Common places for boils: Pictures on Skin, Causes, and Treatment
Pictures on Skin, Causes, and Treatment
Medically Reviewed by Dany Paul Baby, MD on June 26, 2022
A boil is a common, painful infection of a hair follicle and the surrounding skin. It begins as a red lump, then fills with pus as white blood cells rush in to fight the infection. Good home care can often clear up a single boil, also known as a skin abscess. A doctor’s care is needed when a boil resists treatment or develops in certain vulnerable areas of the body.
Boils are usually pea-sized, but can grow as large as a golf ball. Symptoms can include:
- Swelling, redness, and pain
- A white or yellow center or tip
- Weeping, oozing, or crusting
You may also have a general feeling of ill health, fatigue, or a fever, which is reason to call a doctor.
Boils can form anywhere on the body, but they’re most common on the face, neck, armpits, shoulders, back, and buttocks. Hairy, sweaty areas are typical sites, as well as areas of friction, such as the inner thighs. Boils can also develop around the ear or near the nose. The pain often worsens as pus collects under the skin, then eases as fluids begin to drain.
Most boils are caused by staph bacteria (Staphylococcus aureus), which many healthy people carry on their skin or in their noses without a problem. When a scrape, cut, or splinter breaks the skin, the bacteria can enter a hair follicle and start an infection. Others boils, such as those associated with acne, develop from clogged pores that become infected.
MRSA can look exactly like an ordinary boil: red, swollen, pus-filled, and tender. But MRSA infections are caused by one particular type of staph that is resistant to many antibiotics. If a skin infection spreads or doesn’t improve after 2-3 days of antibiotics, your doctor may suspect MRSA. The right treatment given promptly is important to heal a MRSA infection and prevent a deeper, more dangerous infection.
Not exactly, but the germs that cause boils (staph) are easily spread through skin-to-skin contact and contaminated objects. These bacteria usually do no harm unless they find a break in the skin. To avoid spreading staph, don’t share towels, bedding, clothes, or sports gear while you have a boil. Avoid touching the boil, and keep it covered. Frequent hand washing can also help prevent spreading the bacteria.
Folliculitis is an inflammation or infection of the hair follicles that can develop into a boil. Tiny pimples with whiteheads appear around individual hairs, sometimes surrounded by red skin. It can be itchy, tender, and uncomfortable, but is typically not as painful or deep as a boil. Shaving or friction from tight clothing can let staph bacteria slip under the skin — the most common cause of both folliculitis and boils.
When several boils form close together and join beneath the skin, it’s called a carbuncle. They are most commonly found on the back and the neck but can develop anywhere. Men are more likely to develop carbuncles than women. A carbuncle tends to lie deeper beneath the skin than a boil and can take longer to heal.
Cystic acne is a type of skin abscess that forms when oil and dead skin cells clog a hair follicle, creating a place where bacteria grow and thrive. It affects deeper skin tissue than regular acne, leading to firm, painful cysts. It’s most commonly on the face and shoulders and typically occurs in the teenage years.
When lumps and pus-filled abscesses repeatedly develop in these areas of the body, it may be a chronic condition called hidradenitis suppurativa. Infection starts in sweat glands and hair follicles that become blocked. Mild cases heal with home care. Several drugs and treatments are available for more serious and recurring cases.
When a boil forms in the skin just above the buttocks crease, it may be a pilonidal abscess. Hair is believed to play a role, and irritation, pressure, and prolonged sitting may also contribute to the development of a cyst here. If a cyst becomes inflamed and infected, it becomes an abscess. Some children are born with a “pilonidal dimple” where infections can crop up. Signs of infection require a doctor’s attention.
The familiar “stye on the eye” is a boil, usually caused by staph bacteria. It starts in the follicle of an eyelash and may be red, warm, swollen, and uncomfortable. A stye is sometimes confused with a chalazion, which is also a lump on the eyelid, but a chalazion is usually painless and is caused by a blocked oil gland, not an infection.
Anyone can develop a boil. The risk increases with:
- Close contact with an infected person
- Acne, eczema, or other causes of breaks in the skin
- A weakened immune system
You can take care of most boils at home. Apply warm, moist compresses several times a day to help a boil open and drain. After it starts draining, keep it clean, and continue using warm compresses — a clean one every time. Change the bandage often and wash hands well. Resist the urge to squeeze or pop the boil. This can make the infection worse.
