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Abscesses

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Related Terms
  • Acquired immunodeficiency syndrome, AIDS, anorectal, bacteria, bacterium, Bartholin's gland, boil, carbuncle, cystic acne, diabetes, endocarditis, Entamoeba histolytica, epidural, furuncle, furunculosis, groin, Hirradenitis suppurativa, HIV, human immunodeficiency virus, immune, inflammation, meningitis, methicillin-resistant, MRSA, neutrophils, nosocomial, parasite, peritonsillar, pilonidal cyst, pneumonia, pus, pustule, pyogenic, Staph., Staphylococcus aureus,steroids, subcutaneous, sweat gland, vagina.

Background
  • An abscess is a collection of pus in any part of the body that is surrounded by swelling and inflammation. An abscess may develop, enlarge, or subside, depending upon the degree of infection by microorganisms, such as bacteria. Abscesses may develop in any organ and in the soft tissues beneath the skin in any area.
  • Common sites of abscesses include the breasts, gums, and peri-rectal area. Less common sites include the brain and liver. Common sites for abscesses under the skin include the armpit and the groin. These two areas have a large number of lymph glands, which are responsible for fighting infection.
  • Boil: A boil, also referred to as a skin abscess, is a localized infection deep in the skin. A boil generally starts as a reddened, tender area. Over time, the area becomes firm and hard. Eventually, the center of the abscess softens and becomes filled with infection-fighting white blood cells that the body sends from the blood stream to stop the infection. This collection of white blood cells, bacteria, and proteins is known as pus. Finally, the pus forms a head, which can be drained out through the surface of the skin using pressure or surgical methods. Most boils run their course within four to ten days.
  • Furuncle or carbuncle: Furuncles or carbuncles are abscesses in the skin caused by the bacterium Staphylococcus aureus. A furuncle can have one or more openings onto the skin and may be associated with a fever or chills.
  • Cystic acne: Cystic acne is a type of abscess that is formed when oil ducts become clogged and infected. Cystic acne affects deeper skin tissue than inflammation on the skin commonly seen in acne. Cystic acne is most common on the face and typically occurs in the teenage years.
  • Hidradenitis suppurativa: Hirradenitis suppurativa is a condition in which there are multiple abscesses that form under the arm pits and often in the groin area. These areas are a result of local inflammation of the sweat glands. This form of skin infection is difficult to treat with antibiotics alone and typically requires a surgical procedure to remove the involved sweat glands in order to stop the skin inflammation.
  • Pilonidal cyst: Pilonidal cyst is a unique kind of abscess that occurs at the bottom of the tailbone. Pilonidal cysts often begin as tiny areas of infection in the base of the hair follicle (the area of skin from which hair grows). With irritation from direct pressure, over time the inflamed area enlarges to become a firm, painful, tender nodule making it difficult and uncomfortable to sit. These frequently form after long trips that involve prolonged sitting. Pilonidal cysts are more common in men than in women.
  • Other abscesses: Other types of abscesses include amebic liver abscesses (collection of pus in the liver caused by the intestinal parasite Entamoeba histolytica), anorectal (anal or rectal) abscesses, Bartholin's (glands located on either side of the vagina) abscesses, brain abscesses, epidural (outer covering of the brain and spinal cord) abscesses, peritonsillar (beside the tonsils) abscesses, pyogenic (puss generating) liver abscesses, skin abscesses, spinal cord abscesses, subcutaneous (under the skin) abscesses, and tooth abscesses.

Risk factors and causes
  • Abscesses can be caused by minor breaks and punctures of the skin, obstruction of sweat glands and oil (sebaceous) glands, and inflammation of hair follicles. They contain dead cells, bacteria, and other debris, which causes inflammation and pain.
  • Infection: The bacterium Staphylococcus aureus can enter through a cut, scratch, or other break in the skin. These bacteria, which normally inhabit the skin and sometimes the throat and nasal passages, are responsible for a number of serious diseases, including pneumonia, meningitis (inflammation of the membranes surrounding the brain), urinary tract infections, and endocarditis (inflammation of the lining of the heart). They're also a major cause of hospital-acquired infections (called nosocomial infections) and food-borne illnesses.
