Why do docs want to let boils & abcesses get totally ripe instead of lancing them immediately?

I seen more than one poster on the dope be told by their doctor to let a painful, infected boil get a large as possible before lancing it. They also say to put hot compresses on it to make the pus drain out.

Why must people suffer like this? Why not pop it or drain it ASAP? If there is pimple or similar I can get to I’m attacking it immediately and clearing it out.

They want boils and abscesses to ripen before draining in order to mitigate the risk of infection during treatment. An abscess, for example, can form relatively deep under the skin. If you lance something that’s deep you can infect the blood or what was healthy tissue surrounding the area. Sometimes when you’re attempting to lance an abscess you can actually miss it. Better, when possible, to wait until it’s ready to be lanced.

It needs to “point” first, and that way, you know it’s coalesced and can easily tell where it is. In addition, some larger abscesses (carbuncles) can have multiple chambers, and those all need to be located and emptied too.

Homer: It was a gummy bear.

I’ve opened several hundred abscesses over the last 10 years; the only reason I wouldn’t drain one when I first saw it is if I wasn’t convinced there was a pus collection. No sense sticking a knife into skin without getting into a pus pocket. There is no concern for spreading the infection in the way Odesio describes. The definitive treatment for abscess is drainage. I use ultrasound sometimes to determine if there is a fluid collection or not.

USCDiver, MD

It makes for a much better youtube experience if you wait until it has maximum possible pusage.

Before an abscess has a collection of inflammatory debris to drain, it is a solid mass.

The transition is from cellulitis (infected, inflamed soft tissue) to an actual collection of pus cells in a pocket–an abscess.

As USCDiver notes, you have to have “pus” before you can drain it.

If you incise an absess too early, all you do is end up making a hole in solid, inflamed tissue and nothing is accomplished.

We do not want an abscess to “get as big as possible.” However waiting when all that is present is inflamed soft tissue will determine if an abscess is going to form at all, and will sometimes localize more clearly where the best incision point is to drain it. Also, as an abscess forms it’s not uncommon for the surrounding tissue to get less inflamed so that you end up with one specific area inside of which is the abscess, instead of a diffusely reddened larger area with no localization.

The heat also helps your body in the healing process – many infection germs can only survive in very narrow temperature ranges, and heat alone will kill some of them. (That’s one reason your body often reacts to infections by becoming feverish.)

The most common bacteria that cause boils and abscesses are staphand strep, which survive up to 113F (45C) and 116F (47C) quite happily. The heat your body produces or that you can tolerate by warm compress can’t kill them. But the warm compresses help to dilate the capillaries around the area, which signals the body to kick up the inflammatory response a notch, which brings all sorts of extra white blood cells and other immune stuff to try to beat this thing. This speeds up the production of that long sought after puss and the satisfaction of the splortch.

Splortch (French youtube video SFW).

It isn’t so much that fever range temp kill the germs as it is that your immune system seems to be more efficienct at killing germs at elevated temperature ranges. This is why I usually recommend to my patients that they don’t treat their fever unless it is making them feel miserable. Especially in kids who may be running a fever but otherwise are acting normally.