Boil

Definition

Definition of Boil
A boil, also called a furuncle, is a deep folliculitis, infection of the hair follicle. It is most commonly caused by infection by the bacterium Staphylococcus aureus, resulting in a painful swollen area on the skin caused by an accumulation of pus and dead tissue. Individual boils clustered together are called carbuncles. Staphylococcus is a genus of bacteria that is characterized by being round (coccus or spheroid shaped), Gram-positive, and found as either single cells, in pairs, or more frequently, in clusters that resemble a bunch of grapes. The genus name Staphylococcus is derived from Greek terms "staphyle" and "kokkos" that mean "a bunch of grapes", which is how the bacteria often appears microscopically (after Gram staining). In 1884, German physician Ottomar Rosenbach first described and named the bacteria. Two major divisions of the genus Staphylococcus are separated by the bacteria's ability to produce coagulase, an enzyme that can clot blood. Most human infections are caused by coagulase-positive S. aureus strains. Almost any organ system can be infected by S. aureus.

Symptoms

Symptoms of Boil
Boil are bumpy red, pus-filled lumps around a hair follicle that are tender, warm, and very painful. They range from pea-sized to golf ball-sized. A yellow or white point at the center of the lump can be seen when the boil is ready to drain or discharge pus. In a severe infection, an individual may experience fever, swollen lymph nodes, and fatigue. A recurring boil is called chronic furunculosis. Skin infections tend to be recurrent in many patients and often spread to other family members. Systemic factors that lower resistance commonly are detectable, including: diabetes, obesity, and hematologic disorders.

Causes

Causes of Boil
Usually, the cause is bacteria such as staphylococci that are present on the skin. Bacterial colonization begins in the hair follicles and can cause local cellulitis and inflammation. Additionally, myiasis caused by the Tumbu fly in Africa usually presents with cutaneous furuncles. Risk factors for furunculosis include bacterial carriage in the nostrils, diabetes mellitus, obesity, lymphoproliferative neoplasms, malnutrition, and use of immunosuppressive drugs. Patients with recurrent boils are as well more likely to have a positive family history, take antibiotics, and to have been hospitalized, anemic, or diabetic; they are also more likely to have associated skin diseases and multiple lesions.

Diagnosis

Diagnosis of Boil
Your doctor can make the diagnosis with a physical exam. Many parts of the body may be affected by this skin infection, so some of the questions or exam may be about other parts of your body.

Treatment

Treatment of Boil
Home treatment is an option for most simple boils. Ideally, treatment should begin as soon as a boil is noticed since early treatment may prevent later complications.

• The primary home remedy for most boils is heat application, usually with hot soaks or hot packs. Heat application increases the circulation to the area and allows the body to better fight off the infection by bringing antibodies and white blood cells to the site of infection.
• As long as the boil is small and firm, opening the area and draining the boil is not helpful, even if the area is painful. However, once the boil becomes soft or "forms a head" (that is, a small pustule or area of pus is noted in the boil), it can be ready to drain. Once drained, pain relief can be dramatic. Most small boils, such as those that form around hairs, drain on their own with hot soaks. On occasion, and especially with larger boils, medical treatment is required. In this situation, the boil will need to be drained or "lanced" by a health care professional. Frequently, these larger boils contain several pockets of pus that must be opened and drained.
• Antibiotics are often used to eliminate any accompanying bacterial infection, especially if there is an infection of the surrounding skin. However, antibiotics are not needed in every situation. In fact, antibiotics have difficulty penetrating the outer wall of an abscess well and often will not cure an abscess without additional surgical drainage.

Prognosis

Prognosis of Boil
The majority of boils in healthy people resolve on their own with home care (described above). The prognosis is also excellent for boils that are treated in the health care setting by opening or lancing. Antibiotics may or may not be required after a boil has been lanced by a health care professional. Complications of a boil are rare and are more likely to occur in people with suppressed immune systems. Complications include a worsening or spreading to adjacent areas of skin or soft tissue and very rarely, spread of the infection through the bloodstream to sites elsewhere in the body. Recurrence of the infection is another possible complication, which is more likely in certain types of boils. Recurrence is most common in hidradenitis suppurativa and may also occur in situations in which the cause of the boil or abscess is persistent, such as the clogging of oil ducts seen in cystic acne.

Prevention

Prevention of Boil
There are some measures that you can take to prevent boils from forming although boils are not completely preventable. 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 professional 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.