Every now and then, a patient will come through my office with a mild skin infection. Since they’re not coming to me about it, often it’s not bothering them too much, but that fact belies what can happen if the infection is left too long. I think this is where this week’s question from Lucinda comes from:
First off, let’s start with a few definitions to get us all on the same page and talk about how a boil develops. Our skin is a wonderful and diverse organ. In addition to protecting us from the outside world, it also cools our body on hot days and uses the sun to generate vitamin D. The skin is also covered with hair follicles, tiny pits in the skin containing the apparatus to make hair and sweat.
Occasionally, harmful bacteria choose these protected little pits as a new home and start to replicate and infect the skin. As this happens, the body responds, shouting out a warning signal (inflammation) and throwing its best soldiers (white blood cells) at the invader. Blood rushes to the area, making it swollen and hot. As white blood cells die in battle, they build up around the infection, pulling the skin tight and forming a reservoir of pus called an abscess underneath the skin where bacteria continue to multiply.
This whole process starts out small. Maybe you went over to your friend’s hot tub not realizing they hadn’t cleaned it in years. Now you have what looks like a pimple, just not in a place a pimple should be. Over time, though, that infection eats into your skin and spreads into the underlying tissue. When this happens, you’ve developed a furuncle, more commonly known as a boil.
While that all sounds pretty gross, it can get worse. If you’re unlucky enough to get an infection in several neighboring follicles, they can come together to form a huge mass of inflammation and infection. This monster, called a carbuncle, can get so bad that it leads to infection of the whole body and requires antibiotic therapy.
Given that this is an infection, you might think antibiotics are the way to go in treating these things. Unfortunately, they’re not. Because blood doesn’t flow inside the reservoir of pus, antibiotics can’t make it into the part of boil where the bacteria are multiplying. It might kill some out on the fringes, but most will live, happily untouched, deep inside of the growing abscess. This is also why the body often can’t heal a boil on its own: white blood cells can’t get from the blood to where the bacteria are.
As a surgeon, you learn how to deal with these types of infections from day one. If someone has an abscess, you have to cut it open and drain it. Unless you open up the wound and get all the pus and dead tissue out, you’ll never have any hope of curing the problem. You can rub whatever you want on top of the boil and take whatever home cures you might have, but nothing will touch those bacteria until you get them out and clean the wound.
Hopefully Lucinda doesn’t have a boil, but if she did, this is what I would advise. Go see your primary doctor about it. If the boil is small, they may be able to take a tiny knife and drain the pus out in a few seconds (with anesthesia of course!). If it’s large, they’ll probably send you to a surgeon who can do the same job, but on a bigger scale. Again, the only way to fix it is to cut it open, drain the pus out, and let it heal with a nice clean covering.
So, do you need antibiotics as well? The jury is still out. In the past, we generally found that draining the boil was enough to get it to heal, but with the rise of drug-resistant bacteria some doctors are opting for antibiotics. The dreaded MRSA can be a cause of boils and in those cases where MRSA is confirmed, some doctors may decide to treat with an antibiotic.
Unfortunately, even the healthiest people can get boils, although those with weakened immune systems like diabetics are at higher risk. Breaks in the skin from cuts, dry skin or insect bites can easily get infected and cause a boil. Whirlpool footbaths at nail salons can also carry fungus that can cause a boil. My advice? Keep your skin well-hydrated to keep it from cracking, cover up any cuts or breaks in the skin, and steer clear of whirlpool footbaths.