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Patient Information Leaflet

Boils 

What are the aims of this leaflet?

This leaflet has been written to help you understand more about boils (furuncles). It tells you what they are, what causes them, what can be done about them, and where you can find out more about them. 

What are boils?

Hairs form under the surface of the skin in structures known as hair follicles. A boil is an infection (abscess) of the deep part of a hair follicle with a bacterium called Staphylococcus aureus (S.aureus). Infection of a group of adjacent follicles causes a carbuncle. Occasionally, the infection may spread beyond the hair follicle into the surrounding tissues (cellulitis), causing fever and illness.

S.aureus can spread from one part of the body to another, and from one person to another, via fingers, skin-to-skin contact, and contaminated clothing. Boils are most common in adolescents, and affect boys more often than girls. Sufferers of boils seldom have a problem with their immune system, although boils can be very florid when the immune system is abnormal.

Are boils hereditary?

No. However, the bacteria that cause boils can spread from person to person and so boils can affect more than one person in a household.

What do boils feel like and what do they look like?

A boil starts as a small itchy or tender spot that grows over a few days into a large red lump under the skin surface becoming increasingly painful and tender. Boils in the nose or ear can be particularly uncomfortable. At this stage it may come to a head and eventually burst through the surface of the skin, releasing its content of pus, or it may settle gradually without bursting. A healed boil tends to leave a red mark, which slowly goes, usually leaving a small scar. Boils may occur singly or in clusters.

How are boils diagnosed?

They are usually straightforward to diagnose by their appearance. If a boil releases pus, this can be sent to the laboratory to establish the sensitivity of the bacteria to a range of antibiotics, in cases where boils keep appearing.

Can boils be cured?

Yes. Infections caused by S.aureus settle with treatment. However the organism may linger on, or be picked up again from someone else, so that further infections can occur later.

The bacteria survive best in moist areas such as the nostrils, the armpits and the groin, and some people carry the S.aureus at these sites on a long-term basis. If repeated infection occurs, it is wise to treat these areas to get rid of the germs persisting there (see below).

How can boils be treated?

A single boil usually settles naturally, especially if the pus it contains discharges spontaneously. Sometimes your doctor may release the pus by cutting carefully into the boil (lancing it). This should only be done with sterile instruments once the boil has come to a head. An antibiotic cream or ointment can be used around the boil to stop others coming up nearby. Often an antibiotic is given by mouth as well, to make sure that the infection clears properly.

If boils keep coming back, extra measures are needed to help break the cycle of infection and re-infection:

1. Areas where the bacteria tend to survive, such as the armpits, groin and scalp, should be cleaned with an antiseptic wash such as chlorhexidine (e.g. Hibiscrub) or iodine (e.g. Betadine), for a week or two. This treatment, however, may cause irritation, in which case it should be stopped.
2. An antiseptic can be used in the bath, perhaps in the form of a bath additive containing triclosan (e.g. Ster-Zac or Aquasept).
3. For those who still have the bacteria in their noses (nasal carriers), an antibiotic or antiseptic ointment (either Bactroban or Naseptin) should be applied to the inside of each nostril, four times a day for ten days. This usually eradicates the organism from the area. It may be worth treating the noses of family members who are also carrying it in the same way. Carriers are identified by taking swabs from the nose and sending them to the laboratory to see if S.aureus is present. 
4. The hands and nails should be kept scrupulously clean. Avoid picking at any sores.
5. Clothing should be washed frequently, using a hot wash and hot tumble-dry if possible.

It is sensible to seek medical advice if you are not sure of the diagnosis, or if the treatment you have tried seems not to be helping. Recurrent boils may be a sign of unrecognised diabetes, so this is another reason to see your doctor if the problem does not settle.

What can I do?

• Follow the measures outlined above to reduce the spread of the germ around the body.
• Bath or shower daily, and keep your hands clean.
• Do you need to lose weight? Obesity encourages boils, as the bacteria survive most easily in folds of the skin.
• Avoid activities that involve heavy perspiration and skin chafing, as they tend to aggravate the problem.
• Avoid contact sports, such as rugby and judo, until the boils have cleared.

Where can I get more information?

Web links to detailed leaflets:

www.dermnetnz.org/bacterial/boils.html
www.intelihealth.com
www.medicinenet.com

The British Skin Foundation fund vital research into all skin diseases.  To find out how you can help, please visit the British Skin Foundation website here.

This leaflet aims to provide accurate information about the subject and is a consensus of the views held by representatives of the British Association of Dermatologists: its contents, however, may occasionally differ from the advice given to you by your doctor.

BRITISH ASSOCIATION OF DERMATOLOGISTS
PATIENT INFORMATION LEAFLET
PRODUCED JUNE 2007
UPDATED MAY 2010