Dear Doctor Column, February 2, 2004

Infected Hair Follicle Cause of Boils

Question:

My daughter has recurring boils, even though she's been seen by a doctor and been prescribed antibiotics. What can she do? She has very good bathing habits. About 6 months ago when my grandson was living with us, he had the same problem. My daughter and grandson were using the same bath. Do you think that is how she got them? My husband and I use a different bath and have no problem with boils. Please help.

Answer:

Boils, also called furuncles, usually begin when the hair follicle, which is a tiny pit in the skin from which a hair grows, becomes infected. Staphylococcus aureus, a bacterium commonly found on the skin, is usually the culprit. When multiple boils appear, the condition is called furunculosis. In contrast, a carbuncle is either an unusually large boil or a group of boils joined together.

Boils are very common, and virtually everybody has one at some time. Staph bacteria can enter the body through cuts, abrasions, puncture wounds, skin ulcers, or irritated skin, causing infection. They also can cause infection as the result of decreased resistance to the bacteria. Although boils can occur anywhere on the skin, they are most likely to appear on the face, neck, armpits, buttocks, or thighs.

As a hair follicle becomes inflamed and painful, white blood cells, which form part of the body's defense system against bacteria, collect at the site to combat the infection. Starting as a red tender lump, which may throb, a boil becomes larger and more painful over a few days. As pus collects, it develops a white or yellow head, or center. The pus is under pressure, which increases the pain and tenderness. Occasionally, a fever can develop. Eventually, the boil bursts through the skin, relieving the pain. As the infection drains, the boil heals. This process usually takes about 2 weeks. However, the boil may recur later near the same site and go through the same cycle.

Moist heat helps boils "come to a head" so they'll drain. Your daughter should try applying a warm tap-water compress to the boil every 30 minutes for a few hours to help it drain sooner. She should see her doctor, however, if the boil is large and painful or associated with fever or redness spreading from the site. As in your daughter's case, when a boil is severe, antibiotics may be prescribed to help kill the bacteria. Doctors sometimes have to lance the boil to allow the pus to drain.

Physicians warn that boils should not be touched or squeezed, which can force the infection into deeper tissues. Skin cleansers that kill germs can be used to keep the area scrupulously clean during healing.

Washcloths and towels should be laundered after each use. Underwear and bedclothes should be laundered after contact with the lesions. If dressings are changed at home, discard them in a plastic bag and seal it to prevent spread of infection. When boils are present, your daughter should take showers instead of baths to reduce the chance of spreading the infection to other parts of her body. So, it's possible that your daughter's infection spread to your grandson or vice versa. Whenever the same bath is shared by others, the tub should be scrubbed with cleanser after each person bathes, regardless if someone has boils. Other bacteria may be present that can be spread.

Additionally, some people are staph "carriers," meaning that they harbor the common staph bacteria in their nasal passages. However, carriers may or may not have a problem with boils themselves but can infect others. To help eradicate the staph bacteria, ask your doctor about the possibility of prescribing an antibiotic ointment to be applied to the inside of your nose, as well as your husband's and your daughter's nose. You or your husband could be a carrier, and since you're not having a problem with boils, are unaware that you're spreading it to your daughter, who is more susceptible to the bacteria.

Furthermore, recurring boils are sometimes a sign of a system-wide problem. For example, people who have diabetes or kidney disease are more susceptible to boils and other infections. Whatever the cause, large boils need to be evaluated and treated by a physician. Because she's continued to have this problem despite treatment, she should talk to her doctor about a referral to a dermatologist, a physician who specializes in the treatment of skin disorders.