  • Fungal infections sometimes cause abscesses, while amoebae (single-celled protozoal parasites) are a major cause of liver abscesses.
  • Individuals with weakened immune systems, such as with acquired immunodeficiency syndrome (AIDS), may be more prone to abscesses or may have more severe ones.
  • Tight clothing: The constant irritation from tight clothing can cause breaks in the skin, making it easier for bacteria to enter the body and cause abscesses.
  • Other skin conditions: Skin problems, such as acne and dermatitis, make individuals more susceptible to boils and carbuncles. Skin conditions can damage the skin's protective barrier. Infected hairs and skin injury, such as scrapes and cuts, can also lead to abscesses or boils.
  • Immune-suppressing medications: Many medications can suppress the normal immune system and increase the risk of developing boils. These medications include steroid medications, such as prednisone (Deltasone®) and prednisolone (Prelone®), and medications used for cancer chemotherapy, such as methotrexate (Rheumatrex®), etoposide (Veepesid®), and doxorubicin (Adriamycin®).'

Signs and symptoms
  • A boil usually appears suddenly as a painful pink or red bump that is generally not more than one inch in diameter. The surrounding skin also may be red and swollen.
  • Within a few days, the reddened bump fills with pus. It grows larger and more painful for about five to seven days, sometimes reaching golf ball size before it develops a yellow-white tip that finally ruptures and drains. Boils generally clear completely in about two weeks. Small boils usually heal without scarring, but a large boil may leave a scar.
  • A carbuncle is a cluster of boils that often occurs on the back of the neck, shoulders, or thighs, especially in older men. Carbuncles cause a deeper and more severe infection than single boils do. In addition, carbuncles develop and heal more slowly and are likely to leave a scar. Carbuncles sometimes occur with a fever.
  • Boils and carbuncles are generally inflamed, painful lumps. Compared with acne, boils are generally more painful, inflamed, and reddened around the border.

Diagnosis
  • Skin abscesses, boils, and related conditions are diagnosed by visual inspection. Often, a sample of fluid will be taken from the abscess and tested to see what bacteria are causing the problem.

Complications
  • Scarring of the skin can occur with boils and other skin abscesses. Scarring depends upon the size of the cyst or abscess. Most scars are minimal and fade over time.
  • Rarely, bacteria from a boil may enter the bloodstream and travel to other parts of the body. The spreading infection, commonly known as septicemia (blood poisoning), can rapidly become life-threatening.
  • Initially, blood poisoning causes signs and symptoms such as chills, a spiking fever, a rapid heart rate, and a feeling of being extremely ill. But the condition can quickly progress to shock, which is marked by falling blood pressure and body temperature, confusion, clotting abnormalities and bleeding into the skin. Blood poisoning is a medical emergency and can be fatal if left untreated.
  • Another potentially serious problem is the emergence of a drug resistant strain of Staphylococcus aureus. Once mainly confined to hospitals, methicillin-resistant Staphylococcus aureus (MRSA) now affects increasing numbers of military recruits, prison inmates, athletes, and even children. According to the U.S. Centers for Disease Control and Prevention (CDC), about one percent of Americans carry MRSA on their bodies. A healthy immune system can fight off most infections caused by the bacteria. However, individuals with impaired immunity, such as those with health conditions (including diabetes and human immunodeficiency virus or HIV) and those on certain medications (such as steroids and cancer chemotherapy), may have weakened immune systems and be susceptible to MRSA infections.
  • MRSA is highly contagious and spreads rapidly in crowded or un-hygienic situations or where athletic equipment or towels are shared. Although it responds well to several antibiotics, MRSA is resistant to penicillin and can be very difficult to treat.

Treatment
  • 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.

