How to Lance a Boil

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Get the Pus Out! How to Lance a Boil

Boilby James Hubbard, M.D., M.P.H.

Okay, I know you think it’s gross, but if you get a boil and it’s impossible to find a health-care professional, you’re going to want to know this.

A boil is an infected lump in your skin that’s hard and filled with pus. It can be the size of a pea or golf ball. Something as simple as a single infected hair follicle can cause it. Or a cyst might get infected.

A boil can not only be extremely painful, it can get you down. The infection can make you weak and give you a fever.

There are other things to try first, but sometimes, a boil just has to be lanced.

Plan A: What to Try Before the Lance

If you’ve read some of my other skin-infection posts, you’ve probably seen a trend. I like to use heat. Specifications:

  • Moderate temperature
  • Preferably moist (soaking the area or using a wet cloth), but dry will do
  • Ten to twenty minutes at a time every hour or so

The heat gets things going, increases the antibody-carrying blood supply, and helps the infection either go away or come to a head. By “come to a head,” I mean you’ll see a slight tenting close to the middle of the redness. That’s where the pus is trying to make its way to the surface to drain out. Sometimes it makes it, sometimes it needs help by incising and draining. That’s doctorspeak for lancing.

Never squeeze the area. You’re very likely to spread the infection.

If you can’t get to a health-care provider, you might want to take some oral antibiotics if you have them. Mupirocin ointment is a cool alternative. It’s an expensive prescription antibiotic ointment that treats the infection. The over-the-counter ointments prevent infections and are not going to be much use with a boil.

Use the intermittent heat for a few days. Your hope is that the infection will go away or that the boil will drain without lancing. At the least, you’ll be giving the boil time to turn from a firm mass (that will just bleed if you lance it) into a softer, fluctuant one that will drain easier.

Plan B: How to Lance a Boil

If the heat hasn’t worked or the redness is spreading or you’re feverish or the pain is just too bad, it might be time for a lancing. You could leave it alone, but if it’s going to be days before you can get to a health-care provider and it’s too painful or, more important, causing high fever and weakness, consider lancing.

To lance a boil if it’s impossible to get to a health-care provider, you’ll need:

  • Cleaning supplies (soap and water, and alcohol or Betadine)
  • A numbing agent (lidocaine or ice)
  • A sterile scalpel (or a knife with fire and alcohol for sterilization)
  • Clean cloth or gauze—some for catching the drainage and some for covering the wound

Step one: Prep yourself and the boil.

  1. Wash your hands.
  2. Put on some nonporous gloves, such as latex.
  3. Feel for a soft area on the boil, and look for a point or rising in the skin.
  4. Wash the affected skin with soap and water.
  5. Clean the area further with iodine or povidone/iodine (Betadine). If you don’t have that, use alcohol.
  6. If you have lidocaine and know how to use it, numb the area with it. If you don’t have numbing medicine, applying ice for a few minutes might help.

Step two: Prep your equipment.

  1. Unwrap a sterile scalpel blade, or sterilize a clean knife tip. (Put it under a fire until it becomes red. Let it cool. Pour alcohol on the tip.)
  2. Place some of the cloth or gauze under the boil for when the pus starts draining. (Reserve some to cover the wound.)

Step three: Lance the boil.

  1. Stab the skin at a ninety-degree angle. You shouldn’t have to insert the scalpel more than an inch or so. You’re waiting for pus to drain out. If it doesn’t, you can roll the blade around a bit, or try again if the pain’s not to bad,. But don’t just keep stabbing. If there’s pus close by, it’s likely to find it’s way out the hole. Sometimes you’re just not going to get a return.
  2. As soon as the pus flows, you may want to slant the blade a little to open up the wound. Then, remove the knife.
  3. Let the wound drain. Catch the pus with cloth or gauze.
  4. After the draining lessens, be sure to wipe the wound, and throw away any contaminated cloths and gloves. The bacteria from abscesses can be contagious.
  5. Cover the open wound with a loose, absorbent cloth or gauze.

