Boil Drainage: When And How To Drain A Boil Safely

Introduction

Boils, or furuncles, is a painful bacterial skin infection that initially begins with swelling but soon becomes filled with pus.¹ The infection occurs when hair follicles are infected with Staphylococcus Aureus, which is a bacteria that usually resides on your skin. Boils usually begin as an itchy or tender spot and can flare up anywhere on your body.² The most common areas where boils appear are the places that are subjected to friction or sweat like: the neck, armpits, groin, genital area, back, bottom, or thighs.³ Smaller boils usually resolve themselves so do not require medical intervention, however, larger boils would need to be treated properly to prevent complications.

Boils also can form and merge together under the skin; they are known as a carbuncle. This requires a GP appointment as this infection is found deeper into the tissue and requires a more extensive drainage procedure. To distinguish between carbuncles and boils, carbuncles usually are found on the back of the neck or thigh and expels a bloody white discharge from the boils; alongside inducing a fever and fatigue. These symptoms indicate the infection is spreading to other regions of the body. The lumps are also tender and painful, with pus located in the centre of the lump.

Diagnosis

To identify the bacteria responsible for the boil, a sample of the pus is taken to determine the strain. This could be used:

• If the boil is not responding to the treatment where the skin condition is not improving
• The individual has sepsis, which is when bacteria enters the bloodstream
• If the bacteria is potentially resistant to a lot of antibiotics

Cause of boils

Staphylococcus aureus is a bacterium that usually inhabits the skin and inside the nose; part of the normal skin flora. Usually there is no issue with this bacterium, as it lives on your skin, but when there is a cut or injury on your skin this can introduce the bacteria into the body and cause skin infections. This triggers the inflammatory response, causing the accumulation of pus consisting of dead white blood cells and bacteria; resulting in a swollen, red, and painful lump.

There are a few factors that can predispose individuals to developing boils easier, such as:

• Poor hygiene- Inadequate cleaning of the skin can enable bacteria to flourish, increasing the risk of infections
• Being obese- (Obesity is not explained at all)Excessive sweating and skin friction caused by skin folds can cause boil formation
• Weakened immune system- Having a compromised immune system can impact and impair the body’s ability to fight off the infection
• Skin conditions that disrupt and damage the skin barrier- This causes the skin to be exposed and allows the bacteria to penetrate easier
• Skin injury such as a scratch, wound, or insect bite
• Close contact with someone with boils- The boils are not contagious but the pus containing bacteria that leaks out are

It is advised to not go swimming or to the gym until the boil has gone, as it is highly infectious when the boil is actively leaking pus.

Treatment

Boils can occasionally go away on their own but there are methods you can do at home to ease the symptoms. Initially, the bump is not fully hardened so it is soft and filled with fluid and pus. This is the ideal time period to apply a warm sterile compress to the boil in conjunction with a special ointment that draws out pus from the boil.¹ Four times a day, soak a clean cloth in warm water before holding it against the boil for ten minutes.² These will help with the development of the abscess inside the boil to speed up the drainage and healing process.

For larger boils, medical treatment is necessary. Firstly, the area around the boil is cleaned with antiseptic solution to disinfect the area. Then, an incision into the boil is made with a sterile scalpel, allowing the pus to be drained to relieve some pain and advance the healing process. A localised numbing agent or anaesthesia is administered before making the incision.

Although it is tempting, draining boils on your own or letting an untrained non-medical professional treat it can result in a lot of complications rather than benefits. These include:

• The infection spreading to other areas of the body
• Improper removal of the boil can cause the boil to come back and increases the chances of scarring after drainage
• Forcing the bacteria deeper into the tissue, which makes the boil worse and increasing the risk of sepsis

Therefore, the best is to proceed with caution when touching the boil and to seek medical advice.

Topical, oral and even antibiotics injections are also prescribed; they are effective methods to treat boils and prevent any secondary infections.

Antibiotics are generally used only:

• If the boils are on your face
• If you have several boils (carbuncle)
• If the infection begins to spread through the lymph vessels
• If you have symptoms such as a fever, low blood pressure, high pulse rate, and rapid breathing.¹

After the procedure, to manage the pain, over the counter pain relievers such as paracetamol or ibuprofen are useful. Not only is it for the pain but it also reduces the inflammation caused by the boils.

Follow up appointments can also be arranged to ensure that there are no complications subsequently after the procedure and to monitor the condition post drainage.

After treatment care

It is important to:

• Clean the area around the boil with antibacterial soap if pus leaks out of the wound
• Cover the affected area with a gauze until it is fully healed
• Bath or shower everyday as well as wash your hands frequently
• Wash towels and bedding once a week at a high temperature 
• Lose weight if you’re overweight

Complications

After the procedure, complications can still occur,  so it is better to speak to your doctor if you think that:

• The boil is spreading to other regions of the body and it is becoming larger.
• Formation of carbuncles occurs, a severe infection that consists of a cluster of boils. They are more difficult to treat and there is a higher chance the boil will leave a scar after draining
• If the boil is located around the nose and mouth or near the eyes there is a possibility the bacteria can bypass the brain barrier and enter the brain. This could lead to meningitis or life-threatening blood clots in the larger blood vessel3
• The boil was not drained completely and refills with pus
• You develop a secondary infection

In certain cases, repeating infections could be caused by an underlying condition. A medical condition that impairs and impacts your immune system could be the cause. This can result in your body finding it tough to fight off bacterial infections and, therefore, becoming more prone to infections. To determine if this is the case, it is better to consult your doctor and conduct tests if required.

Post-drainage care

The most important advice after draining the boil is to keep the affected area clean and covered with something sterile to ensure the wound is healing in a clean environment, preventing any future infections.

FAQ

What is the difference between an abscess, a boil, folliculitis, and cellulitis?

• Boils are an infection that forms under the surface of the skin. They are tender at first but hardens over time
• Abscesses are larger and much deeper within the tissue, filled with pus and presents characteristics such as redness and painful swelling
• Folliculitis is categorised as the inflammation of the hair follicles, presenting with pus and redness
• Cellulitis is an infection deep within the skin, where the affected area presents an expanding and painful red rash that is tender to touch

Summary

To summarise, to drain a boil it must be done by a medical professional in a sterile environment to reduce the chances of getting any secondary infection. Any recurrent infections should be considered investigating any symptoms of potentially low immunity to address any underlying health issue and follow up with your doctor if you have any concerns.