Category: Illness or disabilities
Introduction and description
A boil, also called a furuncle, is ‘a deep folliculitis’, an infection of the hair follicle. Boils are bumpy, red, pus-filled lumps around a hair follicle that are tender, warm, and very painful. They range from pea-sized to golf ball-sized. A yellow or white point at the centre of the lump can be seen when the boil is ready to discharge pus.
The difference between a boil and all the other skin problems that cause lumps, pus filled spots, pus filled lumps or ulcers, is that the pathogen comes from the outside - the skin surface and is working its way into the body from the surface of the skin. Pathogens trying to get out or being expelled via the immune system through the skin should not be called boils.
The difference may seem somewhat trivial, but it is not. Pathogens within the body may be doing a great deal of damage to internal tissues and organs. They can be a symptom of viruses, bacteria, parasites, fungi, toxins and even heavy metals that are working their way round the body attacking organ after organ. The immune system will fight them and may expel them via the skin. We see this with chicken pox, shingles and measles. Lots of nasty pus filled spots, some which may be enormous, and the best treatment here is to wash very regularly with clean water to flush the pathogens away from the body – a shower not a bath!
But a boil is the start of something which, unless you tackle it quickly, could become more serious. You don’t have a pathogen inside your body, you have pathogens attempting to work their way in.
Boils are thus a symptom of an external attack. Once you are under attack they will manifest as a painful swollen area on the skin caused by an accumulation of pus and dead tissue. The pus is the by-product of both attack by the pathogen and the defence by the immune system. Boils which are expanded are basically pus-filled nodules. Individual boils clustered together are called carbuncles.
Boils may occur in the hair follicles anywhere on the body. They are most common on the face, neck, armpit, buttocks, and thighs. The human skin is the largest organ of the ‘integumentary system’, the organ system that protects the body from various kinds of damage, such as loss of water or abrasion from outside. The skin has multiple layers of ectodermal tissue and guards the underlying muscles, bones, ligaments and internal organs. Nearly all human skin is covered with hair follicles, even though it can appear hairless, as such there is the potential to get a boil almost anywhere on the body.
But by definition a ‘boil’ on the gum is not a boil or even a gumboil; its correct name is an ‘intraoral dental sinus’.
From what we have been able to ascertain from published medical papers, very serious illnesses caused by pathogens lodged in the body can be mis-diagnosed as boils, unless great care is taken.
For example, Hidradenitis Suppurativa (HS) is classified as a ‘chronic skin disease’, which appears as a boil like abscess in the armpits, breasts and groin. It is recurrent, inflammatory, painful and no one has investigated the cause. HS was first described in 1833 by the French anatomist and surgeon Alfred-Armand-Louis-Marie Velpeau, which is where the alternative name for this - Velpeau's Disease - originates. It was later investigated by another French Surgeon called Artistide Auguste Stanislas Verneuil from 1854 to 1865, and yet another name for it was added to the list - Verneuil's Disease. Neither identified the cause. The English name Hidradenitis Suppurativa, means inflammation of a sweat gland (Hidradenitis) containing or associated with pus (Suppurativa).
Are these pathogens going in [true boils] or pathogens coming out? The recurrent nature rather indicates that they are pathogens being expelled via the sweat glands. Sweat is one way the body expels pathogens, a way we of course totally destroy by using anti-perspirants, but assuming we have not been so stupid, and we allow the body to sweat, then the likelihood is that pathogens were going out via sweat, as such these are not boils.
If the apparent boil is recurrent, it may not be a boil at all, it may be the symptoms of a pathogen attack within the body, a viral attack or bacterial attack, for example.
Laboratory tests, such as skin swabs, to establish the exact pathogen take time but are essential. The ideal is that there are also proper tests undertaken of the lymph and the blood to see if pathogens have entered the body. Furthermore there should be an acceptance that any pathogen may be found – from bacteria to viruses, from heavy metals to fungi, from toxins to parasites and protozoa. A person working without gloves and handling something as dangerous as cadmium, for example, may be allowing this to enter their body.
