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Boils

Q: I have been getting boils for about 5 years.† They are quite big, usually on or under my breast and between my legs.† Sometimes they burst on their own or I have to get them lanced.† I have read that recurrent boils are a symptom of diabetes. Is this true?† Right now I have 3 under my breast and 2 between my legs. Can you tell me anything about this?


Dr. Donnica:
A boil is an inflamed, pus-filled swelling of the skin. A cluster of boils is called a carbuncle. Boils are caused by certain bacteria, especially Staphylococcus aureus, which infect a hair follicle. In defense, your white blood cells move in. This produces pus (white or yellow), which is simply white blood cells, bacteria, and dead skin cells. Boils are very common, usually appearing on the face, neck, breasts, and buttocks. They can occur and recur in people who are otherwise healthy, however, people with lowered resistance to infection, including those with diabetes, do have an increased sensitivity. It would be worth discussing this with your doctor and getting screened for diabetes, especially if you have a family history. In the meantime, you can apply hot, damp cloths to the boil both to reduce the pain and to hasten spontaneous drainage.

It may also be worthwhile to consult a dermatologist to rule out a condition called Hidradenitus Supperativa (HS). This condition has been called by many other names including "acne inversa," but is not well known among patients or physicians. Its name describes its appearance: oozing, inflamed sweat glands. This sometimes debilitating autoimmune disorder appears as severe, recurrent boils. Unfortunately, it can often take up to 10 years to diagnose this condition correctly because of limited awareness by healthcare professionals and extreme embarrassment from the nearly one million Americans who suffer from it. Of even greater concern is that its cause is unknown, there is no known consistently effective treatment, and no major research effort under way to aggressively seek a cure.

HS is a non-contagious, recurrent skin disease usually found in areas of the body where there is skin-to-skin contact (such as armpits, groin, thighs, and under breasts) and around hair follicles where apocrine sweat glands are located. Characteristically, it progresses from boils or abscesses to hard lumps and painful, rounded deep-seated inflamed lesions with subsequent scarring and chronic seepage (aka suppuration). These hard lumps occur under the skin and may grow as large as baseballs. In many cases, they are very painful and may persist for years with or without recurrent inflammation. Inflamed lumps may lead to extensive drainage, which may cause the development of sinus tracts under the skin. These may heal slowly or not at all, which may lead to further inflammation and lumps. Bacterial infections are possible at these sites. Draining the lumps may provide some pain relief, but the lumps and tracts often recur.

Because HS may be extremely painful and the drainage may have a foul odor, sufferers often limit their activities including work or even going out in public. As a result, HS sufferers often suffer from depression as well.

For unknown reasons, HS is often associated with several other conditions including polycystic ovarian syndrome (PCOS), insulin resistance, diabetes, Crohns disease, anemia, hyperhidrosis, acne, and pilonidal cysts.

For more information on HS, click here.


Created: 1/3/2003  -  Donnica Moore, M.D.
Reviewed: 6/3/2004  -  Donnica Moore, M.D.


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