Question: My boyfriend gets boils a lot, but refuses to go to the hospital. He says that the medical staff would know he uses and would treat him differently. But even though they go away (like he insists they will!) he gets them A LOT and he is in so much pain! Is there anything I can do?

Answer by Tim C:

This is really a good question. First of all, let me explain what a boil is. A boil, also known as a skin abscess, is a localized infection deep in the skin. It usually starts out as a tender, reddened area that over time becomes firm, hard, and more painful. This is the body trying to "seal off" and prevent the spread of the infection. The body sends white blood cells through the blood stream to the abscess to fight off the infection. The center of the abscess then softens as it fills with pus. The pus is a byproduct of the white blood cells, bacteria, and certain proteins in the area. Finally, the pus forms a "head" which can spontaneously drain out through the surface of the skin. But sometimes the abscess needs to be surgically opened (lanced) so that it can drain.

Now that being said, there are many things that can cause an abscess. Anything from an insect bite to an ingrown hair can cause one. In short, any break in the skin has the potential to become infected and develop into an abscess so healthcare professionals really have no reason to jump to the conclusion that because you have an abscess you are an IV drug user. (Not that I am advocating lying to your doctor, but we will get to that in a moment when I cover "when you need to go to the doctor".

Treatment for the abscess

#1 Of course the best treatment is prevention. In general terms that means good hygiene. You would be surprised how often good old fashioned soap and water combined with plenty of friction (rubbing vigorously) prevents the spread of infection. Let me emphasize that slowly working up a lather with soap is not going to do the trick. It is the friction, with lubrication (soap) that will really kill the germs.

#2 Always use a clean needle. Clean the site well before injecting. A lot of harm reduction centers offer classes on how to inject as safely as possible, I suggest that you take one of these classes. Even if you know how to inject, a refresher course could not hurt and may help you get back the practice of safer injecting because some of us have gotten a little too casual about it.

#3 This is a good practice for many reasons. Try to find a source that you trust so that your speed's quality is consistent and has little or no cut in it.

For home treatment of abscesses first of all let me say that I am ONLY talking about abscesses that form on the limbs or trunk of the body.

Any abscess that you notice near the NECK, FACIAL AREA, or GROIN AREA- GO SEE A DOCTOR!!!!! This is because other more serious types of abscesses may be forming. But for abscesses on the arms, legs or trunk of the body try this treatment.

• Hot water soaks. The heat helps draw the infection to the surface of the skin, while the water softens the skin so when the abscess forms a head it can spontaneously drain out on its own. A tub of hot water (don't burn yourself!) mixed with Epsom salts is excellent. If you don't have Epsom salts plain hot water is fine. Try to do this 4 times a day for 15-30 minutes each time. If you can't soak, apply a clean wet hot cloth (again, don't burn yourself!) over the area. Wrap that in a towel or plastic bag to keep the heat in. Keep it on for about 15 minutes each time and do this every couple of hours.
• DO NOT SQUEEZE THE ABSCESS!!!! Allow the abscess to come to a head on it's own. Squeezing can release some of the infection back into your system and although it will seem like the abscess went away another one will form a little further away from the original a few days later.

If while doing these treatments the abscess becomes more painful, really red and hot to the touch, or you develop a fever of any kind THEN IT'S TIME TO SEE A DOCTOR! Unfortunately there are types of infection (I am not going to go into the technical terms here) that can only be treated with medications and sometimes have to be lanced. Go see a doctor or to a clinic where they can prescribe the kind of treatment for your infection. Now personally, I feel that you should be honest with your doctor as to how you got this abscess for the simple reason that there may be a bad batch of speed out there that is causing these infections. If the health care professionals notice a pattern they report this to public health which can issue public health notices (like they do with heroin) and that benefits everyone.