Boils Health Article

Definition

Boils, also called furuncles, and carbuncles are bacterial infections of hair follicles and surrounding skin that form pustules (small blister-like swellings containing pus) around the follicle. A carbuncle results when several boils merge to form a single deep abscess with several heads, or drainage points.

Description

Boils and carbuncles are firm reddish swellings about 0.2–0.4 inches (5–10 mm) across that are slightly raised above the skin surface. They are sore to the touch. A boil usually has a visible central core of pus; a carbuncle is larger and has several visible heads. Boils occur most commonly on the face, back of the neck, buttocks, upper legs and groin area, armpits, and upper torso. Carbuncles are less common than single boils; they are most likely to form at the back of the neck. Males are more likely to develop carbuncles.

Boils and carbuncles are common problems in the general population, particularly among adolescents and adults. People who are more likely to develop these skin infections include those with:

• diabetes, especially when treated by injected insulin
• alcoholism or drug abuse
• poor personal hygiene
• crowded living arrangements
• jobs or hobbies that expose them to greasy or oily substances, especially petroleum products
• allergies or immune system disorders, including HIV infection
• family members with recurrent skin infections

Causes and symptoms

Boils and carbuncles usually are caused by Staphylococcus aureus, a bacterium that causes an infection in an oil gland or hair follicle, or they might be caused by other bacteria or fungi. Although the surface of human skin is usually resistant to bacterial infection, S. aureus can enter through a break in the skin surface—including breaks caused by needle punctures for insulin or drug injections. Hair follicles that are blocked by greasy creams, petroleum jelly, or similar products are more vulnerable to infection. Bacterial skin infections can be spread by shared cosmetics or washcloths, close human contact, or by contact with pus from a boil or carbuncle.

As the infection develops, an area of inflamed tissue gradually forms a pus-filled swelling or pimple that is painful to touch. As the boil matures, it forms a yellowish head or point. It may either continue to swell until the point bursts and allows the pus to drain, or it may gradually be reabsorbed into the skin. Boils can cause a lot of pain when they occur in the ear canal, nose, or other sensitive areas. It takes between one and two weeks for a boil to heal completely after it comes to a head, discharges pus, and crusts over. The bacteria that cause the boil can spread into other areas of the skin and even into the bloodstream if the skin around the boil is squeezed. If the infection spreads, the patient will usually develop chills and fever, swollen lymph nodes (lymphadenitis), and red lines in the skin running outward from the boil. Fatigue and general discomfort are other possible symptoms.

Furunculosis is sometimes used to refer to recurrent boils. Many patients have repeated episodes of furuncu losis that are difficult to treat because their nasal passages carry colonies of S. aureus. These bacterial colonies make it easy for the patient's skin to be re-infected. They are most likely to develop in patients with diabetes, HIV infection, or other immune system disorders.

Carbuncles are formed when the bacteria infect several hair follicles that are close together. Carbunculosis is sometimes used to refer to the development of carbuncles. The abscesses spread until they merge with each other to form a single large area of infected skin with several pus-filled heads. Patients with carbuncles may also have a low-grade fever or feel generally unwell.

Diagnosis

The diagnosis of boils and carbuncles is usually made by the patient's primary care doctor on the basis of visual examination of the skin. In some cases involving recurrent boils on the face, the doctor may consider acne as a possible diagnosis, but, for the most part, boils and carbuncles are not difficult to distinguish from other skin disorders.

S. aureus can easily be cultured in the laboratory if the doctor needs to rule out inclusion cysts or deep fungal infections that gardeners sometimes get. The doctor can take a culture from pus taken from the boil or carbuncle to confirm the diagnosis of a staphylococcal infection. He or she can also culture the patient's nasal discharge to test for the presence of a S. aureus colony.