Boils: Never Squeeze & When to Go to Hospital

Key takeaways

A boil is a pocket of pus sitting under the skin. Squeezing or piercing it does not push the pus out — it forces the bacteria deeper. This is the most common thing people do and also the most harmful.
A boil on the face around the nose, on the upper lip or around the eye must never be squeezed: the blood vessels in that area drain into the skull.
A boil that has filled with pus needs a doctor to lance and drain it. That is a medical procedure, not something to do at home, and antibiotics are not a substitute for drainage.
Fever, red streaks spreading outwards, swelling that grows noticeably within a few hours, or a cluster of boils in someone with diabetes — be seen now, do not apply a compress and wait longer.

A red, swollen, painful lump on the skin that is tighter every day: the single most important thing is not to squeeze it and not to pierce it. A boil is a pocket of pus under the skin; squeezing does not push the pus out, it forces the bacteria deeper. A boil on the face around the nose, on the upper lip or around the eye must never be squeezed — the blood vessels in that area drain into the skull.

Recognising a boil

A boil starts in an infected hair root, usually caused by Staphylococcus aureus — a bacterium that already lives on the skin and in the nose of many people. It does not come up and settle like an ordinary spot; it grows, hurts more, then fills with pus.

A red lump, hot, painful to touch; firm for the first few days, then softening as pus collects.
A white or yellow head forms in the centre — the pus has gathered into a pocket.
A throbbing, tight pain; clearly worse if you lie on it or if clothing rubs it.
Common where skin is damp, rubs and has hair: neck, face, armpits, back, groin, buttocks, thighs.

A cluster of boils (a carbuncle)

Several boils side by side merging into one mass, with the pus connected under the skin and several heads. The mass is large and deep, usually on the back of the neck, the upper back, the shoulder or the thigh, and there is often fever and chills. This is not a type to watch at home: it needs a doctor to drain it.

What it is mistaken for

Mistaken for	The difference you can see
Folliculitis	Small pustules right at the mouth of the hair follicle, superficial, barely painful, gone within a few days. A boil is a deep lump, painful, growing, then filling with pus.
An abscess	A larger, deeper mass extending beyond the hair follicle area; in the armpit, groin or around the anus it is usually an abscess — which also has to be drained.
Rove beetle dermatitis (kiến ba khoang, common in Vietnam)	A long stinging streak following the direction a hand swept, with tiny blisters on a red background. A boil does not form a streak.

The features above help you describe it to a doctor, but they do not replace an examination.

What to do now

None of the following needs a prescription.

Warm compresses with a clean cloth, several times a day, about fifteen minutes each time: the pus gathers in one place and the pain eases. Do not make it hot enough to scald the skin.
Cover it with clean dry gauze; change it when it is wet or dirty, and wash your hands before and after touching it.
Draw a pen outline around the red edge of the swelling, photograph it and note the time. Compare the next day — the most objective way to know whether it is spreading or settling.
If the boil bursts on its own: let the pus drain out, wash gently with clean water and soap, and cover it again with clean gauze. Do not squeeze to push more pus out.
Wash separately any towels, clothes and pillowcases that have touched the pus; at home, do not share towels, razors or bath sponges.
Leave the area alone: loosen clothing, take off straps, do not sit on it or rub it.

What not to do

Do not squeeze it, do not press it, do not pierce it with a needle or a razor blade sterilised at home — not even once a white head has appeared.
Never squeeze a boil on the face around the nose, on the upper lip or around the eye. According to CDC, do not try to drain an infection yourself: doing so can make it worse and spread it.
Do not apply crushed leaves, medicated plasters, powders, toothpaste, warming balms or alcohol; and do not apply a corticosteroid cream left over from a previous episode — corticosteroids make an infection worse.
Do not take antibiotics left over from your own or someone else's course, and do not rely on surface ointments once the pus has gathered into a pocket: an ointment does not penetrate into a pocket of pus, and antibiotics used wrongly breed resistant bacteria.
Do not apply a compress and wait longer once there is a fever or red streaks spreading.

Once the pus has gathered, the way to deal with it is for a doctor to lance and drain it — a medical procedure that needs sterile conditions, pain relief and drainage of every pocket. Doctors commonly use antibiotics that cover staphylococcus, which may be clindamycin, doxycycline or co-trimoxazole; for pain, paracetamol (acetaminophen) is usual. The names are given so you recognise what you have been prescribed; which one and for how long is for the doctor or pharmacist to decide.

