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Soothing those Boils

Every year, millions of Americans seek treatment for skin problems. Although most skin conditions aren't life-threatening, they can be uncomfortable and emotionally distressing. This is particularly true of inflammatory conditions such as boils and carbuncles -- painful, pus-filled bumps that form under your skin when bacteria infect one or more of your hair follicles.

Boils usually start as red, tender lumps. The lumps quickly fill with pus, growing larger and more painful until they rupture and drain. Although some boils disappear a few days after they occur, most take about two weeks to heal.

Boils can occur anywhere on your skin, but appear mainly on your face, neck, armpits, buttocks or thighs -- hair-bearing areas where you're most likely to sweat or experience friction. Sometimes boils occur in clusters called carbuncles. Although anyone can develop these painful infections, people who have diabetes, a suppressed immune system, or acne or other skin problems are at increased risk.

You can usually care for a single boil at home, but don't attempt to lance or squeeze it -- that may spread the infection. Call your doctor if a boil or carbuncle is extremely painful, lasts longer than two weeks or occurs with a fever. In that case, you may need antibiotics or surgical drainage to clear the infection.

Signs and symptoms
A boil usually appears suddenly as a painful pink or red bump about 1/2 inch in diameter. The surrounding skin may also be red and swollen.

Within 24 hours, the bump fills with pus. It grows larger and more painful for five to seven days, sometimes reaching golf-ball size before it develops a yellow-white tip that finally ruptures and drains. Boils generally clear completely in about two weeks. Small boils usually heal without scarring, but a large boil may leave a mark.

A carbuncle is a cluster of boils that often occurs on the back of the neck, shoulders or thighs, especially in older men. Carbuncles cause a deeper and more severe infection than a single boil. They also develop and heal more slowly and are likely to leave a scar. Carbuncles sometimes occur with a fever.

Boils and carbuncles often resemble the inflamed, painful lumps caused by cystic acne. But boils tend to occur once or to reappear intermittently, whereas cystic acne is often an ongoing problem. Boils are also usually more red or inflamed around the border and more painful than an acne cyst.

Boils usually form when one or more hair follicles -- the tube-shaped shafts from which hair grows -- become infected with staph bacteria (Staphylococcus aureus). These bacteria, which normally inhabit your skin and sometimes your throat and nasal passages, are responsible for a number of serious diseases, including pneumonia, meningitis, urinary tract infections and endocarditis -- an infection of the lining of your heart. They're also a major cause of hospital-acquired infections and foodborne illnesses.

Staph bacteria that cause boils generally enter through a cut, scratch or other break in your skin. As soon as this occurs, specialised white blood cells called neutrophils rush to the site to fight the infection. This leads to inflammation and eventually to the formation of pus a mixture of old white blood cells, bacteria and dead skin cells.

Risk factors
Although anyone -- including otherwise healthy people -- can develop boils or carbuncles, the following factors can increase your risk:

  • Poor general health. Having chronic poor health makes it harder for your immune system to fight infections.
  • Diabetes. This disease also makes it more difficult for your body to fight infection. In fact, recurrent boils sometimes may be a sign of diabetes, especially in people older than 40.
  • Clothing that binds or chafes. The constant irritation from tight clothing can cause breaks in your skin, making it easier for bacteria to enter your body.
  • Other skin conditions. Because they damage your skin's protective barrier, skin problems such as acne and dermatitis make you more susceptible to boils and carbuncles.
  • Immune-suppressing medications. Long-term use of corticosteroids such as prednisone or other drugs that suppress your immune system can increase your risk.

When to seek medical advice
You usually can care for a single, small boil yourself. But see your doctor if a boil occurs on your face or spine or if you have:

  • A boil that worsens rapidly or is extremely painful
  • Boils that are very large, haven't healed in two weeks or are accompanied by a fever
  • Frequent boils
    Red lines radiating from a boil, which may be a sign that the infection has entered your bloodstream
  • A condition that suppresses your immune system, such as an organ transplant or HIV infection
  • Children and older adults who develop one or more boils should also receive medical care.

