Home Forums Hunting & Shooting Hunter's Campfire boils

Yep. I had the same problem in 2008 and it ended up being MRSA. Painful nasty crap. The cure was damn near as bad as the cause.

(thanks for the spelling correction, Dr. Howell!)

Shoulda bit my tongue.

Got into the office this am and our Xray tech walked in with a horrible chalazion, pain beyond toleration, begging me to do incision & drainage. He's on call for the week so he can't leave town, so referral to ophthalmology was out of the question.

So I took him across the street to the ER and I opened it for him. Tricky business, but we got 'er done. No fun for him, I must say!

Wonderin' 'bout a coupla things here �

� Dad maintained that keeping loose eyelashes plucked precluded sties. He and I have always plucked 'em regularly, and have never had a sty. Folklore? Coincidence? Good practice?

� My limited experience with boils is over seventy years past. IIRC, suddenly released internal pressure, for all its drama and relief, doesn't empty the pit, which can't be cleaned while gunk remains. Does a breast pump have enough pull to be of any help?

Doc Rocket, that sounds like an internal hordeolum to me. Chalazion is the fibrotic scar tissue of the meibomian gland that remains after the acute infection (hordeolum). Usually staph a.

Right you are, eyeball.

As I stated earlier, I used to have the difference clearly catalogued in my head in medical school. Now I just call 'em "styes", and send 'em on.

Except in this case I couldn't. Fortunately, my clumsy surgical skills "took". Thanks to the I&D and some hi-dose cephalexin, Kevin is looking and feeling great today.

Doc, are most of the things we, the uneducated, refer to as "boils" really infected sebaceous cysts?

Ed

Dunno, really. If your family is prone to styes, then maybe plucking eyelashes makes a difference. But most folks don't need to do such things. If keeping the meibothian ducts clear was all that difficult, one would assume that women who use mascara would have styes all the time, which they don't...

So there you go, a firm "maybe"!



Pumping the purulent material out really isn't going to take care of the problem. The bacteria that remain in the abscess space will be cleaned up by the immune system provided the abscess doesn't close up again, so what you actually have to do is pack the abscess to allow it to shrink to modest size before you let it heal over.

My rule of thumb is, quite literally, a rule of thumb: i.e., if after incision and drainage I can feel a space under the skin as big as the ball of my thumb or bigger, I pack it with iodophor gauze. The packing may need to be drawn and repacked several times, in instances of large abscesses.

When one of my daughters was about 9 months old it was discovered that she had some sort of cyst/boil at the corner of her eye. A specialist performed surgery to remove & then a plastic surgeon did some sort of procedure to lessen the scar. After a couple of years you couldn't see the scar. We were very concerned at the time. Saw lots of boils & jungle fungus when serving in Vietnam. I had some sort of jungle fungus on my right ankle & later a small one on my lip. Had to have the one on my lip removed with surgery. Never knew what the hell they really were. I have read where a lot of cowboys used to have them on their butts & crotch. Probably from ridding, improper hygiene, & associating with assorted critters (including shady women). Ouch!

I've heard that Marx was such a bastard because he had boils on his azz and couldn't sit down.

Thats good to hear. Typically the lid is inverted and incision made from the back side to reduce the risk of sec. infection and lid scarring. Usually in the acute stage hot compresses are used. If the entire lid becomes involved it is dxed as preceptal cellulitis and txed with keflex and hot compresses. If it involes both lids then it is considered to involve orbital structures and close to the optic nerve and brain and is dxed as orbital cellulitis and sent to you for iv antibiotics. After the acute phase of hordeolum the non infective chalazion bump should be treated with warm comps and digital massage to possibly reduce the size of the mass. If the mass remains large it would be excised for cosmetics or to prevent subsequent deformation og the globe with resultant abnormal refractive error. thanks

No. What is commonly called a "boil" is medically termed a furuncle, or less often a carbuncle. A furuncle is a type of abscess. Abscesses are walled-off collections of pus (bacteria, bacterial byproducts, and leukocytes) that can occur anywhere in the body, but when they occur in/under the skin they're called furuncles. It is primarily an infectious process, the offending bacterium usuallly being a persistent strain of Staphylococcus aureus, or less commonly E. coli, Pseudomonas sp., Streptococcus faecalis, or sometimes an anaerobic bacterium such as Bacteroides sp. or Lactobacillus sp. The furuncle starts as a localized infection such as an infected hair follicle. The bacterial infection follows tissue planes, so the shape of the infection is irregular and can travel deep into the subcutaneous tissues. The key thing to remember is that a furuncle is an infectious process from start to finish.

