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Medically reviewed by, Russell Braun RPH
What is a boil?
A boil is a lesion that appears as a firm lump on the skin. Typically they are raised and red, in some cases pus may ooze from the boil. Boils are sometimes referred to as carbuncles or furuncles.
Pain from a boil will get worse and continue to enlarge until it ruptures and drains.
What causes a boil?
Bacteria that are normally found on our skin sometimes infect a hair follicle or oil gland resulting in a boil. These bacteria are often referred to as our normal flora or part of our microbiome. We are always covered in bacteria invisible to our eyes that protect us from infection. However, sometimes these bacteria get into places they don’t belong.
Boils are usually cased by bacteria from the Staphylococcus species. Tiny breaks in the skin near a hair follicle let the bacteria into a place it is not normally found and it then becomes an invader causing infection.
Certain strains of Staphylococcus are more likely to cause boils. A type known as methicillin resistant Staphylococcus aureus (MRSA) is more serious and harder to treat. Methicillin refers to a type of penicillin that this Staphylococcus species is resistant to. Infection with MRSA can be serious and should always be seen by a doctor.
Progression
Hair follicles make easy places in the skin where the bacteria can get in and cause issues. Folliculitis, which is inflammation of the hair follicle is a common way for boils to get started. Many times after shaving, bacteria can get into the follicle and cause folliculitis.
If folliculitis progresses, it can become a boil. Boils typically start out as a small hard, red, painful bump when first noticed. Over four to seven days it becomes filled with puss, gets larger in size and the amount of pain increases.
Patients will notice when a white pocket of pus forms on top of the boil and that means it is a more advanced infection. At the same time deeper in the skin the infection may spread.
Other symptoms of boils:
- Fever
- Enlarged lymph nodes around the boil
- More boils appear near the original
Furuncle
You may hear boils referred to as a furuncle. The furuncle is a painful infection that forms around a hair follicle and contains pus. The terms are interchangeable.
Carbuncle
Carbuncles are a more serious infection that occurs deeper under the skin. This can happen when several boils appear in a group that have joined together under the skin.
There is more risk of blood infection also known as sepsis with carbuncles if left untreated. They can also cause scarring.
Where do people normally find boils?
Boils are commonly found in areas where skin overlaps or rubs together. They are also found in places where people shave themselves and disturb the hair follicles.
Common sites for boils include:
- Armpits
- Buttocks
- Upper thigh areas and inner legs
- Neck
- Shoulders
- Face
- Genital regions
Risk Factors
Any time the immune system is weakened the threat of infection by staphylococcus is more likely. Many disease states and medications can weaken the immune system.
Disease states include:
- Diabetes
- HIV/AIDS
- Cancer
- Multiple sclerosis
- Lupus
- Diabetes
Medications include:
- Steroids
- Chemotherapy
- Methotrexate
- Cyclosporine
- Tacrolimus
- Rapamune
- Tumor Necrosis Factor (TNF) drugs used for autoimmune issues
*This is not an all inclusive list of disease states or drugs.
Another risk factor is overactivity by oil glands in the skin. This more commonly found in adolescents and young adults.
Finally, lack of adequate hygiene can set the stage for boils. Nutrition is also a factor and that can lower the function of the immune system and put one at risk for boils.
Is the Staphylococcus in a boil contagious?
The bacteria that is in a boil is contagious. Anyone who has a compromised immune system or tears in skin should be cautious not to come in contact with a boil.
The best practice for the person with the boil is to keep it cleaned and covered with a bandage to prevent spreading the bacteria.
Another good idea is to avoid allowing the boils to come in contact with exercise equipment, school sports equipment or sporting facilities. Sharing towels or other community washing facilities could also spread the bacteria. Finally, avoid hot tubs, spas and other areas where Staphylococcus could be spread until the boil is gone.
Should I go to the doctor?
When you first notice the start of a boil as noted above it will be small. Over several days it can become larger and more painful. You should seek medical attention when:
- Another boil appears
- The pain becomes very intense
- Red streaks start to appear on the skin around the boil
- You have swollen lymph nodes and have a fever
Remember, a boil is not a medical emergency. Thus, do not go to the emergency room for treatment.
This is a cost savings tip for your medical expenses! #1
Call and schedule an office visit or go to a retail clinic, those will be lowest cost options. After that go to urgent care if the pain is intense and the last option would be the emergency room.
If you have any type of medical condition or take a medication that can weaken you immune system then you may want to seek treatment sooner than a typical patient would.
Things you should NOT do!
Cost savings tip! #2
Even though at first you may mistake a boil for a pimple, you should NOT continue to pick at it!
Remember the pus inside the boil is contagious. Opening up the skin by popping it or cutting it with a sharp object can spread the bacteria. That would be setting yourself up for a more serious infection or carbuncle.
What is mupirocin 2% ointment for?