If a boil doesn’t heal after a week of home care, call your doctor. Other reasons to call include:
- A boil on the face or spine
- A fever or red streaks coming from the sore
- A very large or painful boil
- A boil that keeps coming back
If the fluid inside a boil doesn’t drain by itself, your doctor may prick the top of the sore with a sterile instrument to be sure it drains completely. A deep infection may be packed with sterile gauze so it continues to drain. Antibiotics and steroid shots are sometimes given to help with healing.
For some people, boils are a recurring problem. In addition to standard treatment, your doctor may try to eliminate or reduce staph bacteria throughout the body. This can include any or all of the following treatments: washing up with a special antiseptic soap, using an antibiotic ointment inside the nose, or, if necessary, 1-2 months of antibiotics taken by mouth.
Most boils heal with home treatment or a doctor’s visit. Sores on the face may require antibiotics because they’re so close to the eyes and brain. Rarely, the staph bacteria from a boil or carbuncle can get into the bloodstream, which can then affect the heart and other internal organs.
Since bacteria are everywhere in our environments and on many people’s skin, the best defense against boils includes:
- Hand washing or use of alcohol-based hand sanitizer
- Careful cleaning of cuts, scrapes, and other wounds
- Keeping wounds covered
- Not sharing towels, sheets, razors, etc.
Wash towels, sheets, and anything else in contact with an infected area in very hot water. Throw away any wound dressings in a tightly sealed bag.
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Nemours Foundation: “Staph Infections.”
University of Chicago Medical Center: “MRSA FAQ.”
Merck Manual of Medical Information, 2nd Home Edition: “Folliculitis and Skin Abscesses.”
NIH Genetics Home Reference: “Hidradenitis Suppurativa.”
Hidradenitis Suppurativa Foundation: “What is Hidradenitis Suppurativa?”
American Academy of Ophthalmology: “What Are Chalazia and Styes?”
Pictures of What They Look Like
Medically Reviewed by Stephanie S. Gardner, MD on November 22, 2022
It’s a lump of fluid, air, or something else. Cysts are very common, and most aren’t cancer. You may need tests (like a CT scan, ultrasound, or biopsy) to confirm that it’s a cyst. They do not go away, but often, cysts don’t need treatment. Your doctor can let you know if yours does. You can get cysts in many different parts of your body, and you may not even know that they’re there.
You get acne when oil and dead skin block a pore. This often causes a small growth, or “pimple,” that goes away on its own or with over-the-counter drugs. If it’s more serious or a pimple gets very irritated, you might get a larger squishy growth called a cyst. (Hard growths are called nodules.) Talk to your doctor about treatment including antibiotics and other medications for your cysts.
A soft, fluid-filled lump can form at the back of your knee if you injure the joint because of arthritis, inflammation, a torn ligament, or other causes. You might mistake it for a blood clot. Rest with your leg raised up and ice the area for 15 minutes at a time. Anti-inflammatory drugs could also help. In some cases your doctor may suggest surgery or use a needle to drain it or inject steroids to lessen swelling.
The tiny Bartholin glands are deep under the skin on either side of the vagina opening. Their job seems to be to make fluids for sex. If something blocks a duct in one of these glands, it fills with mucus and gets bigger. It could even get infected and form a sore called an abscess. Tub soaks can help. In serious cases, your doctor might do surgery to create a permanent drain or remove the cyst.
You might notice one or more smooth lumps with clear edges on your breast, but you can’t always feel them. They may hurt in the days just before your period starts or when you have lots of caffeine. They’re very common and more likely right before menopause, or afterward, if you take replacement hormones. You don’t usually need to treat them, but see your doctor about any breast lump because it may be something more serious than a cyst.
In the womb, a baby’s bladder connects to its belly button through a channel called the urachus in the abdominal wall gut. If it doesn’t close by the time you’re born, a small lump of tissue and fluid (a cyst) can grow there. If it gets infected, you could have belly button pain, fever, and bloody urine. Your doctor may give you antibiotics, drain or remove the cyst, and possibly repair the area with surgery.
Here, something blocks a gland around a hair or irritates the opening (follicle) that holds it, often on your face, ear, head, trunk, or groin. That causes a bump to grow slowly under the skin. It’s usually soft enough to move when you touch it. Usually, it doesn’t hurt, but you might notice a bad smell. Smaller ones usually go away on their own, but your doctor may need to drain or remove larger, swollen, or painful cysts.
