What are boils?
Boils are painful, visible lumps in the skin formed due to an infection of hair follicles.1 This infection leads to the accumulation of pus. Boils are clinically known as furuncles and caused by bacterial infection. The most common bacteria are the Staphylococcus aureus.2 Other types of bacteria can also cause the infection, especially in the regions of the vagina and anus. They can be present on other body parts presenting with tenderness, and will usually appear swollen and red.3
In most people, boils are an occasional occurrence soon forgotten. However, in some cases, boils can recur frequently causing a lot of physical and psychological discomfort.1 These boils can also cause further complications if not properly addressed. An understanding of boils, their causes, proper hygiene and lifestyle changes, are necessary to prevent recurrence. This article will look to provide a comprehensive understanding, tips for avoiding recurrent boils, and adjustments that can be made.
Recurrent boils
Usually, it is termed a recurrence if there are three or more episodes or crises of boils within one year.1 This commonly arises when the bacteria, Staphylococcus aureus, forms a colony in the nose, and also in the warm and heat-prone areas of the skin. These regions would include the area behind the ears, pendulous breasts, and in the groin along with the buttocks, shoulders, armpits, and face.1
This recurrence is caused by methicillin-susceptible Staphylococcus aureus. However, some strains of methicillin-resistant Staphylococcus aureus (MRSA) can also cause severe boils and recurrence.4
Causes of recurrent boils
The primary cause of boils is the bacteria, Staphylococcus aureus. However, there are other factors that increase the risk of this bacteria and the recurrence of boils. They are:5
Poor hygienic practices
Persons who bathe and shower frequently with soap will be able to remove dirt and microorganisms. Thus, decreasing the risk of Staphylococcus infection.
Previous hospital admission
This has been linked to an increased risk of an infection with methicillin resistant Staphylococcus aureus (MRSA)
Poor immunity
Poor immune systems as a result of diseases like HIV and diabetes increase the risk of having recurrent boils.
Associated skin diseases
Like atopic dermatitis, wounds that are not healing, skin ulcers can predispose one to recurrent furunculosis. Also, skin breakouts like acne and eczema also make the skin prone to breaks that allow for bacterial penetration.
Iron-deficiency anaemia
People who are iron deficient have been reported to have an increased risk of developing recurrent boils.
Family history of boils
A positive family history creates avenues for physical contact with a person who has a boil.
Sweat and friction-prone areas
The inner thighs are especially prone to recurring boils, due to the friction that occurs with walking.
How to prevent recurrent boils?
Good hygiene
Good hygiene practices are important in preventing boil recurrence. Proper handwashing techniques and showers are important to prevent the accumulation or colonisation of bacteria on the skin. The use of alcohol-based sanitisers or gels is also recommended. If there is a wound, this should be regularly and properly cared for with clean and dry bandages until they heal.
Personal items
Avoid sharing personal items with other persons. The occupants of a house should have their own razor blades and towels. The communal areas should be regularly disinfected. Touch points like door knobs, light switches, and kitchen and bathroom fittings, should be frequently sanitised.
Clothing
Loose, airy clothing prevents the trapping of sweat that creates a conducive bacterial environment. For gym activities, breathable and moisture-wicking clothing is encouraged.
Weight management
Maintaining a healthy weight reduces the risk of recurring boils. Engaging in exercise in addition to dietary changes is essential to prevent skin conditions that allow for bacterial growth.
Managing other skin conditions
Other skin conditions like acne and eczema should be well managed and treated with gentle skincare products to prevent skin irritation dryness and injuries that allow for the entry of bacteria.
Immune system
General advice on improving the immune system includes proper diet, stress management, and proper sleep. A diet rich in fruits and vegetables rich in vitamin C will promote healthy immune function. Stress management activities like yoga and meditation are also encouraged in daily life.
Management of other health conditions
Diabetes has been noted as a strong risk factor for recurring boils. It is important to manage one’s blood sugar, to prevent boil recurrence. Follow up with your health provider on periodic checks and medical management as needed. Blood tests to check full blood count may also be necessary to exclude other systemic causes.
Management
Medical management of recurrent boils may become necessary if these prevention techniques fail to work.5
Medical examination
Medical exams may involve your clinician looking at the affected body part and directly identifying the condition. In recurrent cases, a swab of the pus or liquid from the boil may be taken. They may also swab common areas through which the bacteria enters the body like the nostrils or perineal areas. These samples are then taken to the lab where the common culprit, Staphylococcus aureus, is identified. It may be relevant to take swabs from other members of the household in recurrent cases.
Antibiotics
For simple boils, antibiotics are not usually encouraged. This is to prevent antimicrobial resistance.6 Rather, a simple incision of the affected area and drainage may just suffice. In some cases, a warm compress and a topical ointment will also promote the healing process.
However, oral antibiotics may be recommended in below situations:1
- For severe cases, where affected areas are multiple and rapidly progressing.
- Generalized sickness
- Elderly patients
- A boil that is difficult to drain
- Poor response to incision and drainage
Decolonization
This is done in cases where there is frequent recurrence despite good hygiene practices, or in cases of household members. It reduces the presence of bacteria and hence, the recurrent boil.
Decolonization involves the use of mupirocin ointment in the nostrils and daily body wash with a disinfectant like chlorhexidine. The decolonization period will last for 5 to 14 days.1
Summary
- Boil or furunculosis is a skin condition caused mostly by the bacteria, Staphylococcus aureus. It is defined as a recurrent boil if there are three or more crises of boils in one year
- The most common cause is poor hygiene. However, other medical conditions like diabetes and anaemia, or a family history, obesity, and hospital admissions, can predispose one to the causing bacteria
- The prevention involves making lifestyle changes and following good hygienic practices. Medical management may also be necessary where there are other underlying causes
References
- Ibler KS. Recurrent furunculosis – challenges and management: A review. Clinical, Cosmetic and Investigational Dermatology. 2014 Feb 18;7.
- Sukumaran V, Senanayake S. Bacterial skin and soft tissue infections. Australian Prescriber. 2016 Oct 1;39(5):159–63.
- Lin HS, Lin PT, Tsai YS, Wang SH, Chi CC. Interventions for bacterial folliculitis and boils (furuncles and carbuncles). Cochrane Database of Systematic Reviews. 2021 Feb 26;2021(3).
- Stevens DL, Bisno AL, Chambers HF, Everett ED, Dellinger P, Goldstein EJC, et al. Practice Guidelines for the Diagnosis and Management of Skin and Soft-Tissue Infections. Clinical Infectious Diseases. 2005 Nov 15;41(10):1373–406.
- El-Gilany AH, Fathy H. Risk factors of recurrent furunculosis. Dermatology Online Journal. 2009;15(1).6. Demos M, McLeod MP, Nouri K. Recurrent furunculosis: a review of the literature. British Journal of Dermatology. 2012 Sep 26;167(4):725–32.