Integrative therapies
  • Note: Currently, there is insufficient evidence available on the safety and effectiveness of integrative therapies for the prevention or treatment of abscesses and boils. The therapies listed below should be used only under the supervision of a qualified healthcare provider, and should not be used in replacement of other proven therapies or preventive measures.
  • Strong scientific evidence:
  • Iodine: Iodine is commonly used in topical disinfectant preparations for cleaning wounds, sterilizing skin before surgical/invasive procedures, or sterilizing catheter entry sites. Betadine solution, for example, contains povidone-iodine. Other topical disinfectants include alcohol and antibiotics and iodine is sometimes used in combination with these as a skin disinfectant. Commercially prepared iodine products are recommended in order to assure appropriate concentrations.
  • There have been reports of severe and even fatal reactions to iodine. Avoid iodine-based products if allergic to iodine. Do not use for more than 14 days. Avoid lugol solution and the saturated solution of potassium iodide (SSKI, PIMA) with high amounts of potassium in the blood, fluid in the lungs, bronchitis, or tuberculosis. Use cautiously when applying to the skin because it may irritate or burn tissues. Use sodium iodide cautiously with kidney failure. Avoid sodium iodide with gastrointestinal obstruction. Iodine is considered to be safe in recommended doses for pregnant or breastfeeding women. Avoid povidone-iodine for perianal preparation during delivery or postpartum antisepsis.
  • Probiotics: Probiotics are beneficial bacteria and are sometimes called friendly germs. They help maintain a healthy intestine by keeping harmful bacteria and yeasts in the gut under control. Most probiotics come from food sources, especially cultured milk products. Probiotics can be taken as capsules, tablets, beverages, powders, yogurts, and other foods. An increasing number of studies support the use of probiotics as a supplement to antibiotic therapy. Probiotic supplementation during a course of antibiotics has been studied for reducing adverse effects of antibiotics in the intestinal environment. This includes reducing growth of Clostridium difficile bacteria, which can lead to colitis, a common complication of antibiotics, especially in the elderly. Some probiotics may also help prevent the development of antibiotic resistance. In acutely ill children, synbiotics have been linked to greater weight gain and fewer bacterial illnesses after antibiotics are ended. The evidence consistently supports supplementation of antibiotics with probiotics.
  • Probiotics are generally considered to be safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant. Caution is advised when using probiotics in neonates born prematurely or with immune deficiency.
  • Unclear or conflicting scientific evidence:
  • Berberine: Berberine is a bitter-tasting, yellow, plant alkaloid with a long history of medicinal use in Chinese and Ayurvedic medicine. Berberine has been found to possess antimicrobial properties, and there is limited evidence of anti-inflammatory properties as well. Additional study is needed to confirm the effects of berberine for parasitic infections.
  • Avoid if allergic or hypersensitive to berberine, to plants that contain berberine (Hydrastis canadensis (goldenseal), Coptis chinensis (coptis or goldenthread), Berberis aquifolium (Oregon grape), Berberis vulgaris (barberry), and Berberis aristata (tree turmeric), or to members of the Berberidaceae family. Avoid in newborns due to the potential for an increase in free bilirubin, jaundice, and development of kernicterus. Use cautiously with cardiovascular disease, gastrointestinal disorders, hematologic disorders, leukopenia, kidney disease, liver disease, respiratory disorders, cancer, hypertyraminemia, diabetes, or low blood pressure. Use cautiously in children due to a lack of safety information. Use cautiously in individuals with high exposure to sunlight or artificial light. Use cautiously for longer than eight weeks due to theoretical changes in bacterial gut flora. Use cautiously if taking anticoagulants, antihypertensives, sedatives, anti-inflammatories, medications metabolized by CYP P450 3A4 including cyclosporin, or any prescription medications. Avoid if pregnant or breastfeeding.
  • Beta-glucan: Beta-glucan is a soluble fiber derived from the cell walls of algae, bacteria, fungi, yeast, and plants. PGG-glucan, an immunomodulator, has been studied in patients undergoing surgery, particularly abdominal surgery. Currently, PGG-glucan appears to have positive results in decreasing postoperative infections. More study is warranted to make a firm conclusion.
