What is the treatment for a skin boil?

Treatment for Skin Boils

The primary treatment for skin boils is incision and drainage, which is considered the definitive intervention for large furuncles and all carbuncles. 1

Understanding Skin 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 2, 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 2, 1
• Approximately 10% of patients with a boil or abscess develop a repeat boil or abscess within 12 months 3

Treatment Algorithm

Small Furuncles

• For small furuncles, application of moist heat is satisfactory and may promote spontaneous drainage 2, 1
• Warm compresses help bring the boil to a head, allowing it to drain naturally 1

Large Furuncles and Carbuncles

• Incision and drainage is the recommended primary treatment 2, 1
• The procedure involves:
  • Making an incision to access the abscess 1
  • Thorough evacuation of the pus 1, 4
  • Probing the cavity to break up loculations 2, 1
  • Covering the surgical site with a dry dressing (most effective approach) 2, 1

Wound Management After Drainage

• Simply covering the surgical site with a dry dressing is usually the easiest and most effective treatment 2, 1
• Some clinicians may pack the wound with gauze or suture it closed, though evidence suggests packing may cause more pain without improving healing 1, 4

When Antibiotics Are Indicated

Systemic antibiotics are usually unnecessary for uncomplicated boils after incision and drainage 2, 4, but should be considered in the following situations:

• Extensive surrounding cellulitis 2, 1
• Severely impaired host defenses 2, 1
• Multiple lesions 2
• Systemic manifestations of infection, such as high fever 2, 1
• Presence of systemic inflammatory response syndrome (SIRS) 1

Prevention of Recurrent Boils

For patients with recurrent boils, preventive measures include:

• Daily chlorhexidine washes to reduce bacterial colonization 1
• Thorough laundering of clothing, towels, and bed wear 2, 1
• Separate use of towels and washcloths 2, 1
• Proper skin care to avoid maceration, which can predispose to infection 5

Risk Factors for Recurrent Boils

Several factors increase the risk of developing recurrent boils:

• 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

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 in complicated cases, but treatment without these studies is reasonable in typical cases 1

Common Pitfalls to Avoid

• Overuse of antibiotics for uncomplicated boils that could be managed with incision and drainage alone 1, 6
• 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
• Failing to recognize when a simple boil requires more aggressive intervention due to surrounding cellulitis or systemic symptoms 2, 1
• Inadequate incision and drainage leading to persistent infection 4