Step four: Watch and wait. After the boil finishes draining, start back on the Mupirocin ointment if you have it, and keep using the heat. If the wound closes before the infection heals, you may need to reopen it. (Only if you’re experienced should you pack the wound to keep it open.)

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Boil image courtesy CDC/Bruno Coignard, M.D.; Jeff Hageman, M.H.S.

  • Freakzilla

    I have never had boils before, and now all of the sudden I have 3 egg sized boils in my armpits. I have been living overseas and my wife brought back some underarm deo / antiperspirant from the states and I used it. The following day is when it started. I have managed to wait for 5 days before seeking medical attention, however the medical attention that’s available here if very questionable to me. The Dr. noted the hard swelling, and also noted that I was feverish and in overall poor condition at the time of the visit, and she prescribed me Co-Amoxiclav twice a day, Clindamycin 3x a day, and 120mg Etoricoxib 1x a day…she also owns the local pharmacy I might add. I am very leary of taking any kind of antibiotic, unless absolutely 100% needed. I do agree that I need some type of antibiotic at this point, but why 2 of them, and why not lance and drain them like I asked her to do? I cannot lance it by myself, as I am alone now, as I am fearful of the drainage causing further boils, etc…I am in extreme pain, and havent slept well in 2 days now, and haven’t been able to eat.

    • Freakzilla

      I will add that on one of them a hole has developed, however it is not draining. I have also been using hot water and a towel to cover them at least 3 times a day.

      • James Hubbard, MD, MPH

        That’s not nearly enough.

      • James Hubbard, MD, MPH

        She may have prescribed one antibiotic to cover the regular types of infections and the clindamycin to cover mrsa. I don’t know. Different countries can have prevalence of different bad bacteria. Again only speculation but perhaps she thought the boils were still so hard that she was unlikely to get out anything if she lanced. Rather than be fearful of drainage, I would welcome it. Just keep the area clean. Are you using frequent heat? Are you going back to follow up? I can’t tell you whether or not to take the antibiotics but I’m guessing it’s either that, or they start draining, or you need to go to the hospital. Especially if you’re running fever and the symptoms are not improving. And I’m not saying you won’t have problems with the antibiotics. There are always risks with them, diarrhea being almost a certainty (Probiotics might help), but there’s also a big risk in not taking them. From your description, I’d probably go to the hospital.

        • Freakzilla

          that was the hospital i went to….Philippines

          • Freakzilla

            time to find a knife i suppose. Thank you.

          • James Hubbard, MD, MPH

            My opinion, is unless that’s sterile, the antibiotics pose a lesser risk. And, again, don’t forget the heat. I know nothing about Philippines Health Care. Perhaps there’s surgeon in an outpatient clinic?

  • JessH128

    Hello, my daughter called me on a Sunday night about a large lump in her groin area. Told her to clean with hydrogen peroxide and put antibiotic ointment on it until I saw her Monday. When indie, breadboard, obviously inflamed, and causing her a great deal of pain. There was what appeared to be a small scab in the center at the peak, she’d been trying to “pop” it with no luck. It was also hard and even clothing pressure was painful. I had her keep cleaning it and applying tea tree oil and antibiotic ointment. She saw a doc on Wednesday morning, who did not take culture, lance or anything. He prescribed oral antibiotics. By Wednesday afternoon it opened up almost on its own after about a half hour in the pool. Puss, some tinged green drained out. Again, had her clean and treat with tea tree oil, then cover with regular bandaid. By Wednesday night hardened puss appeared and her roommate began trying to tweeze it out. Thursday afternoon she was at my home where she tweezed out a rather large, square of hardened puss, leaving a large hole in the tissue. She has to get in pools almost daily, and I am pretty sure the wound is now too open to use tea tree oil or peroxide. I had her clean with warm water and soap, using regular antibiotic ointment, and covered with waterproof tagaderm as we had to get in a pool. It is still form puss and draining, tagaderm is clear, so we can see. Any advice on further care as the doc she saw seemed an idiot?