  • Avoid if allergic or hypersensitive to beta-glucan. When taken by mouth, beta-glucan is generally considered to be safe. Use cautiously with AIDS or AIDS-related complex (ARC). Avoid using particulate beta-glucan. Avoid if pregnant or breastfeeding.
  • Bitter orange: Limited available human study found promising results using the oil of bitter orange for treatment of fungal infections. However, due to methodological weakness of this research, further evidence is needed to confirm these results.
  • Avoid if allergic or hypersensitive to bitter orange or any members of the Rutaceae family. Avoid with heart disease, narrow-angel glaucoma, intestinal colic, or long QT interval syndrome. Avoid if taking anti-adrenergic agents, beta-blockers, QT-interval prolonging drugs, monoamine oxidase inhibitors (MAOIs), stimulants, or honey. Use cautiously with headache, hyperthyroidism (overactive thyroid), or if fair-skinned. Avoid if pregnant or breastfeeding.
  • Black tea: Black tea is made from the dried leaves of Camellia sinensis, a perennial evergreen shrub. In early study, inhaled tea catechin was reported as temporarily effective in the reduction of Methicillin-resistant Staphylococcus aureus (MRSA) infection and shortening of hospitalization in elderly patients with MRSA-infected sputum. Additional research is needed to further explore these results.
  • Avoid if allergic or hypersensitive to caffeine or tannins. Skin rash and hives have been reported after caffeine ingestion. Use cautiously with diabetes. Use cautiously if pregnant. Heavy caffeine intake during pregnancy may increase the risk of SIDS (sudden infant death syndrome). Very high doses of caffeine have been linked with birth defects. Caffeine is transferred into breast milk. If breastfeeding mothers consume black tea, it may lead to anemia, decreased iron metabolism, and irritability in their infants.
  • Blessed thistle: Human research of blessed thistle as a treatment for bacterial infections is currently lacking. Laboratory studies report that blessed thistle (and chemicals contained in blessed thistle, such as cnicin and polyacetylene) may have activity against several types of bacterial infections and no effects on some types. Further evidence is necessary in this area before a firm conclusion can be drawn.
  • Blessed thistle is generally considered to be safe when taken by mouth in recommended doses for short periods of time, with few reported side effects such as birth defects, bleeding, breathing problems, bruising, cancer of the nose or throat, increased production of stomach acid, itching, kidney disease, liver toxicity, skin rash, stomach discomfort, stomach ulcers, and vomiting. Allergic reactions to blessed thistle including rash may occur, as well as cross-sensitivity to mugwort and Echinacea. Cross-reactivity may also occur with bitter weed, blanket flower, Chrysanthemum, coltsfoot, daisy, dandelion, dwarf sunflower, goldenrod, marigold, prairie sage, ragweed or other plants in the Asteraceae/Compositae family. Avoid if pregnant or breastfeeding.
  • Corydalis: Corydalis may be helpful in the treatment of infections caused by the parasite Echinococcus granulosus caused by the Hydatid worm. More studies are needed to confirm the antiparasitic effects of corydalis.
  • Corydalis is generally considered to be safe. Avoid if allergic or sensitive to corydalis. Avoid if taking sedative or hypnotic drugs, drugs that treat abnormal heart rhythms (including bepridil), pain relievers, and anti-cancer drugs. Avoid if pregnant or breastfeeding.
  • Cranberry: Limited laboratory research has examined the antifungal and antibacterial activity of cranberry. Further research is warranted in this area.
  • Avoid if allergic to cranberries, blueberries, or other plants of the Vaccinium species. Sweetened cranberry juice may affect blood sugar levels. Use cautiously with a history of kidney stones. Pregnant and breastfeeding women should avoid cranberry in higher amounts than what is typically found in foods.
  • Garlic: Garlic is used both medicinally and as a food spice. Several studies describe the use of garlic as a topical antifungal to treat fungal infections of the skin, including yeast infections. More research is needed in this area.