When you must go to hospital

Go to a medical facility NOW, do not wait overnight, if: the boil is on the face around the nose, on the upper lip or around the eye; there is fever or chills; there are red streaks running from the boil outwards; the swelling is visibly spreading within a few hours; the mass is large and very painful, or has become a cluster of boils; or the patient has diabetes, is having chemotherapy, takes medicines that suppress the immune system, or is on dialysis. Call 115 (the emergency number in Vietnam) if: the pain is severe and out of proportion to how the area looks, the skin turns dark purple or blisters, a boil on the face comes with a swollen eye, blurred vision, double vision or a severe headache, or the patient is drowsy, cold to the touch or breathing fast.

Be seen by a doctor within 24–72 hours, even with none of the above:

The boil has a pus head or has gone soft — it needs draining; it will not simply dissolve.
It is larger than a fingertip, no better after several days, or the pain is steadily increasing.
Boils keep coming back, or several come up at the same time — the cause needs investigating.
It is in the armpit, groin, buttock or around the anus, or anywhere that makes it hard for you to walk or sit.
The patient is a young child, an older person, pregnant, or has an underlying condition.

What can be done at home, and what needs a medical facility

A small, new boil that has not yet filled with pus can be watched at home, as long as you do not squeeze it and you watch for the right signs of spread. At home, Y Te Xanh (GreenCare) doctors and nurses can: photograph the lesion for assessment, clean and dress a boil that has burst as prescribed, change dressings over the following days, and watch for signs that the infection is spreading. But for any case that needs lancing and draining, for boils on the face, and for a swelling that may be an abscess, we will say plainly that a medical facility is needed.

According to CDC, most staphylococcal skin infections are dealt with by a doctor draining the pus, and not every case needs antibiotics; what you need to do is be seen when the infection grows, becomes very painful, is hot, or does not heal. Source: CDC. Citing CDC here does not imply that CDC endorses Y Te Xanh or our services.

Need personalised advice for your loved one? Call our hotline 094 368 81 15 (24/7) — calling to ask a question or to book costs nothing. GreenCare has doctors who come to examine, nurses who carry out doctor's orders (injections, infusions, dressing changes), remote consultation by video call, and a review of the medicines you are taking; an in-depth remote consultation, or any one after the first, is a paid service. For children we take examination and acute care only — not long-term care at home, and not newborns or expectant mothers. We confirm we have staff in your area and provide transparent pricing before we begin.

Sources

CDC — Staphylococcus aureus Basics
NHS — Boils

Frequently asked questions

How long does a boil take to clear?

A small boil usually tightens over a few days then fills with pus; once the pus has been drained the pain eases very quickly and the wound closes within one to two weeks. The milestone that matters is not how long but which direction it is going: if after several days it is still growing, still more painful, or already has a pus head that has not been dealt with, be seen rather than waiting for it to burst on its own.

The boil has a white head — will squeezing it out make it clear faster?

No, and this is exactly the moment when it is easiest to make things worse. The head is only the visible part; the real pocket of pus sits deeper and has several recesses. Squeezing bursts the pocket downwards under the skin, gives the bacteria a route into the bloodstream, and leaves a worse scar. Lancing and draining at a medical facility empties the pus completely, the pain eases immediately, and the wound heals more neatly.

Why is a boil on the face more dangerous than elsewhere?

Because of where the blood drains to. The area around the nose, the upper lip and the eye socket has veins connected to the venous sinuses inside the skull, so an infection forced inwards can travel that way. For that reason a boil in this area is not squeezed, not dealt with at home, and should be seen by a doctor early — particularly if it comes with a swollen eye, blurred vision, double vision or a severe headache.

I have diabetes — does a boil mean anything different for me?

Yes, and you need to be seen sooner than other people. High blood glucose lets an infection spread fast and heal slowly, which is why clusters of boils — a large mass with several pus heads on the back of the neck, the back or the shoulder — are more common in people with diabetes. Over these few days, monitor your blood glucose more closely and tell your doctor; do not wait to see whether the boil bursts on its own.

What if boils keep coming back?

Treating them one at a time will not stop it. Recurring boils need a doctor to look for the cause behind them: staphylococcus carried in the nose or on the skin, undiagnosed high blood glucose, a condition that weakens the immune system, or a source of spread within the household. While you wait for the appointment, what helps is not sharing towels and razors, washing towels and bedding hot, washing hands often, and noting down the site of each one so the doctor can see the pattern.

Can a boil spread to other people?

The boil itself does not spread like a cold, but the bacteria in the pus do spread through contact — through towels, razors, clothing and surfaces. So cover the boil with clean gauze, wash your hands after touching it, wash towels and pillowcases separately, and do not share personal items — particularly if there are young children, older people or anyone with an underlying condition in the house.