Recurrent boils need treatment

Q. I'm a generally healthy 24-year-old female. I've been getting recurring boils in between and under my breasts for about eight or nine years. I've been to my family doctor, who referred me to a dermatologist who prescribed minocycline. It didn't help, so I was then given cephalexin, which didn't help, either. The dermatologist was very short with me and hardly showed any sympathy. I also believe he didn't tell me all of my options.

These boils are painful and affect my daily life. I know I need to get a second opinion, but could you discuss these lesions and tell me how to help relieve them? What are my options apart from medication? I use a hot washcloth to bring each boil to a head so it pops.

A. A boil is a painful, pus-filled lump under the skin. It appears when one or more of the hair follicles becomes infected and inflamed. The reaction is commonly caused by Staphylococcus aureus bacteria.

Boils generally appear suddenly as painful pink or red bumps. They are typically one to two centimeters in diameter, and the surrounding skin may be swollen. A few days after the lesion appears, it fills with pus and enlarges sometimes growing to the size of a golf ball before developing a yellow-white tip that ruptures, allowing the fluid to drain. This process typically takes a week or two, but may take a month or longer.

These lesions can occur anywhere on the body but are most common on hair-bearing areas that experience friction or are likely to sweat, such as the face, neck, armpits, buttocks or thighs. Women often experience them under their breasts.

Medical treatment should be sought if the boils fail to begin healing within a few weeks, recur, are extremely painful, worsen rapidly, or develop red lines radiating outward. Special attention should be given if a person has a pre-existing condition that suppresses the immune system.

Blood poisoning is a possibility. Signs include chills, a rapid heart rate, spiking fever and a feeling of being extremely ill. The condition may progress quickly to shock, characterized by low blood pressure and body temperature, bleeding into the skin, clotting abnormalities and confusion. If left untreated, it may be fatal.

Because you have recurring boils, they should be cultured to determine what bacteria are causing the infection and which antibiotic will best treat them. A home treatment involves applying a warm washcloth or compress to the area for 10 minutes every few hours. Try soaking the cloth in warm salt water. It may also be beneficial to wash the area gently several times a day, and then cover it with antibiotic cream and a bandage. Some people have had success in treating boils by applying tea-tree oil to the area several times a day. This treatment may cause an allergic reaction in some, but because it contains antiseptic, antibiotic and antifungal agents, tea-tree oil may speed healing.

It is important never to squeeze or lance a boil, because the act may lead to a worsening infection. Also, wash your hands with warm soapy water every time you touch the boil, and launder any clothing or fabric that may have come in contact with it. For prevention, try keeping the affected area(s) as dry as possible, dust with baby powder, and refrain from wearing tight-fitting bras or shirts. Wash with an antibacterial soap. Clean any cuts or scrapes thoroughly. Keep the boils covered to prevent cross-contamination. Finally, change dermatologists until you find one with whom you feel comfortable.

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