Boil

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This article is about the contagious skin disease. For the change in state from liquid to gas, see Boiling. For other uses, see Boil (disambiguation).
Boils
Classification and external resources
Furoncle.jpg
Furuncle
ICD-10 L02
ICD-9 680.9
DiseasesDB 29434
MedlinePlus 001474 000825
MeSH D005667

A boil, also called a furuncle, is a deep folliculitis, infection of the hair follicle. It is most commonly caused by infection by the bacterium Staphylococcus aureus, resulting in a painful swollen area on the skin caused by an accumulation of pus and dead tissue.[1] Boils are basically pus-filled nodules.[2] Individual boils clustered together are called carbuncles.[3] Most human infections are caused by coagulase-positive S. aureus strains, notable for the bacteria's ability to produce coagulase, an enzyme that can clot blood. Almost any organ system can be infected by S. aureus.

Signs and issues[edit]

Boils are bumpy, red, pus-filled lumps around a hair follicle that are tender, warm, and very painful. They range from pea-sized to golf ball-sized. A yellow or white point at the centre of the lump can be seen when the boil is ready to drain or discharge pus. In a severe infection, an individual may experience fever, swollen lymph nodes, and fatigue. A recurring boil is called chronic furunculosis.[1][4][5][6] Skin infections tend to be recurrent in many patients and often spread to other family members. Systemic factors that lower resistance commonly are detectable, including: diabetes, obesity, and hematologic disorders.[7] Boils can be caused by other skin conditions that cause the person to scratch and damage the skin.

Boils may appear on the buttocks or near the anus, the back, the neck, the stomach, the chest, the arms or legs, or even in the ear canal.[8] Boils may also appear around the eye. It is called a stye.[9]

Anyone can get boils but it is easier for a teenager or a young adult to get boils than any other age.[8]

Causes[edit]

Boils appear because the body wants to remove the invading substance through the skin, rather than through the digestive system or the urinary system. This is because the body thinks that removing the substance through the skin is safer than through the other systems.[10] A high level of toxins can cause boils.[2]

Bacteria[edit]

Usually, the cause is bacteria such as staphylococci that are present on the skin. Bacterial colonisation begins in the hair follicles and can cause local cellulitis and inflammation.[1][5][6] Additionally, myiasis caused by the Tumbu fly in Africa usually presents with cutaneous furuncles.[11] Risk factors for furunculosis include bacterial carriage in the nostrils, diabetes mellitus, obesity, lymphoproliferative neoplasms, malnutrition, and use of immunosuppressive drugs.[12]

Family history[edit]

Patients with recurrent boils are as well more likely to have a positive family history, take antibiotics, and to have been hospitalised, anemic, or diabetic; they are also more likely to have associated skin diseases and multiple lesions.[13]

Allergy[edit]

Allergies can cause boils.

High-glycemic foods can cause boils by having a sudden rush of insulin and other hormones, which is highly probable that it causes a large rise in oil production in the hair, which causes cystic acne and boils. The large oil production will then cause the hair follicles to become inflammed.[14][15]

Other[edit]

Boils can also occur because of poor hygiene, poor nutrition, problems with the immune system or exposure to harsh chemicals that irritate the skin[16]

Complications[edit]

The most common complications of boils are scarring and infection or abscess of the skin, spinal cord, brain, kidneys, or other organs. Infections may also spread to the bloodstream (bacteremia) and become life-threatening.[5][6] S. aureus strains first infect the skin and its structures (for example, sebaceous glands, hair follicles) or invade damaged skin (cuts, abrasions). Sometimes the infections are relatively limited (such as a stye, boil, furuncle, or carbuncle), but other times they may spread to other skin areas (causing cellulitis, folliculitis, or impetigo). Unfortunately, these bacteria can reach the bloodstream (bacteremia) and end up in many different body sites, causing infections (wound infections, abscesses, osteomyelitis, endocarditis, pneumonia)[17] that may severely harm or kill the infected person. S. aureus strains also produce enzymes and exotoxins that likely cause or increase the severity of certain diseases. Such diseases include food poisoning, septic shock, toxic shock syndrome, and scalded skin syndrome.[18] Almost any organ system can be infected by S. aureus.

Treatment[edit]

A small boil may burst and drain on its own without any assistance.[19]

Furuncles at risk of leading to serious complications should be incised and drained. These include furuncles that are unusually large, last longer than two weeks, or are located in the middle of the face or near the spine.[1][6] Fever and chills are signs of sepsis that require immediate treatment. [20]

