A “boil” is an abscess that involves the skin. Although boils (also called “furuncles“) refer to skin and subcutaneous tissues, you can get an abscess in just about any organ. I have seen abscesses in abdominal organs like the ovary or liver, or even in other places like gums. Wherever you find them, they are essentially a walled-off pocket of pus. Pus is the debris left over from your body’s attempt to eliminate an infection; it consists of white and red blood cells, inflammatory fluid, and live and dead microbes (in boils, usually Staph species).
If the abscess was not caused by an infected wound or diseased tooth, it is possible that it originated in a “cyst”, which is a hollow structure filled with fluid. There are various types of cysts that can become infected and form abscesses:
- Sebaceous: skin glands often associated with hair follicles, they are concentrated on the face and trunk. These cysts produce oily material known as “sebum”.
- Inclusion: These occur when skin lining is trapped in deeper layers as a result of trauma. They continue to produce skin cells and grow.
- Pilonidal: These cysts are located over the area of the tailbone, and are due to a malformation during fetal development. They easily become infected and require intervention.
To deal with an abscess, a route must be forged to evacuate the pus. The easiest way to do this is to place warm moist compresses over the area, also known as “ripening the abscess”. Apply the compress over the area for 15 minutes or so every couple of hours during the day. This will help bring the infection to the surface of the skin, where it will form a “head” and, hopefully, drain spontaneously. The abscess will go from firm to soft as it ripens; it’ll develop a “whitehead” pimple at the likely point of exit.
You’ll be tempted to squeeze the boil in an effort to relieve the pressure discomfort. Doing this, however, may make the infection worse. Patience is important for a few days to give the abscess a chance to resolve on its own.
If a few days go by without spontaneous drainage, it may become clear that a boil or abscess will not respond to lesser treatment and needs surgical intervention. This is called “lancing a boil” and is otherwise referred to as “incision and drainage” in medical-ese. Always wash your hands and put on gloves before attempting this or, really, any other medical procedure.
Clean the area with an antiseptic and apply a numbing agent (even ice will do). You’ll need a sharp sterile instrument such as a scalpel (a #11 blade is best). If you don’t have a sterile instrument, you can put a thin blade over a fire until it becomes red hot, then let cool.
Using the tip of the scalpel, pierce the skin over the abscess perpendicular to the surface of the skin. The pus should drain freely, and your patient will probably experience immediate relief from the release of pressure. Sometimes a small Kelly clamp is useful to break up little compartments in the abscess called “loculations“, Have some extra gauze handy, as a large boil can be messy to treat.
Irrigate the wound with lots of saline solution or clean water. A thin gauze moistened with Betadine is then placed in the abscess cavity, commercially available as “iodoform packing”. Finally, apply an antibiotic ointment like Bactroban or raw, unprocessed honey to the skin surrounding the incision and cover with a clean bandage. Change the packing twice daily until the abscess cavity fills in. If the abscess returns, the walls may need removal in a more extensive procedure.
Oral antibiotics are a useful additional tool to treat boils, whether or not you decide to lance them. Amoxicillin, Cephalexin, or Erythromycin are options that are available in veterinary equivalents (Fish-Mox, Fish-Flex, and Fish-Mycin, respectively).
Incision and drainage may be helpful for dental abscesses as well, but may not save nearby teeth. Check our articles on this website under “dental” to see what should be in a kit to handle these problems. Of course, in normal times, seek modern medical and dental care whenever and wherever it is available.
Joe Alton, MD