A loose hair gets pushed back into the skin. Your body sees it as a threat and builds a pocket around it that holds dead skin and fluid. You might notice irritation at the base of your spine in the crease where your buttocks start. If it gets infected, it can become very painful and may need to be drained or removed. Younger men get it more often, as do people who sit a lot, aren’t active, or are obese.
It’s a lump filled with liquid, most often near joints or tendons on your wrist or fingers. Tendon or joint stress might cause it, but it’s not clear. It may hurt and sometimes changes in size or goes away on its own. Anti-inflammatory meds or splints might curb pain. In more serious cases, your doctor may drain it with a needle or remove it completely.
Oil from the meibomian glands around the eyelids gets too thick or the opening clogs. Either way, it builds up and inflames the gland and forms a lump. The cause is often unclear, but certain skin types get it more. You may have no pain unless it gets fairly large. Really big ones can press on your eye and blur your vision. It usually goes away on its own, and warm compresses can help. Talk to your doctor if it sticks around.
Eggs from a pork tapeworm, a parasite, can pass into your food or drink contaminated with poop. They hatch in your gut and send small round “oncospheres” through your blood to the brain, muscles, liver, and other organs where they form cysts. You doctor will probably only treat them if they’re in your brain where they could cause headaches, seizures, confusion, or other problems. You’d likely take steroids to ease inflammation.
This cyst forms inside the epididymis, a coiled tube inside a man’s scrotum that connects to their testicles and helps move sperm. It seems to happen when sperm build up at the end of the tube. It’s not cancerous and doesn’t usually hurt, but your doctor should check to be sure. It usually goes away on its own. About a third of all men will get a spermatocele in their lifetime.
It happens before you’re born if the layers of your skin don’t grow together properly, usually on the head, neck, or face. That causes a pocket that traps skin, hair follicles, sweat glands, blood, fat, nails, teeth, and other structures. It might not be noticeable until fluid builds up and makes it bigger, sometimes years after birth. Then it looks like a small lump with skin on top that’s easy to move. Your doctor will likely remove the cyst with surgery.
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American Academy of Dermatology: “Different kinds of pimples,” “What can clear severe acne?”
American Association for Pediatric Ophthalmology and Strabismus: “Chalazion.”
American Pediatric Surgical Association: “Urachal Cysts.”
American Society for Surgery of The Hand: “Ganglion Cysts.”
Cleveland Clinic: “Spermatocele,” “Sebaceous Cysts,” “Breast Cysts,” “What is a Baker’s cyst?”
Johns Hopkins Medicine: “Sebaceous Cysts. ”
Mayo Clinic: “Pilonidal cyst.”
Merck Manual: “Tapeworm Infection,” “Bartholin Gland Cysts.”
Michigan Medicine Kellogg Eye Center: “Chalazion and Stye.”
National Center for Advancing Translational Sciences: “Urachal cyst.”
St. Louis Children’s Hospital: “Dermoid Cyst in Children.”
Furuncle (boil) – symptoms, causes, signs and methods of treatment in adults in “SM-Clinic”
This disease is treated by a Dermatologist
- About the disease
- Types of boils
- Symptoms of a boil
- Causes of boil development
- Expert opinion
- Treatment of furunculosis
- Questions and answers
About the disease
A furuncle is also called a boil. It occurs more often in adulthood. Men are affected somewhat more often than women. The main peak of incidence falls on the autumn and spring periods, when the body’s defenses weaken.
Unlike ostiofolliculitis and folliculitis, the formation of a furuncle is accompanied by the involvement of the surrounding tissue in the inflammatory process. This is due to the severe course of the disease.
On places devoid of hair (palms and palmar surface of the fingers, soles) boils do not develop. Most often they occur on areas of the skin that are subject to contamination (forearms, back of the hand) and friction (back of the neck, lower back, gluteal region, thighs).
Types of boils
Depending on the number of formations, single and multiple boils are distinguished. In the latter case, the disease is called furunculosis.
In the process of development, pathology passes through three successive stages:
- infiltrative: accompanied by tissue infiltration;
- purulent-necrotic: characterized by purulent fusion of the central part of the boil and the formation of a purulent-necrotic core;
- healing stage: begins from the moment of spontaneous or artificial opening of the abscess and lasts until the formation of a scar.
