What is the recommended treatment for a boil?

Treatment of Boils

The primary recommended treatment for boils (furuncles) is incision and drainage, which is considered the definitive management for large furuncles and all carbuncles. 1

Understanding Boils

• Boils are infections of hair follicles, usually caused by Staphylococcus aureus, where infection extends through the dermis into 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 1

Treatment Approach

First-Line Treatment

• Incision and drainage is the primary treatment for simple abscesses or boils 2, 1
• The procedure involves:
  • Making an incision to access the abscess 1
  • Thorough evacuation of pus 1
  • Breaking up loculations by probing the cavity 1
  • Covering the surgical site with a dry dressing 1
• Antibiotics are not recommended for simple abscesses or boils that can be adequately drained 2

Small Boils

• 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

When to Consider Antibiotics

Antibiotics should be added to incision and drainage in the following situations:

• Presence of systemic inflammatory response syndrome (SIRS) such as fever >38°C or <36°C, rapid breathing, tachycardia, or abnormal white blood cell count 1
• Markedly impaired host defenses 1
• Extensive surrounding cellulitis 1
• Severe systemic manifestations of infection 1
• Immunocompromised patients 2

Management of Recurrent Boils

• 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

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
• Risk factors for recurrence include obesity (RR 1.3), diabetes (RR 1.3), smoking (RR 1.3), age <30 years (RR 1.2), and prior antibiotic use (RR 1.4) 3
• Approximately 10% of patients with a boil or abscess develop a repeat boil or abscess within 12 months 3

Common Pitfalls to Avoid

• Packing the wound with gauze has been found to cause more pain and does 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 is not recommended 1
• Self-lancing of boils can lead to severe infections, including osteomyelitis and bacteremia 4
• Overuse of antibiotics for uncomplicated boils that could be managed with incision and drainage alone 1
• Comparative trials have not identified important differences in efficacy or safety outcomes between different oral antibiotics for treating bacterial folliculitis or boils 5

Evidence Quality

The recommendations for incision and drainage as the primary treatment for boils are based on strong clinical evidence and consensus guidelines 2, 1. The evidence regarding specific antibiotic regimens is less robust, with most comparative studies showing similar efficacy between different antibiotics 5.