Antibiotic therapy is advisable for large or recurrent boils or those that occur in sensitive areas (such as around or in the nostrils or in the ear).[1][4][5][6] Staphylococcus aureus has the ability to acquire antimicrobial resistance easily, making treatment difficult. Knowledge of the antimicrobial resistance of S. aureus is important in the selection of antimicrobials for treatment.[21] Poor personal hygiene being common, the role of nasal S. aureus carrier may differ from communities with good hygienic practices. Staphylococcus aureus re-infection may result from contact with infected family members, contaminated fomites, or from other extra-nasal sites. This raises a suggestion to treat household contacts and close contacts if recurrence persists, because it is likely that one or more contacts are asymptomatic carriers of S. aureus. In addition to the increase in the cost of treatment in poor countries, the possibility of developing drug resistance must be considered. The most important independent predictor of recurrence is a positive family history. Boils are spread among individuals by touching or bursting a boil. The role of iron deficiency anemia in recurrent furunculosis was demonstrated, all patients were free from recurrence during the six months follow-up period after iron supplementation.[22] A variety of host factors, such as abnormal neutrophil chemotaxis, deficient intra-cellular killing, and immuno-deficient states are of importance in a minority of patients with recurrent furunculosis.[23] Health education about sound personal hygiene and correction of anemia should be mandatory in management of furunculosis.[13] It was found that recurrence was significantly associated with poor personal hygiene.[24] A previous study reported that MRSA infection was significantly associated with poor personal hygiene.[citation needed] It was reported that frequent hand and body washing with water and antimicrobial soap solution[citation needed] decreases staphylococcus skin colonization. Previous use of antibiotics is associated with a high risk of recurrence. This may be due to the development of resistance to the antibiotics used.[25] An associated skin disease favors recurrence. This may be attributed to the persistent colonization of abnormal skin with S. aureus strains, such as is the case in patients with atopic dermatitis.[25]

People with boils in their ear canals should not insert a cotton bud into there to clean any pus because cotton buds may obstruct the ear canal.

Home remedies include applying warm compresses and soaking the boil in warm water, which will decrease the pain and help draw the pus to the surface. Once the boil comes to a head, it will burst with repeated soakings. Another home remedy is to wash burst boils with antibacterial soap until all pus is gone, and then with rubbing alcohol, and continue washing the same way for 2–3 days.

See also[edit]

References[edit]

  1. ^ a b c d e MedlinePlus Encyclopedia Furuncle
  2. ^ a b http://www.healthguidance.org/entry/11040/1/Causes-and-Cures-of-Skin-Boils.html
  3. ^ MedlinePlus Encyclopedia Carbuncle
  4. ^ a b Blume JE, Levine EG, Heymann WR (2003). "Bacterial diseases". In Bolognia JL, Jorizzo JL, Rapini RP. Dermatology. Mosby. p. 1126. ISBN 0-323-02409-2. 
  5. ^ a b c d Habif, TP (2004). "Furuncles and carbuncles". Clinical Dermatology: A Color Guide to Diagnosis and Therapy (4th ed.). Philadelphia PA: Mosby. 
  6. ^ a b c d e Wolf K, et al. (2005). "Section 22. Bacterial infections involving the skin". Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology (5th ed.). McGraw-Hill. 
  7. ^ Steele RW, Laner SA, Graves MH (February 1980). "Recurrent staphylococcal infection in families". Arch Dermatol 116 (2): 189–90. doi:10.1001/archderm.116.2.189. PMID 7356349. 
  8. ^ a b http://www.patient.co.uk/health/boils-carbuncles-and-furunculosis
  9. ^ http://www.kidshealth.org.nz/boils
  10. ^ http://www.healingdaily.com/conditions/boils.htm
  11. ^ Tamir J, Haik J, Schwartz E (2003). "Myiasis with Lund's fly (Cordylobia rodhaini) in travellers". J Travel Med 10 (5): 293–5. PMID 14531984. 
  12. ^ Scheinfeld NS (2007). "Furunculosis". Consultant 47 (2). 
  13. ^ a b El-Gilany AH, Fathy H (January 2009). "Risk factors of recurrent furunculosis". Dermatol Online J 15 (1): 16. PMID 19281721. 
  14. ^ http://www.livestrong.com/article/448495-can-certain-foods-cause-boils/
  15. ^ http://medical-dictionary.thefreedictionary.com/Boils
  16. ^ http://www.webmd.com/skin-problems-and-treatments/guide/boils
  17. ^ Lina G, Piémont Y, Godail-Gamot F, Bes M, Peter MO, Gauduchon V, Vandenesch F, Etienne J (November 1999). "Involvement of Panton-Valentine leukocidin-producing Staphylococcus aureus in primary skin infections and pneumonia". Clin Infect Dis 29 (5): 1128–32. doi:10.1086/313461. PMID 10524952. 
  18. ^ http://www.emedicinehealth.com/staphylococcus/page4_em.htm
  19. ^ Mayo Clinic
  20. ^ ref=http://www.mayoclinic.com/health/boils-and-carbuncles/DS00466/DSECTION=complications
  21. ^ Nagaraju U, Bhat G, Kuruvila M, Pai GS, Babu RP (2004). "Methicillin-resistant staphylococcus aureus in community-acquired pyoderma". Int J Dermatol 43 (6): 412–4. doi:10.1111/j.1365-4632.2004.02138.x. PMID 15186220. 
  22. ^ Demircay Z, Eksioglu-Demiralp E, Ergun T, et al. (1998). "Phagocytosis and oxidative burst by neutrophils in patients with recurrent furunculosis". Br J Dermatol 138 (6): 1036–8. doi:10.1046/j.1365-2133.1998.02274.x. PMID 9747369. 
  23. ^ Fitzpatrick JE (1996). "Bacterial infection". In Fitzpatrick JE, Aeling JL. Dermatology secrets. Hanley and Belfus. p. 174. 
  24. ^ Shah KS, Hansotia MF (2005). "Personal hygiene". In Iliyas M. Community medicine and public health. p. 557. 
  25. ^ a b Laube S, Farrell M (2002). "Bacterial skin infection in the elderly: diagnosis and treatment". Drugs and Aging 19 (5): 331–42. doi:10.2165/00002512-200219050-00002. PMID 12093320. 

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