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| | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
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| {{Infobox_Disease | | {{Infobox_Disease |
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| {{Boil}} | | {{Boil}} |
| {{CMG}} | | {{CMG}} |
| ==Overview== | | ==[[Boil overview|Overview]]== |
| '''Boil''' or '''furuncle''' is a skin disease caused by the inflammation of [[hair follicle]]s, thus resulting in the localized accumulation of [[pus]] and dead tissue. Individual boils can cluster together and form an interconnected network of boils called [[carbuncle]]s. In severe cases, boils may develop to form [[abscess]]es. In general:
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| :*'''Furuncle'''
| | ==[[Boil historical perspective|Historical Perspective]]== |
| ::*tender abscess arising in hair follicle with extension into deep dermis
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| ::*almost invariably due to [[S. aureus]] infection
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| ::*occurs in areas subject to friction and perspiration (neck, face, buttocks)
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| :*'''Carbuncle'''
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| ::*deeper, interconnecting abscesses arising in contiguous hair follicles
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| ::*commonly occurs at nape of neck and on back, thighs
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| ::*a potential complication of furunculosis
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| == Risk Factors == | | ==[[Boil classification|Classification]]== |
| :*Chronic [[S. aureus]] carrier state (nares, axillae, perineum)
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| :*[[Obesity]]
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| :*[[Corticosteroid]] Rx
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| :*[[Diabetes]]
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| :*Defects in [[neutrophil]] function – uncommon
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| ==Symptoms== | | ==[[Boil pathophysiology|Pathophysiology]]== |
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| The symptoms of boils are red, [[pus]]-filled lumps that are tender, warm, and/or painful. A yellow or white point at the center of the lump can be seen when the boil is ready to drain or discharge [[pus]]. In a severe infection, multiple boils may develop and the patient may experience [[fever]] and swollen [[lymph node]]s. A recurring boil is called chronic furunculosis.
| | ==[[Boil causes|Causes]]== |
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| In some people, itching may develop before the lumps begin to develop. Boils are most often found on the back, underarms, shoulders, face, lip, eyes, nose, thighs and buttocks, but may be found elsewhere. Boils on the ear tend to be more painful, and can create shooting pain in the entire area when touched.
| | ==[[Boil differential diagnosis|Differentiating Boil from other Diseases]]== |
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| Sometimes boils will emit an unpleasant smell, particularly when drained or when discharge is present, due to the presence of bacteria in the discharge.
| | ==[[Boil epidemiology and demographics|Epidemiology and Demographics]]== |
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| ==Causes== | | ==[[Boil risk factors|Risk Factors]]== |
| Boils are generally caused by an infection of the hair follicles by ''[[Staphylococcus aureus]]'' or ''[[Staphylococcus epidermidis]]'', a strain of [[bacterium]] that normally lives on the skin surface. It is thought that a tiny cut of the skin allows this bacterium to enter the follicles and cause an infection. This can happen during bathing or while using a razor.
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| People with [[immune system]] disorders, [[diabetes]], poor hygiene or malnutrition ([[Vitamin A]] or [[Vitamin E|E]] deficiency) are particularly susceptible to getting boils; however, they also occur in healthy, hygienic individuals, due to over scratching a particular area of the skin.
| | ==[[Boil natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ''[[Hidradenitis suppurativa]]'' causes frequent boils and boils in the [[armpits]] can sometimes be caused by anti-perspirant deodorants.
| | ==Diagnosis== |
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| The development of boils throughout the body is also a symptom of [[smallpox]].
| | [[Boil history and symptoms|History and Symptoms]] | [[Boil physical examination|Physical Examination]] | [[Boil laboratory findings|Laboratory Findings]] |
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| Boils can also be caused by not washing an area of the body, particularly the face, where two or more areas of skin cleft together, such as where the nose meets the cheek or where the ear meets the head. Boils formed in this manner often have a visible core of dirt that emerges when drained.
| | ==Treatment== |
| | [[Boil medical therapy|Medical Therapy]] | [[Boil surgery|Surgery]] | [[Boil primary prevention|Primary Prevention]] | [[Boil cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Boil future or investigational therapies|Future or Investigational Therapies]] |
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| ==Treatments== | | ==[[Boil case study one|Case #1]]== |
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| Most boils run their course within 4 to 10 days. For most people, self-care by applying a warm compress or soaking the boil in warm water can help alleviate the pain and hasten draining of the pus (colloquially referred to as "bringing the boil to a head"). Once the boil drains, the area should be washed with antibacterial soap and bandaged well.