Symptoms of a boil
At the initial stage of the development of the disease, the patient feels slight itching and tingling. On the 1st-2nd day, a formation appears that protrudes conically above the skin. The tissues turn red and become painful when touched. As the boil matures, a head appears on its top – a small accumulation of pus with a black dot in the center.
On the 3-7th day in the form of a rod, together with the remnants of the hair, they are excreted with pus. The resulting wound is cleaned, filled with granulation tissue and healed. The swelling around it gradually decreases, the pain disappears. A small, whitish, somewhat retracted scar remains at the site of inflammation.
Multiple lesions of boils that appear simultaneously or sequentially one after another in different parts of the body – called furunculosis. A disease that lasts with small remissions for several years is considered chronic, relapsing.
Furuncle usually does not cause significant disturbances in well-being. With the defeat of a significant amount of tissue, symptoms of intoxication appear: weakness, headaches, fever. The intensity of pain depends on the location of the formation. In the face area (lips, forehead), as well as on the scrotum, the formation of a boil is accompanied by swelling of the surrounding tissues, which is explained by the looseness of the subcutaneous tissue.
Causes of the development of a boil
The main cause of the development of a furuncle is the defeat of the hair follicle or its surrounding tissues by Staphylococcus aureus, rarely white. An important factor is also a decrease in general or local immunity against the background of chronic diseases, metabolic disorders, and infections. Pathology occurs especially often in patients with diabetes mellitus, obesity, chronic liver and kidney damage, oncological diseases, etc. Infection of tissues often occurs against the background of skin damage: scratches, cuts, abrasions, constant exposure to sweat or purulent discharge (from the nose, ears).
The causes of localized furunculosis are most often incorrect methods of therapy and ignoring the doctor’s recommendations (use of compresses, undertreatment of residual compaction, washing the place where the elements appear).
If you experience these symptoms, we recommend that you make an appointment with your doctor. Timely consultation will prevent negative consequences for your health.
You can find out more about the disease, prices for treatment and sign up for a consultation with a specialist by phone:
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Diagnosis of boils is not difficult. During a visual examination of the patient, a dermatologist discovers a characteristic formation. Its appearance allows you to assess the stage of development of the disease. During the conversation, the doctor determines the possible cause of the development of boils, identifies risk factors. For an accurate diagnosis and determination of the pathogen, bakposev of the discharge is prescribed. In case of multiple lesions, additional diagnostics is carried out:
- general and biochemical blood test;
- assessment of hormone levels;
- examination by ENT, endocrinologist and other specialists;
- examination of internal organs, paranasal sinuses, lungs, etc. depending on the specific clinical situation.
Furuncle is a rather serious disease, which should be treated with great care. In no case should you self-medicate: you should not make compresses, use various ointments – in most cases this leads to the spread of the inflammatory process.
A complication of a boil can be lymphadenitis and lymphangitis (damage to the lymphatic vessels and nodes). Of particular danger are rapidly progressing acute thrombophlebitis and sepsis.
Acute thrombophlebitis usually develops with boils located near the large saphenous veins, and sepsis – with boils of the face. They are often the result of attempts to squeeze out the contents of the boil, cutting it off during shaving, trauma during massage. The prognosis for these complications is very serious.
Omarova Andzhelika Mutaevna
Coloproctologist, surgeon, Ph.D.
Treatment of furunculosis
Treatment of furuncle is only surgical, because no other therapy will be successful if the focus of purulent inflammation is not removed or opened and drained in a timely manner.
The opening of the boil is usually performed under local anesthesia and is painless for the patient. At the same time, antibiotic therapy, means for correcting immunity and eliminating background pathologies, if any, are prescribed.
Simple (uncomplicated) lesions can be treated on an outpatient basis and do not require hospitalization. But in case of a severe course, if the patient develops swelling of the soft tissues of the cheek, lip or eye, urgent hospitalization is necessary in the surgical department to constantly monitor the development of the process and prevent complications.
Strict bed rest and appropriate therapy are prescribed for high fever.
To minimize the risk of developing boils, it is necessary to regularly cleanse the skin of impurities and fully treat any tissue damage. People with hyperhidrosis and/or excess sebum need to pay special attention to hygiene. General measures are also important: proper nutrition, a healthy lifestyle, timely treatment of acute and chronic diseases.
