Treatment of Erupted Buttocks Boil
For a ruptured buttocks furuncle (boil), incision and drainage is the primary recommended treatment, followed by covering the surgical site with a dry dressing rather than packing with gauze. 1
Initial Management
- Incision and drainage is the recommended treatment for large furuncles and all carbuncles, ensuring thorough evacuation of pus and breaking up of loculations 1, 2
- After drainage, simply cover the surgical site with a dry dressing - this is more effective and less painful than packing the wound with gauze 1, 2
- For small furuncles that have already ruptured, application of moist heat can help promote complete drainage 1, 2
- Thoroughly clean the area with antiseptic solution to prevent further contamination 2
Antibiotic Therapy
Systemic antibiotics are usually unnecessary for uncomplicated furuncles after adequate drainage 1
Consider antibiotics only if specific conditions are present: 1, 2
- Fever or other evidence of systemic infection
- Extensive surrounding cellulitis
- Systemic inflammatory response syndrome (SIRS)
- Markedly impaired host defenses
- Multiple lesions
When antibiotics are indicated, choose an agent active against Staphylococcus aureus, which is the most common causative organism 1
Consider MRSA coverage in high-prevalence areas or if risk factors are present 1
Wound Care After Drainage
- Keep the area clean and dry 2
- Daily washing with antibacterial soap such as chlorhexidine 2
- Change dressings regularly to maintain cleanliness 2
- Monitor for signs of recurrent infection or inadequate drainage 2
Prevention of Recurrence
- Evaluate for predisposing factors such as nasal colonization with S. aureus 1
- For recurrent cases, consider decolonization with intranasal mupirocin twice daily for 5 days each month (reduces recurrences by approximately 50%) 1
- Daily chlorhexidine washes can help reduce bacterial colonization and prevent recurrences 1, 2
- Thoroughly launder clothing, towels, and bedding 1, 2
- Use separate towels and washcloths to prevent spread of infection 1, 2
Special Considerations for Buttock Location
- Due to the location, maintain good hygiene to prevent contamination from stool 3
- Consider positioning to minimize pressure on the affected area during healing 2
- For extensive or multiple buttock furuncles, more aggressive management may be needed to prevent complications 4, 5
When to Seek Further Medical Attention
- If the boil doesn't improve within 2-3 days after drainage 1
- Development of fever or worsening pain 2
- Spreading redness or swelling beyond the initial area 2
- For recurrent abscesses at the same site, search for local causes such as a pilonidal cyst, hidradenitis suppurativa, or foreign material 2
Risk Factors for Recurrence
- Obesity (RR 1.3) 6
- Diabetes (RR 1.3) 6
- Smoking (RR 1.3) 6
- Age <30 years (RR 1.2) 6
- Prior antibiotic use (RR 1.4) 6
Approximately 10% of patients with a boil or abscess develop a repeat boil or abscess within 12 months, so preventive measures are important 6.