By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

BOILS THAT ARE LARGE, PAINFUL OR CAUSE FEVER NEED DOCTOR’S CARE

Question:  What is a boil and what causes them? Sometimes I get a boil on the inside of my thigh in the crease of my leg. It becomes red and swollen and very sore. Is there a home remedy or over-the-counter medicine to get rid of a boil? Also, are there any changes in diet that will prevent boils from returning?

Answer: A boil -- a furuncle in medical terms -- usually starts as an infected hair follicle, and as it progresses, the infection spreads to deeper tissues. The infection site becomes a walled-off area that is filled with pus. A carbuncle is a cluster of boils in the same area that are connected together under the skin. These usually are deeper in the tissues and more difficult to treat.

Sometimes you may hear boils referred to as skin abscesses. By whatever name, they are caused by bacteria, usually staphylococcus aureus.

Boils occur most commonly in areas of skin friction, like the crease of the leg that you describe. A boil starts off as a red area that’s sore to the touch. As it increases in size, it becomes even more tender. Often a boil will spontaneously burst, letting the pus out and allowing the infection to heal on its own. Aggressively using warm compresses in the early stages of an abscess can promote complete, prompt resolution of the infection.

As you can see, not every boil needs to be seen by a physician. But if you are a diabetic or have underlying systemic illnesses that decrease the immune system, you should seek medical attention early. You should also see a physician any time a boil is associated with fever, is extremely painful or is larger than a nickel. If such a boil is not treated, it can lead to cellulitis -- infection in the surrounding tissues -- or systemic infection, especially if you are immune deficient.

When you seek medical intervention, your doctor may decide that the boil needs to be opened and drained, or he or she may opt for not opening it and rely instead on hot packs and antibiotic therapy. Either approach should lead to complete healing of the abscess.

Obesity, diabetes mellitus, long-term use of steroids, and diseases that suppress the immune system, like cancer or HIV, can increase the likelihood of getting a furuncle. Most people who get boils have good personal hygiene. That being said, some people seem to have a high bacterial skin count that makes them prone to boils.

Several things can be done to prevent boils. Using antibacterial soaps, especially in the groin and arm pit regions, can help with long-term prevention. Gentle scrubbing with a loufa sponge can help keep hair follicles from plugging up. If you are overweight, weight loss can decrease skin friction and prevent abscesses.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.