Mupirocin is the generic name of an antibiotic ointment that is typically used for skin infections. It is also known by the brand name Bactroban and is a ointment that should be applied to intact skin.
Mupirocin is available in one strengths which is 2%. It is used to treat infections that are caused by staphylococcus and streptococcus bacteria. Both of these bacteria are commonly found on the skin.
Typical uses for mupirocin are infections caused by:
- Impetigo
- Eczema
- Psoriasis
- Cold sores
- Wounds
- Cuts
- Dermatitis
- Burns
Mupirocin can help prevent MRSA infection in hospitalized patients. When applied to the nasal passages mupirocin is very effective at preventing MRSA, which can be very difficult to treat.
Mupirocin is a prescription only medication, meaning you can’t buy it over the counter. That is good because most boils do not require antibiotics. Since mupirocin is effective at treating resistant types of bacteria such as MRSA, limiting its use to only when it is needed prevents resistance.
Can I use mupirocin ointment on a Boil?
In the progression of treating a boil, mupirocin should not be the first option. Rather, it should be reserved for resistant and hard to treat cases. Lets take a look at what you should do first, when treating a boil.
How to get rid of a boil
Incision and drainage of the boil is the most common way to treat. This is a minor procedure that can be done in the doctors office. Depending on the progression of the boil your doctor may prescribe antibiotics, though they are not normally needed.
Using heat in the form of a warm washcloth over the area after it has been drained can speed the healing process.
Over the counter products
Pain relief should be the only over the counter products used to treat a boil. Oral medications such as acetaminophen, ibuprofen, naproxen can be used to help decease the pain from the boil.
The American Academy of Dermatology does not recommend any over the counter antibiotics for the treatment of boils.
Cost savings tip! #3
- Don’t waste your money on over the counter antibiotics for a boil.
Prescription antibiotics
In certain cases your doctor may prescribe an antibiotic for you after they have drained the boil. Your doctor may chose an antibiotic empirically, meaning they use what they think will treat the bacteria is likely to cause a boil. Some doctors may want a lab culture of what the bacteria in your boil will be killed by. This would require sending a sample of the pus to the lab so they can test it.
Several different types of oral antibiotics could be used including penicillins, cephalosporins, fluoroquinolones.
Cost savings tips! #4 & #5
- Some of these antibiotics could be expensive brand names, make sure to tell your doctor you want a generic. There are many generics available that can treat boils.
- If the antibiotic is working, the boil will start to shrink and the pain will lessen. DO NOT stop taking the antibiotic until you have taken the entire amount prescribed! This could cause antibiotic resistance and you could end up with recurrent boils that are much harder to treat.
When would mupirocin be prescribed?
Some boils will not respond well to antibiotic treatment. When this happens you need to see the doctor again and let them know the antibiotic is not working. More than likely they will order a culture to see what antibiotic staph bacteria causing your boil would be killed by.
This is where mupirocin comes in. You may be prescribed a different oral antibiotic plus mupirocin. The reason is that mupirocin is very effective at treating MRSA infections that cause treatment resistance or recurrent boils. In fact, MRSA is thought to be the cause of 60% of boils that recur or turn into carbuncles.
Another benefit of mupirocin is that because it is an ointment you apply topically it has fewer side effects. Oral antibiotics can wreak havoc on the bacteria that colonize the GI tract killing many of the bacteria that keep you healthy. This can lead to side effects such as diarrhea and even subsequent intestinal infections.
How to use mupirocin
Use a small amount of mupirocin cream and apply it with a gauze pad to the skin around the affected area. Cover the area with a bandage or dressing to keep the mupirocin from being wiped off and keep the bacteria from spreading.
You should apply the ointment three times per day. Making sure to clean the area each time before applying another dose.
Your doctor will likely prescribe mupirocin for 7 to 10 days. The boil should be improving within 3 to 5 days and if not, you should contact your doctor.
Mupirocin cost
Cost savings tip! #6
- Make sure you are getting the generic, there is no need to pay the higher cost of brand name Bactroban.
Mupirocin comes in a 22 gram tube that is more than enough to treat a single boil and it’s cost is relatively low.
According to GoodRx
- Mupirocin 2%, 22 gram tube costs $12.43
- Bactoban 2%, 30 gram tube costs $177.73
Cost savings tip #7
- Generic Mupirocin should be covered by your insurance, so your copay may be lower but make sure you ask for the cash price and compare it to your copay.
Preventative measures
The most cost effective way to treat a boil it to not have one! Here are some basic things you can do to prevent having a boil.
- Simple hand washing
- Disinfecting personal items that you touch often
- Daily body showering/washing with soap and water
- Washing of bedding and towels on a regular basis
- Washing of clothing especially undergarments
Click here to get Dr. Jason Reed’s exclusive list of medication questions you MUST ask your doctor, for FREE!
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Have you used mupirocin? How well did it work for you? Please chime in below with your comments and thoughts below
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