After opening an uncomplicated boil, the patient goes home after 1-2. In the next 2 weeks, he needs to regularly visit a doctor for dressings, take prescribed medications. It is strictly forbidden to play sports, swim in open water or pools, overheat.
Questions and Answers
No. Self-medication and the use of folk remedies can cause complications.
Yes, if a purulent focus is located on the face, the infection can go to the meninges.
Gostishchev Victor Kuzmich. Clinical operative purulent surgery. Guide for doctors. GEOTAR-Media, 2016
Rodionov Anatoly Nikolaevich, Sydikov Akmal Abdikaharovich, Zaslavsky Denis Vladimirovich. Clinical dermatology. Illustrated guide for doctors. GEOTAR-Media, 2022
Nikolsky V. Yu., Imbryakov K. V. Furuncles and carbuncles of the face // Russian Dental Journal. 2013. No. 5.
Okulich V.K., Fedyanin S.D. RATIONAL USE OF ANTIBACTERIAL DRUGS IN PATIENTS WITH PURULENT WOUNDS, FURUNCULOSIS, BOILS AND CARBUNCULES // Bulletin of the Voronezh State Medical University. 2003. No. 4.
Diseases referred by the Surgeon
Soft tissue abscess
soft tissue hematoma
Giant cell tumor of bone
Hernia of the white line of the abdomen
Diastasis rectus abdominis
salivary gland cyst
Cancer of the extrahepatic bile ducts
Fistula of the gallbladder
Peptic ulcer of the stomach and duodenum
Diseases referred to Dermatologist
Human papillomavirus (HPV)
Ingrown toenail (onychocryptosis)
Herpes (herpes virus 1, 2 types)
Foot hyperhidrosis (excessive sweating)
Hyperkeratosis of the nails
Nail fungus (onychomycosis)
Rash under the breast
Loss of skin tone and elasticity
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description, causes, symptoms, diagnosis and treatment
Inflammation of the skin and soft tissues of the epidermis, accompanied by purulent accumulations, is popularly called a boil, in medicine – a furuncle. The process of formation of such formations is painful and in a neglected situation provokes complications. In order to successfully deal with this problem, it is necessary to delve into the nature of the phenomenon.
How does the disease manifest itself?
It is impossible not to notice the formation of a boil – already at the initial stage, in the place where a small nodule is formed under the skin, discomfort is felt, often accompanied by itching. The disease always develops according to the same scenario:
A cone-shaped tubercle forms under the skin. The dermis in this place acquires a reddish-purple hue.
Itching changes to soreness.
Inflammation captures nearby tissues, as evidenced by the appearance of swelling.
A white dot appears in the center of the focus – the head of the boil.
If the inflammation is not treated, an abscess develops inside the boil. The skin over the boil becomes thinner and breaks under the pressure of the accumulated purulent masses. Together with them, necrotic hair follicles leave the wound.
Do not take a boil as something harmless. This problem will not be eliminated on its own, and in a neglected situation it will lead to serious consequences. The furuncle is very quickly reclassified as a carbuncle. Other complications are also possible (depending on the location of the focus):
cutaneous nocardiosis and lymphadenitis;
inflammation of the eyelids;
abscesses not only of external tissues, but also of internal organs;
accumulation of pus in the brain;
If a woman has a furuncle on her genitals, it will lead to various kinds of gynecological diseases.
Furuncle is not such a rare disease. About 17% of the total mass of patients turn to dermatologists with this problem. Recently, a significant proportion falls on inflammation in the nose.
A seemingly harmless boil in this case can lead to a chronic pathology – non-allergic idiopathic rhinitis.
These abscesses are caused by pathogens. Staphylococcus aureus can exist on human skin for a long time without showing itself. But as soon as the immune system weakens, the dermis partially loses its protective properties, and bacteria easily penetrate the epidermis.
Leaking deep into the pores, staphylococcus attacks the hair follicles. In damaged bulbs, an inflammatory process begins, leading to necrotic phenomena.
The main factors in the development of a boil
Not only poor health becomes an impetus for the activity of Staphylococcus aureus. Improper skin care or the individual characteristics of the dermis are common prerequisites leading to the development of a boil.
