- Boils can range in severity from a pimple to an abscess. They
occur when the skin becomes infected by bacteria(usually
- Some people are more susceptible than others to boils.
- Single boils may be lanced and heal eventually. Recurrent
boils can prove difficult to treat, although there are several
possible treatments that may break the cycle including washing
with chlorhexidine soap and specialised antibiotic regimens.
- Several methods can be used to treat boils at home, speed up
healing and prevent spread to others.
- Anyone with a boil entering a hospital must let medical staff
know, to prevent spread of the boil bacteria.
What is a boil?
Boils are a very common skin infection. They are a skin disease
and in most cases are not due to anything wrong with the blood.
Another name for a boil is a furuncle, and when multiple boils
occur on the body, the condition is called furunculosis.
Several boils joined together with tunnels under the skin are
called a carbuncle.
As a boil gets larger it gets a cavity inside it filled with pus.
This is called an abscess.
A pimple is a mini-boil.
How are boils formed?
Boils are caused by a hair follicle (a tiny tunnel in the skin
where hair grows from) or a tiny cut or scratch becoming infected by
a bacteria (usually Staphylococcus aureus).
As a boil starts to develop, the body's immune system carries
white cells in the blood to the site of the boil to do battle with
the invading bacteria. The body also creates a fibrous wall around
the 'battleground" to contain the infection.
Once the boil reaches a certain size, this fibrous wall prevents
antibiotics in the bloodstream penetrating into the boil. Dead white
cells and dead bacteria make up the liquid pus in the center of the
boil and, because this liquid forms under pressure, it becomes
A boil will always start to "point" towards the skin surface and
will eventually burst, draining the pus, relieving pain and will then
heal. This whole process can take 2 weeks, and often doctors will
"lance" the boil early - make a deliberate hole in it to allow the
pus to drain - to speed up the healing process.
It is very common for boils to "crop", that is, to occur as
several boils that go through their life-cycle and heal and then
occur weeks or months later. This condition is known as recurrent
staphylococcal furunculosis. This condition can be very distressing
and although a blood test will usually be arranged by a doctor(to
exclude diabetes and other conditions), it is not often due to
anything wrong with the sufferer's internal immunity. It is due to
the continuing presence of the bacteria Staphylococcus aureus on the
skin and the susceptibility of the person to it.
Who is at risk of getting boils?
Staphylococcus aureus bacteria occurs on the skin of 25% of the
average population, with or without the occurrence of boil, but is
more prevalent in certain groups.
Usually all sufferers of chronic dermatitis carry Staphylococcus
aureus, as do three quarters of those on haemodialysis; half the
diabetics taking insulin; and just under half injecting drug
What are the treatment options?
If a boil is lanced, a "wick" will usually be inserted. A wick is
a piece of ribbon gauze put into the empty cavity of the boil to
prevent the hole made in the skin surface closing over too quickly.
This allows any further pus that forms to drain through the open
hole. The lancing procedure has to be done at the right time. If a
boil is lanced too early, there will be no pus to drain and the pain
of lancing will have been in vain.
Antibiotics can sometimes prevent a boil forming when used early
but will do little to a well developed boil. However antibiotics are
sometimes still used to prevent deeper infection occurring.
Staphylococcus aureus bacteria is often resistant to ordinary
penicillin so this is not usually prescribed. A special form of
Staphylococcus aureus has emerged over recent years called MRSA
(Methicillin Resistant Staphylococcus aureus) which can be very
difficult to treat with antibiotics and is particularly dangerous
when it occurs in hospitals.
How are recurrent cropping boils treated?
Patients suffering recurrent boils need to eradicate
Staphylococcus aureus from their skin.
Many types of treatment have been tried to prevent boils cropping
without much success. In general, longer continuous courses of
antibiotics by mouth do not seem very successful, presumably because
they do not act on the Staphylococcus aureus living on the surface of
Use of a special liquid soap containing chlorhexidine on a long
term basis, combined with good hygiene and washing of clothes may
The antibiotic mupirocin has been shown to reduce the nasal and
hand carriage of Staphylococcus aureus and may prove useful to some
sufferers of recurrent boils. A combination of washing using
chlorhexidine, and application of mupirocin nasally, twice daily for
a week, then three times a week for a further three week period may
break the cycle. If this fails, the combination system described
below may prove effective.
Various hospitals have developed their own regimens to eradicate
carriage of Staphylococcus aureus in nasal passages. To prevent
antibiotic resistance, these regimens concentrate on intermittent
treatment .(e.g.using two antibiotics, fluctoxacillin and
This combination is cycled one week in every four (one week on,
three weeks off), for a six month period. Flucloxacillin at a dose of
250 mg is taken three times a day on an empty stomach, whilst
rifampicin is taken in a single 600 mg morning dose. The patients who
have completed this procedure have been successfully stopped
recurrent boils, although up to 20% experienced breakthrough
occurrences early in treatment. These breakthroughs should be treated
conventionally while continuing the regimen.
Those patients allergic to penicillin or with MRSA, substitute
fluctoxacillin with clindamycin at a 300 mg dose, three times
Rifampicin causes red discoloration to urine and tears and stains
contact lenses; interferes with oral contraceptives; and if used
alone, Staphylococcus aureus is almost certain to develop resistance.
Rifampicin and clindamycin require specialist approval for use(In
How can minor boils be treated at home or prevented?
These self-help suggestions may help when a boil occurs.
- Make sure the boil sufferer uses their own towel and
facecloth, and wash these frequently in hot water along with their
clothing worn close to the skin.
- Avoid close body contact with other people if a boil is
- Eat a good selection of fruit and vegetables and keep good
- Avoid squeezing a boil as it can force infection into the
- Apply a warm wet compress (towel or other cloth) to the boil
for 10 minutes, several times a day to try and speed up its life
The most simple and practical prevention of boils cropping seems
to be once daily use of a special liquid soap containing
chlorhexidine on a long term basis, combined with good hygiene and
washing of clothes. However some people are sensitive to
chlorhexidine and react to it. Boil sufferers visiting or going into
hospital for any treatments must let medical staff know they have a
boil, to reduce any chance of the Staphylococcus transferring to
others in hospital.