Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
While boils typically resolve on their own and therefore have an excellent prognosis, there are special cases in which medical care should be sought when boils develop. Rarely, boils may spread or persist, leading to more widespread infections.
Any boil or abscess in a patient with diabetes or a patient
with an underlying illness that can be associated with a weakened immune system (such as cancer, rheumatoid arthritis, etc.) should be evaluated by a health-care practitioner. Additionally, many medicines, especially prednisone, that suppress the immune system (the natural infection-fighting system of the body) can complicate what would be an otherwise simple boil. Those who are taking such medications should consult their health-care practitioner if they develop boils. (If you are not sure about your medications' effects on the immune system, your pharmacist may be able to explain to you which medicines to be concerned about.)
Any boil that is associated with a fever should receive medical
attention. Increasing reddening of the nearby skin and/or formation of red streaks on the skin, the failure of a boil to "form a head," and the development of multiple boils are other symptoms that warrant a visit to a health-care practitioner.
A "pilonidal cyst," a boil that occurs
between the buttocks, is a special case. These almost always require
medical treatment, including drainage and packing (putting gauze in the opened
abscess to assure it continues to drain). Finally, any painful boil that
is not rapidly improving should be seen by a health-care practitioner.
What can be done to prevent boils (abscesses)?
There are some measures that you can take to prevent boils
from forming. Good hygiene and the regular use of antibacterial soaps can help to prevent bacteria from building up
on the skin. This can reduce the chance for the hair follicles to become infected and prevent the formation of boils. In
some situations, your health-care practitioner may recommend special
cleansers such as pHisoderm to even further reduce the bacteria on the skin. When the hair follicles on the back of the arms or around the thighs are continually inflamed, regular use of an abrasive brush (loofah brush) in the shower can be used
to help break up oil plugs and buildup around hair follicles.
Pilonidal cysts can be prevented by avoiding continuous direct pressure or irritation of the buttock area when a local hair follicle becomes inflamed. At that point, regular soap and hot water cleaning and drying can be helpful.
For acne and hidradenitis suppurativa (see above),
topical or oral antibiotics may be required on a long-term basis to prevent recurrent abscess formation. As mentioned above, surgical resection of sweat glands in the involved skin may be necessary. Other medications, such as isotretinoin (Accutane), can be used for
cystic acne and have been helpful in some patients with hidradenitis
suppurativa. Recurrences are common in patients with hidradenitis
suppurativa.
Finally, surgery may occasionally be needed, especially for pilonidal
cysts that recur but also for hidradenitis suppurativa. For pilonidal
cysts, surgically removing the outer shell of the cyst is important to clear the boil. The procedure
is typically performed in the operating room. For hidradenitis
suppurativa, extensive involvement can require surgical repair by a plastic surgeon.
A boil, or skin abscess, is a collection of pus that
forms in the skin.
Antibiotics alone can be inadequate in treating
abscesses.
The primary treatments for boils include hot packs
and draining ("lancing") the abscess but only when it is soft and ready to
drain.
If you have a fever or long-term illness, such as
cancer or diabetes, or are taking medications that suppress the immune system,
you should contact your health-care practitioner if you develop a boil
(abscess).
There are a number of methods that can be used to reduce the likelihood of developing some forms of boils, but boils are not completely preventable.
Staphylococcus or Staph is a group of bacteria that can cause a multitude of diseases. Staph infections can cause illness directly by infection or indirectly by the toxins they produce. Symptoms and signs of a Staph infection include redness, swelling, pain, and drainage of pus. Minor skin infections are treated with an antibiotic ointment, while more serious infections are treated with intravenous antibiotics.
Night sweats are severe hot flashes that occur at night and result in a drenching sweat. In order to distinguish night sweats that arise from medical causes from those that occur because one's surroundings are too warm, doctors generally refer to true night sweats as severe hot flashes occurring at night that can drench sleepwear and sheets, which are not related to an overheated environment.
MRSA (methicillin resistant Staphylococcus aureus) bacteria causes skin infections with the following signs and symptoms: cellulitis, abscesses, carbuncles, impetigo, styes, and boils. Normal skin tissue doesn't usually allow MRSA infection to develop. Individuals with depressed immune systems and people with cuts, abrasions, or chronic skin disease are more susceptible to MRSA infection.
Acne is a localized skin inflammation as a result of overactivity of oil glands at the
base of hair follicles. This inflammation, depending on its location, can take the form
of a superficial pustule (contains pus), a pimple, a deeper cyst, congested pores, whiteheads, or blackheads. Treatments vary depending on the severity of the acne.
Ingrown hairs may be caused by improper shaving, waxing or blockage of the hair follicle. Symptoms and signs of ingrown hairs include itching, tenderness, and small red pus bumps. Ingrown hairs usually heal on their own, but topical antibiotics, chemical depilatories, and hair-removal laser may be used in the treatment of ingrown hairs.
Cysts are saclike structures that can occur throughout the body and usually contain a semisolid, liquid, or gaseous substance. Infections, tumors, genetic conditions, chronic inflammatory conditions, and wear and tear can cause cysts. Though some cysts may be palpable, others may not produce any symptoms. Treatment depends upon the location and cause of the cyst.
A pilonidal cyst is a cyst that forms near the cleft of the buttocks. The cysts are thought to be caused by the penetration of loose hairs into the skin. Symptoms and signs include pain, swelling, redness, warmth, and drainage of pus from the area of the cyst. Treatment of a pilonidal cyst involves incision and drainage.
Sporotrichosis is a skin infection caused by a fungus called Sporothrix schenckii. The fungus, which may be present in sphagnum moss, thorny plants, or baled hay, enters the skin through punctures and small cuts. Symptoms include painless bumps on the skin near the site of infection. The nodules may open and look like boils. The infection is treated with potassium iodide or itraconazole (Sporanox).
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