    • James Hubbard, MD, MPH

      If, by pools, you mean warm soaks, then that can help, If you mean a public pool, she should not be getting it at all.

  • worried girl

    I have a boil on the mound of my vagina and I went to quick are care today and they just gave me bacterium. I’m getting sharp pains where the boils are. Plzz help. Should I go to ER/ and its like a few together

    • James Hubbard, MD, MPH

      Remember to use moist heat. (Plan A). Getting in a tub is an option. Did they give you a followup time? I would think you’d need to be rechecked tomorrow.

  • eeck27!

    It started out as a bump on my inner labia minora. I foolishly squeezed it as I get ingrown hairs from shaving. Puss and blood came out. The next day it swelled back up and became even more tender. I have been soaking in the tub the past few weeks and this has not helped any. Do you think lancing this will help?

    • James Hubbard, MD, MPH

      Sounds like you definitely need a healthcare professional to take a look so you don’t risk making it worse. The only reason you would ever try lancing it on your own would be in an only option survival situation.

  • PinkBird

    Hey Doc,

    I have a boil like lesion under my stomach that my doctor says is related to my hidradenitis supprativa. I am on doxycycline for several months now. I have tried to get several doctors to remove it, because it feels like a sack is in there. It pops and fills back up with blood and pus. Finally the doctor lanced it a few days ago, but you can still feel a cylander shaped object in there and I imagine it’s just going to fill up again. The doctor said she wasn’t sure it was a cyst and keeps putting off removing it. If this is related to HS would it be removable so that it doesn’t return?

    • Shawna

      It may not be possible to get rid of it entirely. I have several that just come back over and over, no matter what I do.

      • James Hubbard, MD, MPH

        Unfortunate but true, Shawna.

    • James Hubbard, MD, MPH

      It’s speculation on my part but a doctor may have to do more than just lance it. They may have to kind of “bore it out” for lack of a better term and pack it, keeping the wound open to heal from the inside out. I may not have explained it the best but your doctor will probably know what I’m talking about.

  • sham11bsb

    I got a boil this march, on my thigh, it was reddening and the puss came out and all fine now. But after few days i got few smaller boils around that area but they subsided when i used hot compress.
    Recently i have got two boils , one on my inner thigh and the other on the bottom area. I am not able to sit , get up or do any physical movements much. Both the boils have burst and the puss is coming out but for quite long.The pain from the boil in the bottom is excruciating. Its like a boil with multiple heads. Its burning and i am not able to clean and apply anything. I got fever and sore throat when these boils appeared. More than the cure, I would like to know how i can prevent one next, the reasons for such boils(never experienced them until last march.Assumed it to be body heat,diet or hygiene issues, but in spite of taking precautions, nothing improved),etc…Also since i cannot turn around or do much, my body pain has increased.

    • James Hubbard, MD, MPH

      Sounds like that one boil is really a group of several, also called a carbuncle. I would advise you to see a doctor and have these treated. The doctor can do a culture from the pus, find what specific bacteria is causing the problem, and what antibiotic works the best. Other than that, wear loose fitting, breathable clothes (like cotton) and use an antibacterial soap like Phisoderm or Hibiclens.

      • Shawna

        This is the typical advice, but I respectfully disagree. There is no bacteria in the boils caused by HS.

        • James Hubbard, MD, MPH

          Thanks, Shawna. But, first, although Sham may very well have hydradentitis suppura she/he has never been diagnosed with it. So I don’t think that can be assumed. And, as you know, there are other causes for boils that are caused from bacteria. An exam by a doctor could help make a diagnosis and a culture from the pus could tell if, in fact, something like staph aureus, or the MRSA form was the culprit.

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  • Crystal

    I have an abscess on my knee area & just started the warm moist compress tonight. I also have a prescription of Cipro. Will that help alone without having to cut it open?? I can’t get to a dr.