  • Use cautiously as garlic can cause severe burns and rash when applied to the skin of sensitive individuals. Avoid if allergic or hypersensitive to garlic or other members of the Lilaceae(lily) family (e.g. hyacinth, tulip, onion, leek, or chive). Avoid with a history of bleeding problems, asthma, diabetes, low blood pressure, or thyroid disorders. Stop using supplemental garlic two weeks before and immediately after dental/surgical/diagnostic procedures with bleeding risks. Avoid in supplemental doses if pregnant or breastfeeding.
  • Ginseng: In patients treated with Hochu-ekki-to, which contains ginseng and several other herbs, urinary Methicillin-resistant Staphylococcus aureus (MRSA) has been reported to decrease after 10 weeks. Further study of ginseng alone is necessary in order to draw firm conclusions.
  • Avoid with a known allergy to plants in the Araliaceae family. There has been a report of a serious life-threatening skin reaction, possibly caused by contaminants in ginseng formulations.
  • Hydrotherapy: Hydrotherapy is broadly defined as the external application of water in any form or temperature (hot, cold, steam, liquid, ice) for healing purposes. It may include immersion in a bath or body of water (such as the ocean or a pool), use of water jets, douches, application of wet towels to the skin, or water birth. These approaches have been used for the relief of various diseases and injuries, or for general well being. There is preliminary evidence that some hydrotherapy techniques may reduce skin bacteria. There may be benefits in people with skin wounds or ulcers who are at risk of infection. Evidence that infection of the skin itself (cellulitis) is improved is currently lacking. More research is needed in this area.
  • Avoid sudden or prolonged exposure to extreme temperatures in baths, wraps, saunas, or other forms of hydrotherapy, particularly with heart disease, lung disease, or if pregnant. Avoid with implanted medical devices, such as pacemakers, defibrillators, or liver infusion pumps. Vigorous use of water jets should be avoided with fractures, known blood clots, bleeding disorders, severe osteoporosis, open wounds, or during pregnancy. Use cautiously with Raynaud's disease, chilblains, acrocyanosis, erythrocyanosis, or impaired temperature sensitivity, such as neuropathy. Use cautiously if pregnant or breastfeeding. Hydrotherapy should not delay the time to diagnosis or treatment with more proven techniques or therapies, and it should not be used as the sole approach to illnesses. Patients with known illnesses should consult their physicians before starting hydrotherapy.
  • Lavender: Early laboratory studies suggest that lavender oils may have topical antibiotic activity. However, this has not been well tested in human studies.
  • Avoid if allergic or hypersensitive to lavender. Avoid with a history of seizures, bleeding disorders, eating disorders (such as anorexia or bulimia), or anemia (low levels of iron). Avoid if pregnant or breastfeeding.
  • Oregano: Early study shows that taking oregano by mouth may help treat parasites. Further research is needed to confirm these results.
  • Research suggests that oregano is well tolerated in recommended doses. Avoid if allergic or hypersensitive to oregano. Use caution if allergic or hypersensitive to other herbs from the Lamiaceae family including hyssop, basil, marjoram, mint, sage and lavender. Use caution with diabetes and bleeding disorders.Pregnant or breastfeeding women should not consume oregano at doses above those normally found in food.
  • Pomegranate: In clinical study, an extract of pomegranate was shown to be as effective as a commonly used oral gel when used topically to treat candidiasis associated with denture stomatitis (mouth sores). Additional study is needed to confirm pomegranate's antifungal effects.
  • Avoid if allergic or hypersensitive to pomegranate. Avoid with diarrhea or high or low blood pressure. Avoid taking pomegranate fruit husk with oil or fats to treat parasites. Pomegranate root/stem bark should only be used under the supervision of a qualified healthcare professional. Use cautiously with liver damage or liver disease. Pomegranate supplementation may be unsafe during pregnancy when taken by mouth. The bark, root, and fruit rind may cause menstruation or uterine contractions. Avoid if breastfeeding due to a lack of scientific data.
