Treatment of Boils
The primary treatment for a boil is incision and drainage, which is the definitive management for large furuncles and all carbuncles. 1, 2
Understanding Boils
- Boils (furuncles) 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
Small Boils
- Application of moist heat (warm compresses) is satisfactory for small furuncles and may promote spontaneous drainage 1
- Apply warm compresses to the area for 10-15 minutes several times daily to help bring the boil to a head 1, 3
- Warm water compresses have been shown to be effective and inexpensive for reducing inflammation 3
Large Boils and Carbuncles
- Incision and drainage is the recommended treatment for large furuncles and all carbuncles 1, 2
- The procedure involves:
Important Considerations
- Packing the wound with gauze is generally unnecessary and may cause more pain without improving healing 1, 2
- Needle aspiration has low success rates (only about 25% overall) and is not recommended 1, 2
- Do not attempt to lance boils at home, as this can lead to severe invasive infections 4
When to Consider Antibiotics
Systemic antibiotics are usually unnecessary for uncomplicated boils after adequate incision and drainage, but should be added when there is:
- Systemic inflammatory response syndrome (temperature >38°C or <36°C, tachypnea >24 breaths per minute, tachycardia >90 beats per minute) 1
- Extensive surrounding cellulitis 1, 2
- Markedly impaired host defenses 1
- Multiple lesions 2
Prevention of Recurrent Boils
About 10% of patients develop recurrent boils within 12 months 5. Prevention measures include:
- Daily chlorhexidine washes to reduce bacterial colonization 1, 2
- Thorough laundering of clothing, towels, and bedding 1, 2
- Separate use of towels and washcloths 1
- Daily decontamination of personal items 1, 2
Risk Factors for Recurrent Boils
- Obesity (RR 1.3) 5
- Diabetes (RR 1.3) 5
- Smoking (RR 1.3) 5
- Age <30 years (RR 1.2) 5
- Prior antibiotic use (RR 1.4) 5
When to Seek Medical Care
- Boils that are extremely painful, large, or accompanied by fever 1
- Boils that don't improve after a few days of home treatment 1
- Boils that recur frequently, which may indicate an underlying condition requiring evaluation 1, 2
- Boils located on the face, spine, groin, or other sensitive areas 2
Common Pitfalls to Avoid
- Self-lancing of boils, which can lead to severe invasive infections 4
- Overuse of antibiotics for uncomplicated boils that could be managed with incision and drainage alone 1, 2
- Failure to evaluate for underlying causes in patients with recurrent boils 1, 2
- Not obtaining cultures in cases of recurrent boils or treatment failures 2