Persistent Folliculitis and Boils: Causes and Treatment Options

Recurrent folliculitis and furuncles?

Hello Dr.
Huang: I am not sure why I have been suffering from folliculitis on my buttocks.
Could it be because I haven't been consistently using medication to completely eradicate it? I spend almost 24 hours a day in an air-conditioned room, avoid prolonged sitting or standing, wear only cotton clothing, refrain from spicy or irritating foods, and do not stay up late, yet the folliculitis persists stubbornly.
Should I consult other specialties, such as endocrinology or immunology? Or is it simply a matter of certain individuals having a predisposition? Additionally, I have developed a boil (which I have already seen a doctor for) that is red, swollen, hot, and about the size of a ten-dollar coin.
It is extremely painful to touch, and it feels hard upon light contact.
Can I treat it with 2% fusidic acid cream (Fucidin cream)? Will the body absorb the impurities inside the boil on its own? Is it true that regardless of the type of acne, folliculitis, or boil, one should never squeeze them? If I have inflamed folliculitis or a boil, will it heal on its own if I do not squeeze or apply medication?

He shi cai you xue bai de pigu?, 20~29 year old female. Ask Date: 2007/06/29

Dr. Huang Ruiyun reply Dermatology

Except for a few exceptions due to special physical conditions or genetic factors, most young individuals who repeatedly suffer from furuncles are otherwise healthy.
Fortunately, these cases often improve on their own within a few years, but the episodes can cause significant distress to the patients.
An important aspect of treating furuncles is incision and drainage, which means that if the furuncle has "matured," the pus needs to be expelled.
Doctors advise against squeezing with hands because some patients may 1.
attempt to squeeze the furuncle before it has matured, worsening the condition, and 2.
use non-sterile tools, complicating the infection further.
However, if a furuncle spontaneously ruptures and drains pus, it can be managed at home: using clean hands (sterile surgical gloves are preferable), take sterile gauze to clean the pus, apply Fulosin cream, and cover it with clean gauze.
Of course, it is better to have the furuncle treated at a hospital, ideally with a bacterial culture performed.
For a furuncle the size of a ten-dollar coin, topical medications may not penetrate adequately, so it is advisable to seek medical attention for oral antibiotics.
If the furuncle is hard and cannot be drained, it should be allowed to soften (mature) before drainage is performed.
Oral antibiotics should be taken continuously for at least one week.
In daily care, in addition to maintaining the cleanliness of personal clothing, towels should be frequently washed, and oxygen bleach can be added during washing, followed by drying in a dryer or sunlight.
Avoid using bath sponges or washcloths, as they can harbor dirt and bacteria.
Apply Fulosin cream inside the nostrils twice daily for a week, as Staphylococcus aureus tends to reside in the nasal passages.

Reply Date: 2007/06/29

More Info

Persistent folliculitis and boils can be quite frustrating and uncomfortable conditions. They often arise from a variety of factors, including bacterial infections, skin irritation, and even underlying health issues. In your case, it seems that despite taking precautions and maintaining good hygiene, you are still experiencing recurrent folliculitis in the buttock area.
Folliculitis is an inflammation of the hair follicles, often caused by bacteria such as Staphylococcus aureus. It can manifest as red, swollen bumps that may be itchy or painful. Boils, or furuncles, are deeper infections of the hair follicle and can be more severe, presenting as larger, painful lumps filled with pus. The fact that you are experiencing these conditions persistently suggests that there may be an underlying issue that needs to be addressed.

Your lifestyle choices, such as avoiding spicy foods, not sitting or standing for prolonged periods, and wearing breathable cotton clothing, are all positive steps towards managing skin health. However, if the folliculitis persists, it may be worth considering other factors. For instance, hormonal imbalances, immune system deficiencies, or even certain medications can contribute to skin issues. Consulting with an endocrinologist or an immunologist could provide insights into whether there are underlying hormonal or immune-related causes for your recurrent skin infections.

Regarding the treatment of boils, topical antibiotics like 2% fusidic acid cream (Fulosin) can be effective in treating localized infections. However, if the boil is large, painful, and hard to the touch, it may require drainage by a healthcare professional. The body can sometimes absorb the pus from a boil, but this process can take time and may not always be effective. Therefore, if the boil does not improve or worsens, it is advisable to seek medical attention.

As for the question of whether you should avoid squeezing or picking at boils or folliculitis, the answer is a resounding yes. Manipulating these lesions can introduce more bacteria into the area, potentially worsening the infection and leading to complications such as cellulitis or abscess formation. In general, it is best to leave them alone and allow your body to heal naturally. If you notice signs of worsening infection, such as increased redness, swelling, or fever, you should seek medical attention promptly.

In summary, persistent folliculitis and boils can be indicative of underlying issues that may require further investigation. While topical treatments can help, it is essential to avoid squeezing or manipulating the lesions. If the condition persists, consider consulting with a specialist to explore potential hormonal or immune-related causes. Additionally, if you experience severe or worsening symptoms, do not hesitate to seek medical care for appropriate management.

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