As we saw above, the pathogen could be anything, bacteria, fungi, parasites, heavy metals, viruses and toxins. This said, parasites generally result in cysts. But why did they get in?
Compromise of the skin biome
Pathogens can get in via the mouth, the nose, the vagina, the anus, the penis, the eyes, and the ears. The mouth has friendly bacteria and saliva to act as a defense. The nose has hairs, and nasal secretions. The vagina has a balanced mucal acid/alkali coating to protect it from pathogens. The anus has mucus. The penis [unless you are circumcised] has a protective mucus filled ‘cap’ of skin. The eyes are protected by tears and eyelashes. The ears by earwax.
The skin, if it is healthy, is covered by protective bacteria.
The human skin is a rich environment for protective microbes. Around 1000 species of bacteria from 19 bacterial phyla have been found. Most come from only four phyla:
- Actinobacteria (51.8%),
- Firmicutes (24.4%),
- Proteobacteria (16.5%), and
- Bacteroidetes (6.3%).
Propionibacteria and Staphylococci species are the main species in sebaceous areas. There are three main ecological areas: moist, dry and sebaceous. In moist places on the body Corynebacteria together with Staphylococci dominate. In dry areas, there is a mixture of species but dominated by b-Proteobacteria and Flavobacteriales. Ecologically, sebaceous areas have greater species richness than moist and dry ones. The areas with least similarity between people in species were the spaces between fingers, the spaces between toes, axillae, and umbilical cord stump. Most similarly were beside the nostril, nares (inside the nostril), and on the back.
The NIH has launched the Human Microbiome Project to characterize the human microbiota which includes that on the skin and the role of this microbiome in health and disease.
Microorganisms like Staphylococcus epidermidis colonize the skin surface. The density of skin flora depends on region of the skin.
So what can cause this compromise?
Anti-bacterial skin washes and other types of skin wash products
An anti-bacterial skin wash, or a disinfectant or similar is more likely to kill the microbes that are protecting you than those that may be attacking you. There is also another alarming source for bacteria and that is the very shampoo we are using to supposedly get our hair clean. Here is a case where a dog suffered instead of a human
An acute onset furunculosis due to Pseudomonas aeruginosa following grooming is a well recognized condition [sic]. Although contaminated shampoos have been suspected to be the source of the infection, a molecular confirmation of this association has been missing. This case report describes a dog with postgrooming furunculosis in which Pseudomonas aeruginosa with an identical genetic fingerprint was isolated from the skin lesions as well as from the shampoo used prior to the disease onset. PMID: 27237982
If you damage the hair follicle or the skin near it, a wound, a scratch or some damage to the skin, and compromise the protective barrier in some way – for example using anti-bacterial handwashes or body washes, which serve to wash away your helpful bacteria - pathogens can attack from the outside and start to enter the body. The follicle is a good place to attack as it provides a route into the lower layers of the skin and from there to the blood stream.
If using heavy duty chemicals and soaps you have washed off the natural protective microbes on the skin, the body attempts to recolonise the skin using bacteria residing in the deeper areas of the hair follicle, intestine and urogenital openings. If you are given antibiotics, this reserve supply is destroyed.
Boils and abscesses are common in primary care but the burden of recurrent infection is unknown. Aim: To investigate the incidence of and risk factors for recurrence of boil or abscess for individuals consulting primary care.
Result: Overall, 164 461 individuals were identified who consulted their GP for a boil or abscess between 1995 and 2010. …. First consultations were most frequent in younger age groups (16-34 years) and those with the greatest levels of social deprivation. The rate of repeat consultation for a new infection during follow up was 107.5 .. per 1000 person-years. Obesity, diabetes, smoking, and prior antibiotic use were all associated with repeat consultation for a boil or abscess……prescription of an antibiotic in the 6 months before initial presentation were independently associated with recurrent infection, and may represent options for prevention. PMID: 26412844
Antibiotics are known to be one cause of obesity. This is why bad farmers give them to animals – they know it will fatten them up, so obesity is not actually the cause. Diabetes can also be caused by antibiotics. Smoke particles are an irritant and may be being released via the skin.