  • Prayer/distant healing: Prayer can be defined as a "reverent petition," the act of asking for something while aiming to connect with God or another object of worship. Prayer may help reduce the length of hospital stay as well as the duration of fever in patients with infections. However, early study is controversial and additional study is needed before a conclusion can be drawn.
  • Prayer is not recommended as the sole treatment approach for potentially serious medical conditions, and it should not delay the time it takes to consult with a healthcare professional or receive established therapies. Sometimes religious beliefs come into conflict with standard medical approaches and require an open dialog between patients and caregivers.
  • Probiotics: There is limited evidence that probiotic supplementation may reduce bacterial infections. Results are mixed regarding the ability of probiotics to reduce infective complications of medical treatment. Reduced incidence of infection has been seen in patients treated for brain injury, abdominal surgery and liver transplantation. Other studies have shown no such reduction in elective abdominal surgery and critical care patients. More studies are needed to determine the effectiveness of probiotics for these indications.
  • Probiotics are generally considered to be safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant. Caution is advised when using probiotics in neonates born prematurely or with immune deficiency.
  • Propolis: Propolis is a natural resin created by bees to make their hives. Propolis is made from the buds of conifer and poplar trees and combined with beeswax and other bee secretions. Animal and laboratory studies suggest that propolis may be a beneficial treatment for various types of bacterial, parasitic, and fungal infections. Initial human research reports possible benefits against oral/dental bacteria, genital herpes, urine bacteria, intestinal giardia infections or H. pylori.
  • Avoid if allergic or hypersensitive to propolis, black poplar (Populas nigra), poplar bud, bee stings, bee products, honey, or Balsam of Peru. Severe allergic reactions have been reported. There has been one report of kidney failure with the ingestion of propolis that improved upon discontinuing therapy and deteriorated with re-exposure. Avoid if pregnant or breastfeeding because of the high alcohol content in some products.
  • Seaweed, kelp, bladderwrack: Bladderwrack (Fucus vesiculosus) is a brown seaweed found along the northern coasts of the Atlantic and Pacific oceans and North and Baltic seas. Another seaweed that grows alongside bladderwrack is Ascophyllum nodosum, andit is often combined with bladderwrack in kelp preparations. Laboratory research suggests that bladderwrack may have antifungal and antibacterial activity. However, reliable human studies to support this use are currently lacking in the available literature.
  • Avoid if allergic or hypersensitive to Fucus vesiculosus or iodine. Avoid with a history of thyroid disease, bleeding, acne, kidney disease, blood clots, nerve disorders, high blood pressure, stroke, or diabetes. Avoid if pregnant or breastfeeding.
  • Selenium: Selenium is a mineral found in soil, water, and some foods. Preliminary research reports that selenium may be beneficial in the prevention of several types of infection, including recurrence of erysipelas (bacterial skin infection associated with lymphedema) or Mycoplasma pneumonia. Further research is needed to confirm the effects of selenium for infection prevention.
  • Avoid if allergic or hypersensitive to products containing selenium. Avoid with a history of non-melanoma skin cancer. Selenium is generally regarded as safe for pregnant or breastfeeding women. However, animal research reports that large doses of selenium may lead to birth defects.
  • Sorrel: There is currently not enough evidence on the proposed antiviral and antibacterial effects of sorrel. More research is needed.
  • Avoid large doses of sorrel because there have been reports of toxicity and death. This may be because of the oxalate found in sorrel. Many sorrel tinctures contain high levels of alcohol and should be avoided when driving or operating heavy machinery. These sorrel formulations may cause nausea or vomiting when taken with the prescription drugs metronidazole (Flagyl®) or disulfiram (Antabuse®). Avoid if pregnant or breastfeeding.
  • Tea tree oil: Tea tree oil is purported to have antiseptic properties, and has been used traditionally to prevent and treat infections. Laboratory studies report that tea tree oil has activity against methicillin-resistant Staphylococcus aureus (MRSA) colonization. It has been proposed that using tea tree oil ointment in the nose and a tea tree wash on the body may treat colonization by these bacteria. However, there is currently not enough information from human studies to make recommendations for or against this use of tea tree oil.
