Boils are generally treated by a doctor. When the boil is “ready,” the doctor makes a small cut to allow the pus to drain and the wound to heal. Antibiotics are used in certain situations. People who try to squeeze boils themselves increase the risk of the infection spreading inside their body and leading to complications.
A boil (furuncle) is a bacterial skin infection that looks a bit like a very big pus-filled pimple. It starts off as a noticeable swelling that then becomes filled with pus. Boils are often very painful.
Sometimes they drain on their own, and go away without causing any problems. But medical treatment may be needed, particularly for big boils.
If someone gets boils often, it could be a sign that they have a medical condition that has weakened their immune system, increasing the risk of infections. It is then important to find out what that medical condition is, and treat both the underlying condition and the boils.
When are compresses and ointments an option?
When a boil first appears, the pus-filled space inside the swollen bump (abscess) hasn’t yet fully developed. In this phase, doctors usually recommend applying a warm, moist, antiseptic compress (a cloth pad held in place by a bandage) or a special ointment that draws (pulls) pus out of the boil. This kind of ointment is also known as “drawing salve.” It typically contains a drug called ammonium bituminosulfonate, also known as Ichthyol. The compress and ointment are meant to speed up the development of the abscess inside the boil, so that it can drain and heal on its own later on – or be cut open and drained by a doctor.
What does cutting and draining involve?
The cutting and draining of boils is a standard treatment, particularly for large boils. It is usually an outpatient procedure (no need to stay overnight in a hospital). Before piercing the skin covering the boil, the doctor numbs the area around the infection with a local anesthetic, or by cooling it.
Sometimes one or more strips of gauze or silicone are placed inside the open wound. These help to remove any remaining pus and fluid from the wound, keeping it clean and allowing the tissue to gradually recover. The strips are usually replaced every day, for instance by a family doctor.
In many cases, the wound is also cleansed with a sterile saline (salt) solution. Doctors sometimes use antiseptic solutions, ointments or dressings too. The wound generally isn’t sewn shut – it gradually closes up on its own. This is known as open wound healing or healing by secondary intention. While the wound is still open, a compress or plaster are used to protect it from dirt and germs.
Which treatment is considered for more severe cases?
Boils usually don't need any further treatment, but sometimes other measures are necessary – for instance, if the boil is on the face or if several boils have merged, forming a carbuncle.
Keeping still
If you have a boil on your face, it’s important to keep the infected area still. This is because movement and pressure can increase the risk of bacteria spreading to the brain through the bloodstream. So you should try to avoid using your face muscles. In other words: Don’t talk, and only eat liquid or mushy food that doesn’t have to be chewed, if possible. Bed rest is also recommended.
Antibiotics
If complications arise or are likely, antibiotics are taken as tablets or a liquid, or given in the form of an infusion (IV drip) or injection. When used in this way, they travel around the whole body in the bloodstream. This type of treatment is called systemic antibiotic therapy.
Antibiotics are usually only needed
if the boil is on your face, particularly on your nose or upper lip,
if you have several boils (furunculosis) or a carbuncle,
if the infection starts spreading through the lymph vessels,
See AlsoBlack Drawing Salve Recipeif you have symptoms such as a fever, high pulse rate, low blood pressure and rapid breathing – or if blood tests suggest that the infection is spreading in the body.
Doctors usually prescribe an antibiotic that is effective in the treatment of boils, which are nearly always caused by the same type of bacteria.
In rare cases, samples of pus are taken and analyzed in a laboratory to find out exactly which type of bacteria is causing the infection. This may be done
if the normal treatment approach doesn’t seem to be working,
if it’s thought that the person may have blood poisoning (sepsis), or
if there’s a risk that the bacteria are resistant to a lot of antibiotics. Once doctors know which strain of bacteria is causing the infection, they can use the type of antibiotic that is most likely to work.
Sources
Fahimi J, Singh A, Frazee BW. The role of adjunctive antibiotics in the treatment of skin and soft tissue abscesses: a systematic review and meta-analysis. CJEM 2015; 17(4): 420-432. [PubMed: 26013989]
Gesenhues S, Gesenhues A. Praxisleitfaden Allgemeinmedizin. München: Urban und Fischer; 2020.
Moll I. Duale Reihe Dermatologie. Stuttgart: Thieme; 2016.
Singer AJ, Thode HC. Systemic antibiotics after incision and drainage of simple abscesses: a meta-analysis. Emerg Med J 2014; 31(7): 576-578. [PubMed: 23686731]
Sterry W. Kurzlehrbuch Dermatologie. Stuttgart: Thieme; 2022.
Stevens DL, Bisno AL, Chambers HF et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis 2014; 59(2): e10-52. [PubMed: 24973422]
IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.
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