But the use of antibiotics also destroys the natural intestinal flora protecting you from pathogens entering the blood stream. As such antibiotics may not only cause boils by damaging the natural defences of the skin and the body’s ability to rejuvenate the skin microbiome, but it may also be allowing pathogens to enter the blood stream, which is why they emerge as boils and spots.
The ‘socially deprived’ in the UK, where this study was undertaken, are not hesitant to use the ‘free’ services of the NHS and frequently demand antibiotics for every ailment from flu to warts, which of course antibiotics do not help with.
A regimen of glucocorticosteroids or other immunosuppressive drugs depresses the immune system and thus allows pathogens to enter the skin unchallenged.
A number of papers on PubMed link low vitamin levels with the presence of boils. In general, low levels of nutrients are principally resulting in a failing or almost inactive immune system. In other words, the poor diet results in immunosuppression and this in turn allows pathogens to enter and grow. For example
Neutrophils play a critical role in host defense against a variety of microbial pathogens. There is much information to suggest a role for vitamin C in the physiology of neutrophils. Thus, the effects of vitamin C treatment were studied in a patient with a history of recurrent furunculosis [A boil is also called a furuncle], who showed altered neutrophil functions…… Treatment with vitamin C (500 mg/day) for 30 days caused a dramatic clinical response and a significant improvement of all three neutrophil functions to values similar to those of the controls….. The treatment with vitamin C probably prevented neutrophil oxidation, thus contributing to recovery of neutrophil function and arrest of furunculosis. PMID: 8270350
There are papers for other vitamins – D, B6 and so on, as well as deficiency in minerals and amino acids, so this is general deprivation.
One strategy is to let the boil burst of its own accord, being careful to clean the wound afterwards, and dress it with surgical dressings. The area must be kept clean, hands washed after touching it, and any dressings disposed of carefully, in order to avoid spreading the pathogen.
An alternative approach is to cauterise the boil. A doctor may cut open or "lance" a boil to allow it to drain, but squeezing or cutting should not be attempted at home, as this may further spread the pathogen. The advantage of going to the doctor is that she is able to collect the pus and identify the pathogen [if she has not already done so]. As you do not want the pathogen to get into your blood stream or the rest of your body, lancing also has the advantage that it lessens the risk of this happening.
Fever and chills are signs of sepsis and indicate immediate treatment is needed.
It was once a common practise to apply a poultice to boils. A poultice is a “soft moist mass, often heated and medicated, that is spread on cloth over the skin to treat an aching, inflamed, or painful part of the body.” Poultices are still recommended for boils, but without any medication:
apply hot washcloths to the boil 3 or 4 times a day, for 20 minutes or more at a stretch. You might also try a hot water bottle or heating pad applied over a damp towel. These warm compresses can help bring the boil to a head, although the process may take 5 to 7 days. If the boil opens, keep applying the compresses for three more days. An opened boil should be covered with a bandage. Change the bandage every day. Continue cleaning the area twice a day until the boil has drained completely and begins to heal
The key here is actually warmth. If the area is warm, it enables the blood vessels to dilate and the immune system can send its troops to fight the pathogen and then heal the wound.
References and further reading
Please also refer to the section on Skin diseases
- Br J Gen Pract. 2015 Oct;65(639):e668-76. doi: 10.3399/bjgp15X686929. Incidence and recurrence of boils and abscesses within the first year: a cohort study in UK primary care. Shallcross LJ1, Hayward AC2, Johnson AM1, Petersen I3.
- Vet Dermatol. 2016 Aug;27(4):320-e80. doi: 10.1111/vde.12332. Epub 2016 May 30. Molecular confirmation of shampoo as the putative source of Pseudomonas aeruginosa-induced postgrooming furunculosis in a dog. Tham HL1, Jacob ME2, Bizikova P1,3.
- Int J Dermatol. 1993 Nov;32(11):832-4. Successful treatment of a patient with recurrent furunculosis by vitamin C: improvement of clinical course and of impaired neutrophil functions. Levy R1, Schlaeffer F.
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