Screening and diagnosis
Doctors usually diagnose a boil simply by looking at your skin, but sometimes they take a sample of pus to check for the type of bacteria it contains. If you have recurring infections, you may be tested for diabetes or other illnesses that weaken your immune system.

In some cases, bacteria from a boil can enter your bloodstream and travel to other parts of your body. The spreading infection, commonly known as blood poisoning (septicemia), can rapidly become life-threatening.

Initially, blood poisoning causes signs and symptoms such as chills, a spiking fever, a rapid heart rate and a feeling of being extremely ill. But the condition can quickly progress to shock, which is marked by falling blood pressure and body temperature, confusion, clotting abnormalities and bleeding into the skin. Blood poisoning is a medical emergency -- untreated, it can be fatal.

Another serious problem is the rapid emergence of a drug resistant strain of Staphylococcus aureus. Once mainly confined to hospitals, methicillin-resistant Staphylococcus aureus (MRSA) now affects growing numbers of military recruits, prison inmates, athletes -- especially those involved in contact sports such as wrestling -- and even young children.

MRSA is highly contagious and spreads rapidly in crowded or unhygienic situations, or where athletic equipment or towels are shared. Although it responds well to several antibiotics, MRSA is resistant to penicillin. If treated with the wrong medications, the infection can be fatal.

Your doctor may drain a large boil or carbuncle by making a small incision in the tip. This relieves pain, speeds recovery and helps lessen scarring. Deep infections that can't be completely cleared may be covered with sterile gauze so that pus can continue to drain. Sometimes your doctor may prescribe antibiotics to help heal severe or recurrent infections.

Although it's not always possible to prevent boils, especially if you have a compromised immune system, the following measures may help you avoid staph infections:

  • Thoroughly clean even small cuts and scrapes. Wash well with soap and water and apply an over-the-counter antibiotic ointment.
  • Avoid constricting clothing. Tight clothes may be stylish, but make sure they don't chafe your skin.
  • Eat a healthy diet. Instead of reaching for sugary or fat-laden foods, choose whole grains, fresh fruits and vegetables and small amounts of lean protein.

The following measures may help the infection heal more quickly and prevent it from spreading:

  • Apply a warm washcloth or compress to the affected area. Do this for approximately 30 minutes every few hours. If possible, soak the cloth or compress in warm salt water, which helps the boil rupture and drain more quickly. To make salt water, add 1 teaspoon of salt to 1 quart of boiling water and cool to a comfortable temperature.
  • Gently wash the boil twice a day. After washing, apply an over-the-counter antibiotic and cover with a bandage.
  • Never squeeze or lance a boil. This can spread the infection.
  • Wash your hands thoroughly after treating a boil. Also, launder clothing, towels or compresses that have touched the infected area.

Complementary and alternative medicine
Some people have found that these treatments help relieve discomfort and speed healing:

  • Tea tree oil. This essential oil, which is extracted from the leaves of the Australian tea tree (Melaleuca alternifolia), has been used for centuries as an antiseptic, antibiotic and antifungal agent. For best results, apply the oil to a boil several times a day. Most natural food stores and pharmacies carry tea-tree oil products. The oil can cause allergic reactions in some people, so be sure to stop using it if you have any problems.
  • Homeopathic remedies. Homeopathy is a method of healing based on the principle that "like cures like." It uses minute, highly diluted amounts of various substances to stimulate the body to heal itself. Homeopathic remedies for boils include belladonna, hepar sulphuris and silica. You can find them in many natural food stores.
  • Herbs. Herbal teas such as dandelion and red clover are believed to help bacterial infections. Ointments containing marshmallow or slippery elm may relieve inflammation. Because herbs can interfere with other medications, be sure to talk to your doctor before taking any herb internally.

Source: CNN Health/Library Online

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