by 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.
- Wash your hands.
- Put on some nonporous gloves, such as latex.
- Feel for a soft area on the boil, and look for a point or rising in the skin.
- Wash the affected skin with soap and water.
- Clean the area further with iodine or povidone/iodine (Betadine). If you don’t have that, use alcohol.
- 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.
- 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.)
- 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.
- 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.
- As soon as the pus flows, you may want to slant the blade a little to open up the wound. Then, remove the knife.
- Let the wound drain. Catch the pus with cloth or gauze.
- 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.
- 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.)
Boil image courtesy CDC/Bruno Coignard, M.D.; Jeff Hageman, M.H.S.