Factors stimulating the appearance of boils:
Body sweat contains aggressive salts. They negatively affect the beneficial microflora of the dermis. But they are an excellent breeding ground for Staphylococcus aureus
Abrasions, scratches, wounds – “gates” through which pathogens penetrate the epidermis
Various rashes on the skin weaken the protective barrier, so that the pathogen easily penetrates to the follicles
Violation of hygiene
Improper skin care provokes irritation and creates favorable conditions for the growth of bacteria
Incorrectly selected cosmetic skin care products (without taking into account the type of dermis or low quality) is another factor leading to the formation of a boil
Certain activities associated with dust, harmful substances and other irritants cause damage to the natural microflora of the skin.
Appearance is an indicator of those problems that occur inside the body. Even 1 small boil on the body signals a malfunction in the immune system. The protective barrier of the epidermis ceases to perform its main function, and pathogenic microflora easily penetrates into the subcutaneous layers.
Recent viral infections can provoke such a situation. Other factors also influence the decrease in immunity:
long-term use of psychotropic drugs;
Boils also appear against the background of hormonal imbalance, which disrupts the rhythm of blood circulation. As a result, epidermal tissues do not receive the nutrition they need and lose their ability to resist pathogens.
Therefore, even a small inflammation under the skin is already a reason to see a doctor and be examined. This is especially important for people with diabetes.
Stages of development of the disease
Furuncle formation occurs in 3 main stages. Each of them has its own characteristics:
Infiltration. Around the hair follicle, “captured” by Staphylococcus aureus, fluid accumulates. The tissues swell and thicken. The diameter of the reddened area is still insignificant – 1-3 cm. At this stage, the pain is mild, but when you touch the focus, you feel an internal tingling sensation.
Purulent-necrotic. From 3-4 days of inflammation, a core is formed inside the boil – a mixture of dead tissues and viscous pus. His white head is already visible under the raised skin. When the rod acquires a significant size, the outer layer of the dermis does not withstand the onslaught and breaks through. Purulent accumulations flow from the recess.
Healing. When the fossa from the boil is completely cleared, it gradually overgrows. If the boil was small, the scar at the site of inflammation will not remain. But the scar that appeared after an impressive boil will disappear over time.
The disease should be treated already at the 1st stage of its development. In the future, the purulent-necrotic fluid accumulated in the epidermis will cause various complications. Self-opening of the boil will also lead to negative consequences.
Prevention of boils lies in a healthy lifestyle. Proper nutrition, active movements, hardening, compliance with hygiene standards – all contribute to strengthening the immune system. This should include taking care of your health, timely treatment of diseases.
The boil requires treatment, and it can be either medical or surgical. Which option the doctor chooses depends on the stage of development of the disease and the complexity of the situation.
This tactic is used when the patient has addressed in a timely manner to the doctor. As a rule, the assistance provided is based on local therapy. Each stage has its own:
For the first days, it is enough to cauterize the area of inflammation several times a day with an iodine solution. It is recommended to apply dry heat. Important! It is strictly forbidden to make compresses – this will complicate the patient’s condition.
At the time of the formation of the rod, bandages with ichthyol ointment are applied to the focus. It will soften the dermis, which contributes to the rapid and less painful outflow of purulent masses.
At the last stage, applications with ointments containing an antibiotic are applied to the site of the boil. Also, the doctor will prescribe drugs that accelerate the healing of tissues.
If the inflammation was severe, and a lot of pus accumulated in the wound, after opening the boil, the specialist will install a drain for better discharge of necrotic masses. At the final stage of treatment, the cleaned recess is washed with an antiseptic composition.
Please note! It is impossible to cure a boil with folk remedies, especially if the process is delayed.
If the boil is not treated in time, complications will arise. Then the problem will have to be solved radically – surgically. In most cases, the operation is performed on an outpatient basis, under local anesthesia.
The doctor quickly removes the purulent-necrotic rod, which alleviates the patient’s suffering. After washing the wound and applying a medical bandage, the patient goes home.
Inpatient treatment is indicated if the boil is large or an abscess has begun to develop under the skin. This will require regular monitoring of medical personnel over the course of tissue healing.
Assistance from specialists of the center
Our doctors not only eliminate the already formed boil, but also prevent the appearance of new boils. In the selection of the correct therapy, the exact establishment of the root cause of the development of the disease helps.