An epidermal cyst or sebaceous cyst can be thought of as a giant out-of-control blackhead, which for the majority of its clinical life is noninfectious. The cyst is usually spherical, and is lined with stratified squamous epithelium which secretes keratin and the oils normally found in sebum (natural skin oil/lubricant). A large amount of sebum may be produced (see the youtube video posted earlier for an example of this!), and over time the cyst may become quite large. Eventually the cyst will become infected, at which point it may point and drain on its own, or it may need to be incised.

If you incise & drain (I&D) a furuncle, and pack it if necessary, it usually heals closed, leaving no potential space that can be reinfected in the future. A drained epidermal cyst, however, remains the size it grew to on its last "growth spurt", and usually re-fills with sebum over time. This is why I like to excise sebaceous and other epidermal cysts, not just I&D 'em.

yep,
cupping works wonders on 'em

I had a mill helper years ago, and exAmish kid
He would get huge ones all over his back and shoulders.
He would be weraing a tee shirt while working at the hot rolling mill( up to 4000deg C furnaced )

At times he would stoop and bend to pick up something heavy and they would explode under his shirt.

Some gross smellin crap!

Right! However, given the circumstances here out in the sticks, my anesthesia options were limited, so inversion with a globe-side incision was out of the question. I used ethylene chloride (VERY carefully!!!! ) for cutaneous anesthesia, then a bit of 2% lidocaine with a 30-ga needle. Then I opened it as close to the eyelash line as I could get with a #11 blade and teased the deeper tissues with a very fine mosquito forceps. Bleeding was brisk, as I'm sure you can imagine. Pain relief was almost instantaneous.

I would not have attempted this if the guy hadn't been using warm compresses and antibiotics for 3 weeks already when the current flare occurred. (And also, as stated earlier, couldn't leave town because he's the ONLY xray/CT tech here for the next week!) Under such circumstances, and after phone consultation with an ophthalmologist colleague in Angelo, I concluded that he faced significant risk of greater morbidity if I didn't cut.

Fortunately the patient in question has never seen me gut a deer or antelope (ask eh76 or other Antelope Armageddon veterans... sigh), or I'm sure he would've found a local midwife to do the surgery!

I would have been begging for the same. i just thought i would go over the considerations as chalazions are often not removed when they should be and vice versa. I just had a pt. sent in by the pharmacy she works at after a dr rxed augmentin for a mild case of viral conjunctivitis. Also, many people don't worry about a stye until they need to go to the ER, when hot compresses can often prevent a serious condition.

10-4

Haven't had a boil in seventy-three years.

Now I'm sure to get one from this thread � like my father-in-law when he was reading-up on tropical medicine during weeks of waiting for his travel papers to Cameroon. (He came down with whatever he happened to be reading about right then.)

As physician-surgeon in China, 1921�1949, he'd pioneered many of the treatments that that huge textbook described in detail. Meeting "old friends" didn't convey any psychosomatic prophylaxis in 1964!

Thanks, Doc!

My task here is done. I have learned something today, so I guess I shoud go get some work done.

Ed

When I worked in a feedlot, abcesses, or boils were one of the most common things we treated in the cattle. Most were probably smaller than a softball, but I saw a few that looked like the bovine had a beach ball under their skin.

We'd get them in the chute and lance them with a clean knife. By the way they acted it had to be very painful. What comes out will test your ability to hold your lunch. Then we'd flush it with an idodine mixture and load them up with antibiotics. We did quite a few of them but they always seemed to be pretty easy to clear up.