Self treatment: Most simple boils can be treated at home. Ideally, the treatment should begin as soon as a boil is noticed. Early treatment may prevent later complications. The primary treatment for most boils is heat application, usually with hot soaks or hot packs. Hot soaks or hot packs are generally either hot towels or heated pack containing sodium acetate and water. The heated pack, which is purchased at a pharmacy or retail outlet, is placed in a microwave for a few minutes to retain enough heat for application to the affected site. Heat application increases the circulation to the area and allows the body to better fight off the infection by bringing antibodies and white blood cells to the site of infection.
As long as the boil is small and firm, opening the area and draining the boil is not helpful, even if the area is painful. However, once the boil becomes soft or forms a pustule (a small collection of pus in the top layer of skin or beneath it), it can be ready to drain. Once drained, pain relief can be dramatic and immediate. It is not recommended to drain a boil or carbuncle, as infection may develop. Healthcare professionals recommended seeing a doctor for the lancing of a skin abscess. Most small boils, such as those that form around hairs, drain on their own or with application of a hot, wet washcloth.
Soaking the abscess in a tub of hot water is often recommended by healthcare providers. This works well if the abscess is on the hand or lower arm. Soaking in hot water mixed with Epsom® salts can also be used. Make sure the water is hot, but not so hot that it burns the skin. In abscesses on the face and under the arms, hold a hot, wet wash cloth over the abscess. Soaking at least three to four times a day, 10-15 minutes each time, is recommended by healthcare providers.
Medical treatment: A doctor should be seen if the abscess or boil becomes extremely painful, very large, has not healed in two weeks, or is accompanied by a fever. Doctors should see individuals with frequent boils or those with red lines radiating from the boil, which may be a sign that the infection has entered the bloodstream. On occasion, and especially with larger boils, the larger boil will need to be drained or lanced by a healthcare provider. Frequently, these larger boils contain several pockets of pus that must be opened and drained.
Antibiotics: Antibiotics, such as amoxicillin (Amoxil®) and tetracycline (Vibramycin®), are often used to eliminate the bacterial infection.
Unclear or conflicting scientific evidence
Zinc: In one clinical study, patients with recurrent boils treated with zinc found their furuncles did not reappear. Well-designed clinical trials are needed to confirm this potential benefit.
Historical or theoretical uses lacking sufficient evidence
Arnica: Arnica (Arnica Montana) is commonly used in herbal ointments and oils applied on the skin as an anti-inflammatory and pain-relieving agent for aches, boils, bruises, sprains on unbroken skin, and furunculosis. Highly diluted homeopathic preparations are considered safe and are widely used for the treatment of injuries and abscesses.
Blessed thistle: Laboratory studies report that blessed thistle (Cnicus benedictus) has activity against several types of bacteria and no effects on some types. Historically, blessed thistle has been used for boils. Reliable human study is lacking. Further evidence is necessary in this area before a firm conclusion can be drawn.
Echinacea: Echinacea (Echinacea angustifolia or E. purpurea) has been studied alone and in combination preparations for immune system stimulation, including in patients receiving cancer chemotherapy. It remains unclear if there are clinically significant benefits. Historically, both topical and internal echinacea supplements have been used for boils and abscesses. Additional studies are needed in this area before conclusions can be drawn regarding safety or effectiveness.
Fenugreek: Historically, fenugreek (Trigonella foenum-graecum) has been taken by mouth for the treatment of boils, furunculosis, and abscesses. Fenugreek may lower blood sugar levels, so caution is advised in individuals with diabetes and in those taking blood sugar-lowering medications such as insulin.
Goldenseal: Goldenseal (Hydrastis canadensis), and one of its chemical components called berberine, has laboratory studies that support its use as an antibacterial agent. Goldenseal has historically been used both topically and internally for boils. Goldenseal and berberine may lower blood sugar levels, so caution is used in individuals with diabetes and those taking blood sugar lowering medications such as insulin. They both may also increase the incidence of bleeding in sensitive individuals, including those taking blood thinning drugs such as aspirin or warfarin (Coumadin®).
Slippery elm: Slippery elm (Ulmus fulva) bark has historically been used by mouth for abscesses, boils, and carbuncles. However, there are no scientific studies evaluating the common uses of this herb, but due to its high mucilage content, slippery elm bark may be a safe herbal remedy to treat irritations of the skin and mucus membranes.
Tea tree oil: Tea tree oil (Melaleuca alternifola) is reported to have antiseptic properties and has been used traditionally to prevent and treat infections such as boils, carbuncles, and furunculosis. Tea tree oil should be avoided by mouth, as reports of toxicity after oral ingestion have been published. When used topically, tea tree oil is reported to be mildly irritating and has been associated with the development of allergic contact dermatitis, which may limit its potential as a topical agent for some patients.
Other integrative therapies used in abcesses and related conditions such as boils, furunculosis, and carbuncles include: aromatherapy, ashwagandha (Withania somnifera), bromelain (from the pineapple), burdock (Arctium lappa), calendula (Calendula officinalis), cat's claw (Uncaria tomentosa), dandelion (Taraxacum officinale), devil's claw (Harpagophytum procumbens), ground ivy (Glechoma hederacea), topical (on the skin) marshmallow (Althaea officinalis), noni (Morinda citrifolia), psyllium (Plantago ovata, Plantago isphagula), thyme (Thymus vulgaris), thymol, and turmeric (Curcuma longa).
Cleaning wounds: Thoroughly cleaning even small cuts and scrapes is recommended by healthcare providers. Washing well with soap and water and applying an over-the-counter antibiotic ointment such as Neosporin® is also recommended. If a skin abscess has formed, it is recommended to apply a warm washcloth or compress to the affected area. Do this for at least ten minutes every few hours. If possible, first soak the cloth or compress in Epsom® salts or warm salt water. This will allow the boil to rupture and drain more quickly. It is important to wash the hands after treating a boil. Allow the compress to dry between applications to prevent bacterial growth on it.
Avoiding constricting clothing: Tight clothes may irritate the skin and cause infection. Wearing loose fitting clothing, especially in areas that may chafe, may help prevent the formation of abscesses.
Avoiding spreading infection: Lancing (opening) a boil may spread the infection. For most individuals, self-care by applying a warm compress or soaking the boil in warm water can help alleviate the pain and hasten draining of the pus. Healthcare providers do not recommend self-lancing a boil.