How to Drain an Abscess or Boil

At some point in your life, most people will have experienced a condition called a boil (also known as an abscess or furuncle). Draining these painful skin infections can be tricky and is typically best left to a medical professional.

This is especially true if the boil is on the face, neck, hands, ankles, genitals, rectum, or any vulnerable area of skin as it would likely need to be drained by a specialist in an operating room. The same would apply if you have diabetes or have a compromised immune system.

Superficial boils that affect fleshy parts of the skin — think the upper leg or torso — are more routinely drained as an in-office procedure. However, even some of these require surgical care if they are large or especially deep.

An abscess must be drained in a sterile environment using sterile instruments which include, among other things, gloves, a mounted surgical blade, an irrigating syringe, sterile saline, and dressing.

Anesthesia can be challenging when draining a boil. Injecting lidocaine in and around the painful mass can make the pain worse and risk puncturing the pus-filled abscess (particularly if it's a carbuncle, a consolidated cluster of multiple boils).

Smaller boils may benefit from an ethyl chloride spray which can numb the area of skin around the boil.

As an in-office procedure, every effort is made to ensure a sterile environment. The procedure only takes around five to 10 minutes in total and most typically involves the following steps:

1. The doctor dons the appropriate protective clothing and sterile gloves. A plastic absorbent pad is placed under the area to be drained.
2. The doctor finds the point of maximal fluctuance or "bubbliness" (the head or point of the boil). Ethyl chloride may be used at this stage to numb the area.
3. He makes a quick nick where the abscess is most fluctuant to release the pus. A sample of pus may be collected and sent to the lab for culturing.
4. Depending on the size of the boil, the doctor may need to make subsequent incisions to ensure that little pockets (or loculations) of pus are completely drained.
5. The cavity is irrigated with sterile saline, packed with gauze, dressed, and bandaged.

After the boil is drained, your physician should prescribe a course of antibiotics. Because community-acquired MRSA (methicillin-resistance Staphylococcus aureus) is a common cause of skin and soft-tissue infections, Bactrim (TMP-SMX) is considered the best choice of treatment. Doxycycline and minocycline are good options for the treatment of abscesses and MRSA as well.

It is important that you complete the course of antibiotics as directed to avoid the development of antibiotic drug resistance. Ideally, a follow-up appointment with your primary care physician should be made in the next few days.

Despite warnings, people will often opt to lance a boil themselves. It might certainly seem to make sense if it is pimple-sized and not inordinately painful. The problem is that the unexpected can and does happen, and a "superficial" boil can turn out to be deeper and more extensive than imagined.

Avoid the temptation. Instead, place a warm, wet cloth on the boil for 20 to 30 minute for four to five times per day. You can cover it with a heating pad to provide additional warmth. In about a week or maybe less, the boil may open on its own.

When it does, wash the affected area with soap and water and dress with a sterile bandage. You can also use an over-the-counter antiseptic preparation like Bacitracin, Neosporin, or Betadine if the wound is small. Keep using heat for the next few days to promote draining, washing the area twice daily and applying a fresh bandage every time.

If the boil fails to open on its own, don't get frustrated and try to "pop" it. Squeezing only forces the infection deeper into your skin. Make an appointment to have it drained in a sterile environment.

If you have a boil and experience any complications, including fever or a worsening of symptoms, see your doctor immediately or visit your nearest emergency room.