Boils on the face are an annoying but inevitable part of life, especially throughout your teenage years. However, these skin infections are not limited to adolescents - we are all at risk of an unwelcome visitor on our faces. Alongside the embarrassment you may feel, a boil on the face can be painful, especially when eating or talking. It is necessary to know when an unsightly blemish becomes a health concern. This article will discuss the risks, treatment and care of boils on the face, giving you the information you need to take care of your most important feature. 

What are boils?

Also known by their technical name furuncle, boils are a common bacterial infection affecting hair follicles and surrounding skin tissue. The hair follicle consists of one hair, its root, a sebaceous gland and a muscle that raises the hair in response to the environment.¹ Related conditions include folliculitis, which involves inflammation of one or more follicles, and carbunculosis, in which a group of follicles are infected.²

S. aureus causes boils. A break in the skin allows the bacteria in through the follicle, and then to the deeper tissues underneath. Later, skin tissue dies, leaving an abscess that fills with pus. It gives the boils their characteristic water-balloon-like appearance. When multiple boils combine into a larger bump, it is known as a carbuncle.²

Boils appear anywhere on the body but are common in sweaty areas like the armpit, thighs and buttocks, and often occur on the neck and face. They occur once in a lifetime or become chronic - recurring multiple times after healing.² 

Most boils are self-healing on their own (with proper care, as detailed in Care and Prevention). It is important to know when to seek medical attention. Hospital admissions from furuncles and carbuncles have increased in recent years - one study recorded double hospitalisations between 1998 and 2010.³ Data from the UK recorded 280,000 primary care consultations for boils in 2010 - a figure that has likely increased since then.⁴

Symptoms and effects

You may initially think a boil is simply a pimple, especially if you are an adolescent or young adult, as these growths present as red, tender swelling on a firm patch of skin. If you notice the patch filling with white or yellow pus and increasing in size, the blemish is likely a boil. In some cases, boils can swell to the size of a golf ball, though most range between the size of a pea and a coin. Itching causes oozing or weeping from the boil. Alongside the physical manifestation of the bacterial infection, boils can also cause more general symptoms such as fatigue, fever and generally feeling unwell.²

It is important to monitor boils on the face. If not cared for properly, the bacteria in these boils can spread, enter the bloodstream and reach the brain, putting one at risk of meningitis or blood clots in large blood vessels - which can be life-threatening.¹

Risk factors

Boils are most common in adolescents and young adults, where factors such as poor hygiene and dirty living conditions are more present. 

Overcrowding can also be a risk factor, meaning that large families living in small spaces and lower-income families will be more affected.

People with weakened immune systems, through the likes of diabetes and cancer, have a greater chance of developing boils. Other conditions such as eczema and conjunctivitis. Weight is a contributing factor, as boils can thrive in between folds of the skin.¹

More immediate risk factors include coming into contact with pus from a boil, either directly or through clothing, towels or surfaces (British Association of Dermatologists).

Treatment

In some cases, boils drain and heal on their own. Depending on the severity of the boil, some home remedies may aid the process. 

Place a warm, antiseptic compress over the boil. It protects the boil from further infection and may speed up the natural draining process.

You can hasten the draining further by using a drawing salve with a compress, such as Ichthyol. This ointment speeds up the boil development so it can drain soon.⁵ 

When the boil is large,  painful and is present for more than 2 weeks,  it needs drainage.  An incision is given and the boil is drained. It is done as follows:

1. The affected area is anaesthetized using an anaesthetic
2. The medical professional makes an incision in the boil, allowing the pus to drain out
3. Strips of gauze are added to the wound to aid in pus removal and to keep the area clean
4. The wound is cleaned with saline solution or antiseptic ointment, then covered with gauze and a plaster. The wound heals with secondary healing protected from further infection.
5. The dressing on the wound should be changed daily

Extra care is required when boils form on the face, due to the risk of bacteria entering the bloodstream. It is important to keep the face still to reduce pressure on the boil - this means limiting facial movements such as talking or eating. Healthcare professionals suggest restricting your consumption to liquids and eating foods that require little chewing, such as soups, porridges and broths. Bed rest is also recommended during this time, alongside a warm antiseptic compress, to allow the boil to run its course and drain without complication. In the case of complications, antibiotics can be prescribed. These are usually administered via tablets, in liquid form or through intravenous drip.⁵

Care & prevention

While you assess the severity of the boil, take care of the infected area. This is important while caring for the boils on the face. You must resist the urge to touch or pop the boil, as it can introduce more bacteria to the follicles or leave you with a dangerous open wound. However, it is necessary to clean the boil regularly with antiseptic cloths and change any dressings one may have applied. Handwashing is key to avoid the transfer of bacteria - hands should be washed before and after interacting with the boil. During this period, towels and washcloths should not be shared between infected and uninfected persons. These items, along with clothing and sheets of infected persons, should be washed regularly (ideally immediately after contact with the boil). Care should be taken when disposing of dressings, as these will contain the most concentrated amounts of infected material. Dressing should be thrown out in sealed bags, along with other infected single-use material. To avoid spreading the bacteria outside your household, you should avoid using public pools or gyms while you are suffering from a boil.² 

Preventative measures are relatively simple. Use antibacterial soaps where possible and wash areas that may have come into contact with bacteria with an antiseptic solution.² Generally maintaining good hygiene is usually enough to protect you from boils. Good handwashing is key to preventing boils on the face, as your hands come into contact with countless bacteria and many people touch their face throughout their day. 

Summary

Boils on the face are painful in more ways than one - they can ruin your appearance and leave you unable to smile out of soreness. On top of being an eyesore, a facial boil can become a serious health risk if not taken seriously. Boils form as bacteria enter a break in the skin, causing damage to hair follicles and leading to an accumulation of white/yellow liquid called pus. You’re more likely to develop a boil if you’re a teenager or young adult, or immunocompromised. Alongside a painful pus-filled spot, other symptoms of boils include fatigue and fever. If you believe you’re developing a boil, your first step should be to soothe the area with a warm, antiseptic compress. This should speed up the development and draining process. If the boil worsens, you may need to seek professional help to drain the boil for you. Extra precautions must be taken for facial boils, such as limiting facial movement as much as possible and taking bed rest for the duration of the infection. Maintaining good hygiene, especially handwashing, and a clean environment are the best measures to protect yourself from boils on the face.