils that could be managed with incision and drainage alone 1