  • Tea tree oil may be toxic when taken by mouth and therefore, should not be swallowed. Avoid if allergic to tea tree oil or plants of the Myrtle (Myrtaceae) family, Balsam of Peru, or benzoin. Use cautiously with a history of eczema. Avoid if pregnant or breastfeeding.
  • Thyme: Thyme has been used medicinally for thousands of years. Beyond its common culinary application, it has been recommended for many indications based on proposed antimicrobial, antitussive, spasmolytic, and antioxidant activity. Thyme essential oil and thymol have been shown to have antifungal effects. However, there is currently insufficient reliable human evidence to recommend for or against the use of thyme or thymol as a treatment for fungal infections.
  • Avoid if allergic or hypersensitive to thyme, members of the Lamiaceae (mint) family, any component of thyme, or rosemary (Rosmarinus officinalis). Avoid oral ingestion or non-diluted topical application of thyme oil due to potential toxicity. Avoid topical preparations in areas of skin breakdown or injury or in atopic patients due to multiple reports of contact dermatitis. Use cautiously with gastrointestinal irritation or peptic ulcer disease due to anecdotal reports of gastrointestinal irritation. Use cautiously with thyroid disorders due to observed anti-thyrotropic effects in animal research of the related species Thymus serpyllum. Avoid if pregnant or breastfeeding.
  • Zinc: In limited available 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.
  • Zinc (zinc sulfate, zinc acetate, zinc glycine, zinc oxide, zinc chelate, and zinc gluconate) is generally considered safe when taken in the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. While zinc appears safe during pregnancy in amounts lower than the established upper intake level, caution should be used since studies cannot rule out the possibility of harm to the fetus.
  • Fair negative scientific evidence:
  • Macrobiotic diet: A macrobiotic diet has been advocated to preserve intestinal health. However, it apparently does not reduce the incidence of antibiotic resistant bacteria, nor infections caused by resistant strains in the gastrointestinal tract, compared to a diet with animal products.
  • Use cautiously with cancer or other medical conditions without expert planning or supplementation. Avoid in children or adolescents without professional guidance or appropriate supplementation. Avoid in pregnant or lactating women due to potential deficiencies, unless properly supplemented.
  • Probiotics: Bacterial infection translocation, the passage of bacteria from the gut to other areas of the body where they can cause disease, is of special concern in surgery. Limited evidence suggests that supplementation with probiotics may not reduce this problem.
  • Probiotics are generally considered to be safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant. Caution is advised when using probiotics in neonates born prematurely or with immune deficiency.
  • Traditional 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 abscesses, boils, bruises, sprains on unbroken skin, and for furunculosis. Highly diluted homeopathic preparations are considered safe and are widely used for the treatment of injuries and abscesses.
  • Avoid if allergic or hypersensitive to arnica or any member of the Asteraceae or Compositae families (sunflowers, marigolds or any related plants like daisies, ragweed or asters). Use cautiously with blood thinners, protein-bound drugs, cholesterol or heart medications, or diabetes drugs. Use cautiously with a history of stroke. Avoid contact with open wounds or near the eyes and mouth. Avoid if pregnant or breastfeeding.
  • Blessed thistle: 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.
  • Blessed thistle is generally considered to be safe when taken by mouth in recommended doses for short periods of time, with few reported side effects such as birth defects, bleeding, breathing problems, bruising, cancer of the nose or throat, increased production of stomach acid, itching, kidney disease, liver toxicity, skin rash, stomach discomfort, stomach ulcers, and vomiting. Allergic reactions to blessed thistle including rash may occur, as well as cross-sensitivity to mugwort and Echinacea. Cross-reactivity may also occur with bitter weed, blanket flower, Chrysanthemum, coltsfoot, daisy, dandelion, dwarf sunflower, goldenrod, marigold, prairie sage, ragweed or other plants in the Asteraceae/Compositae family. Avoid if pregnant or breastfeeding.
