Acne boils are hard, red, painful swellings, usually beginning as pimples or nodules about hair roots. They increase rapidly in size and develop “cores” in their centers. Carbuncles are unusually severe boils, usually with more than one core or head, accompanied by general illness and debility.
Boils and carbuncles are caused by the same kind of germ – Staphylococcus aureus as a rule. To start a boil or carbuncle, the germs must gain entrance to an oil or sweat gland or hair follicle. It has often been noticed, however, that a general low level of resistance, a low metabolic rate, rubbing in of dirt by clothing, or diabetes paves the way for boils or carbuncles.
The core of an acne boil consists of innumerable bacteria interspersed with white blood cells. It tends to soften and form thick liquid pus around it, which escapes through a break in the skin. The pus, containing live germs, may spread the infection and cause other boils if it comes in contact with unprotected skin. Warmth and moisture hasten the formation and breakdown of the core, and help to keep the skin soft so that the pus may more easily break through. If the skin is kept wet continually, however, it may become soft enough to encourage the spread of germs through it. Dressings wet with strong solutions of salt or other chemicals stimulate drainage of the pus from the tissues into the dressings. Following adequate drainage, a boil subsides quickly.
Never squeeze or pick at a boil. The collection of germs in the forming core may be broken up and spread into surrounding tissues. The germs may even spread into the bloodstream, causing septicemia or “blood poisoning.” The most dangerous spot in the body for a boil to be located is the area marked out by the bridge of the nose, the corners of the mouth, and the outer corners of the eyes. This includes the inside of the nostrils. Many cases fatal septicemia or meningitis has resulted from improper interference with boils or pimples in this area.
What to Do
1. Immediately upon the appearance of a pimple which appears severe enough to develop into a boil – if it is not deep-seated ad has a small yellow spot in the center – dip the point of a needle into tincture of iodine or carbolic acid and open the pimple by thrusting the needle sideways through the yellow spot and lifting the needle. Do not press or squeeze. Wipe off the small amount of pus with a bit of sterile gauze or absorbent cotton. Apply 2 percent tincture of iodine to and around the opened pimple at once. This may abort the boil.
2. If the pimple is deep-seated, or if it does not have a definite yellow center, do not attempt to open it, but paint it and the surrounding skin twice a day with 2 percent tincture of iodine. Let the solution dry on the skin and apply no dressing of any kind for one hour. This will help to protect the surrounding skin from infection.
3. After the skin has been left dry for an hour, apply dressings of several layers of gauze kept wet with a warm saturated solution of Epsom salts on a repeat schedule of two hours on and one hour off. The dressings may be covered with waxed paper, oiled silk, or plastic to prevent their drying out. It is helpful to keep them warm by covering with a hot-water bottle with a layer or two of Turkish toweling between dressing and bottle.
4. The pain of the boil will be considerably relieved if the treatment outline in (2) and (3) is followed, and the boil will probably come to a head and break within a few days. If instrumental opening becomes necessary, it is better to have a physician do it.
5. Penicillin injections and sulfadiazine by mouth are recommended for a carbuncle or a severe boil. The use of these requires the supervision of a physician.
6. It is wise to keep a wide area of skin surrounding the boil disinfected by frequent application of rubbing alcohol or mild tincture of iodine, as described in (2), to prevent the germs in the pus from getting a foothold in the skin and starting new boils.
7. A “run of boils” should always lead to consultation with a physician. If diabetes is a factor, it must be treated. It may be advisable to build up resistance to the special strain of staphylococcus germ causing the boils by giving a course of injections of “autogenous vaccine,” which the physician can have made. Frequent changes of clothing, alcohol sponging, and frequent baths are also important.