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| For recurring cases, sufferers may benefit from diet supplements of [[Vitamin A]] and [[Vitamin E|E]].
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| In serious cases, prescription oral [[antibiotic]]s such as [[dicloxacillin]] (Dynapen) or [[cephalexin]] (Keflex), or topical antibiotics, are commonly used. For patients allergic to penicillin-based drugs, [[erythromycin]] (E-base, Erycin) may also be used.
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| However, some boils are caused by a [[Antibiotic resistance|super bug]] known as '''Community-Associated Methicillin-Resistant ''Staphylococcus Aureus''''', or '''[[MRSA|CA-MRSA]]'''. [[Bactrim]] or other [[sulfa]] drugs must be prescribed relatively soon after boil has started to form. [[MRSA]] tends to increase the speed of growth of the infection.
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| [[Magnesium sulfate]] paste applied to the affected area can prevent the growth of bacteria and reduce boils by absorbing pus and drying up the lesion.
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| === Acute Pharmacotherapies ===
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| :*If [[fever]], [[carbuncle]]s, recurrences -> systemic abx vs. [[S. aureus]]
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| ::*[[Dicloxacillin]] 500 mg po q6h x 10-14 days
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| :*Alternatives:
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| ::*[[cephalexin]] 250 mg qid
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| ::*[[clindamycin]] 150 mg qid
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| ::*[[Bactrim]]
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| :*Abx
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| ::*[[Mupirocin]] 2% ointment to anterior nares bid x 5 days
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| :::*Eliminates [[S. aureus]] nasal carriage for up to 90 days
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| :::*Also effective against [[MRSA]], but 40% recur on maintenance Rx
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| ::*[[Rifampin]] 600 mg po qd x 10 days
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| :::*Eliminates nasal carriage for up to 3 months
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| :::*Consider in patients who have failed other preventive measures
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| :::*Rx acute recurrence simultaneously w/[[dicloxacillin]] or alternative x 10d
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| ::*[[Clindamycin]] 150 mg po qd x 3 months (suppressive regimen)
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| :::*Shown in one study to decrease frequency of recurrence
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| === Indications for Surgery ===
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| :*If persistent despite Rx -> incision and drainage
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| ==Prognosis==
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| For most cases, there are no serious complications and a full recovery is expected.
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| ==See also== | | ==See also== |
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| * [http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/9562.html InteliHealth - Boils and Carbuncles] | | * [http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/9562.html InteliHealth - Boils and Carbuncles] |
| * [http://www.healthinplainenglish.com/health/skin/boil/index.htm Health In Plain English - Boil or Furuncle] | | * [http://www.healthinplainenglish.com/health/skin/boil/index.htm Health In Plain English - Boil or Furuncle] |
| * [http://www.emedicinehealth.com/articles/20077-1.asp eMedicine Health - Boils Overview]
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| * [http://www.medicinenet.com/boils/article.htm MedicineNet.com - Boils] | | * [http://www.medicinenet.com/boils/article.htm MedicineNet.com - Boils] |
| * [http://www.skinverse.com/turmeric-for-painful-boils.html Cure Boils naturally with Turmeric powder] Home remedy | | * [http://www.skinverse.com/turmeric-for-painful-boils.html Cure Boils naturally with Turmeric powder] Home remedy |
| * [[DermAtlas]] | | * [[DermAtlas]] |
| {{Diseases of the skin and subcutaneous tissue}}
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| [[Category:Dermatology]] | | [[Category:Dermatology]] |
| [[Category:Infectious disease]] | | [[Category:Infectious disease]] |
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| [[da:Furunkel]]
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| [[de:Furunkel]]
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| [[et:Furunkul]]
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| [[fr:Furoncle]]
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| [[he:פורונקל]]
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| [[lt:Šunvotė]]
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| [[nl:Steenpuist]]
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| [[ja:せつ]]
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| [[pl:Czyrak]]
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| [[pt:Furúnculo]]
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| [[ru:Фурункул]]
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| [[simple:Boil]]
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| [[fi:Furunkuloosi]]
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| [[sv:Furunkel]]
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| [[tr:Çıban]]
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