  • Echinacea: Echinacea (Echinacea angustifolia or E. purpurea) has been studied alone and in combination preparations for immune system stimulation. 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.
  • Avoid if allergic to echinacea, its constituents, or any members of the Asteraceae/Compositae family (ragweed, chrysanthemums, marigolds, daisies). Use cautiously in patients prone to atopic reactions and in those with hemochromatosis and diabetes. Some natural medicine experts discourage the use of echinacea by people with conditions affecting the immune system, such as HIV/AIDS, some types of cancer, multiple sclerosis, tuberculosis, and rheumatologic diseases (such as rheumatoid arthritis or lupus). Use parenteral preparations of echinacea(no longer approved for use in Germany) cautiously. Use tinctures cautiously with alcoholic patients or in patients taking disulfiram or metronidazole. Avoid in patients presenting for anesthesia. Use cautiously if pregnant or breastfeeding.
  • Fenugreek: Historically, fenugreek (Trigonella foenum-graecum) has been taken by mouth for the treatment of boils, furunculosis, and abscesses. Clinical research is needed before conclusions can be drawn regarding safety or effectiveness.
  • Use cautiously in patients with diabetes and in those taking blood sugar-lowering medications such as insulin. Avoid if allergic to fenugreek or chickpeas. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Use cautiously with asthma or a history of ulcers or stroke. Avoid if pregnant. Children should not take doses larger than what is commonly found in foods.
  • 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.
  • Use cautiously is used in patients with diabetes and in those taking blood sugar lowering medications such as insulin. Goldenseal and berberine both may also increase the incidence of bleeding in sensitive individuals, including those taking blood thinning drugs such as aspirin or warfarin (Coumadin®). Avoid if allergic or hypersensitive to goldenseal or any of its constituents, like berberine and hydrastine. Avoid if pregnant or breastfeeding.
  • Slippery elm: Slippery elm (Ulmus fulva) bark has historically been used by mouth for abscesses, boils, and carbuncles. Due to its high mucilage content, slippery elm bark may be effective in treating irritations of the skin and mucus membranes. However, scientific studies evaluating the use of slippery elm for these indications are currently lacking.
  • Avoid if allergic or hypersensitive to slippery elm. Avoid if pregnant or breastfeeding.
  • 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 may be toxic when taken by mouth and therefore, should not be swallowed. Avoid if allergic to tea tree oil or plants of the Myrtle (Myrtaceae) family, Balsam of Peru, or benzoin. Use cautiously with a history of eczema. Avoid if pregnant or breastfeeding.

Prevention
  • 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.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. American Academy of Dermatology. . Accessed May 1, 2009.
  2. American Academy of Family Physicians. . Accessed May 1, 2009.
  3. Bahrain M, Vasiliades M, Wolff M, et al. Five cases of bacterial endocarditis after furunculosis and the ongoing saga of community-acquired methicillin-resistant Staphylococcus aureus infections. Scand J Infect Dis. 2006;38(8):702-7. .
  4. Brown TJ, Rosen T, Orengo IF. Hidradenitis suppurativa. South Med J. 1998;91(12):1107-14. .
  5. Edlich RF, Winters KL, Britt LD, et al. Bacterial diseases of the skin. J Long Term Eff Med Implants. 2005;15(5):499-510. .
  6. Muller-Premru M, Strommenger B, Alikadic N, et al. New strains of community-acquired methicillin-resistant Staphylococcus aureus with Panton-Valentine leukocidin causing an outbreak of severe soft tissue infection in a football team. Eur J Clin Microbiol Infect Dis. 2005;24(12):848-50. .
  7. Natural Standard: The Authority on Integrative Medicine. . Copyright © 2009. Accessed May 1, 2009.
  8. United States Department of Health and Human Services. . Accessed May 1, 2009.
  9. Zetola N, Francis JS, Nuermberger EL, et al. Community-acquired meticillin-resistant Staphylococcus aureus: an emerging threat. Lancet Infect Dis. 2005;5(5):275-86. .

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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