    • James Hubbard, MD, MPH

      Crystal, every abscess is different. Some will drain on their own. Others won’t. And, if it’s mrsa, Cipro won’t help. Also, if it ever starts spreading and gets in the knee joint, that’s a big problem. Bottom line is if it doesn’t start getting better soon, or if it starts getting worse, you really need to see a doctor.

  • bryan

    hello, i have a large boil in the groin area and one in the armpit area, they are both draining, however the one on my groin area is now a large hole about the size of a nickel. it was covered in this white looking sack, and after i took hot showers the cover opened and now i am left with this hole about 1/2 deep do i need to go to the doctor to get it stitched up i am not in that much pain but it is kinda uncomfortable please help me kinda scared of the hole.

    • Shawna

      This happened to me in both armpits simultaneously. It was HS, which had gotten infected with MRSA. That’s when the holes appeared. I still have about 5 in each armpit but they have healed now. Unfortunately you are probably stuck with those scars, and likely stuck with HS forever. I can’t imagine stiching it up, what if it came back in that same place? Mine come and go. It really sucks, no more sleeveless anything for me.

    • James Hubbard, MD, MPH

      In general, doctors don’t stitch up that sort of thing. It’s too likely to get infected and basically turn into another boil. We let it heal from the inside out. But if you have questions about the healing or infection, you should be checked.

  • Jen

    I need some advice or help on how to heal my grandmother’s wound that is confirmed mrsa. My grandmother mysteriously got a large red bump on her stomach close to a surgical scar on her abdomen that she had done 7 years ago, I looked at it and wasn’t sure what it was. I made a doctor’s appointment because I was concerned it was from her massaging her stomach which she didn’t do after her surgery but just started doing, two days later on the day of her appointment it had started to drain and formed three holes on its own without being touched. The doctor thankfully gave her the proper medication before her swab results confirmed it as mrsa and the topical antibiotic for it as well. I don’t think she maintained it properly because two weeks later it was still there, the dr also had her get further testing and we got other bad news as well but my concern is that the wound is not healed yet. It’s still draining and he informed her that if it’s not completely healed in two weeks or gets worse he will have it cut out! My grandma will not do it if it comes to that, I’m already furious with this doctor because my grandfather had it while he was in the hospital and no one told us. I had to find out myself by looking in his chart and I ended up with mrsa in my nose, her crap doctor refused to test her because he said it wasn’t necessary and now almost a year after my grandpa’s passing she has a mrsa sore. Since her last appointment I have been going myself to change her dressing once a day so I know it’s cared for properly, it’s still draining slightly and I need help how to speed this process up if possible. I’m literally running out of time, she took two weeks of oral antibiotic and has been using the cream for almost a month. It is scabbing slightly but whenever she changes it herself she rubs off part of the scab and it seems to still have a slight drainage. How should I care for this to get it to finally heal. Any help would be greatly appreciated and yes I wash my hands and sanitize them before and after touching anything and make sure only new clean products are used on her wound.

    • James Hubbard, MD, MPH

      If any foreign body, such as an old suture, is in the infected area, the area won’t heal until the foreign body is taken out. If you don’t have confidence in that doctor, perhaps she could seek a second opinion and asked to be referred surgeon or an infectious disease doctor or both.

      • Jen

        I truly don’t believe that’s the case with her, it’s not related to her previous surgery. He had her do an ekg as well it’s not deep so it didn’t come from anything on the inside, my initial reaction was that I thought it came from that but it didn’t. She just got a bump and it started draining two days later. I don’t know if I should let the scab form or try to keep it moist, I’m not sure if it’s done draining. I just want to make sure it goes away and heals properly. Thank you soo much for your quick response, I’m sorry for the confusion about how it started. The doctor is not educated enough on mrsa, no one in my area seems to be. He’s trying to tell us she got a bump from her irritating the skin by wearing jeans with the button rubbing on her skin and she furthered its irritation by massaging her stomach. Smh, I’ve done my best to research mrsa and be knowledgeable about it because I helped care for my grandfather and ended up with it in my nose. From what I’ve seen and read it’s just the common mrsa sore, started as a bump and thankfully started to drain on its own.