Rx for Readers: Boils

Treatment for recurrent boils is relatively simple and involves oral as well as topical antibiotic therapy.

By JUDY SIEGEL-ITZKOVICH
I am a 57-year-old woman who has a problem with large painful boils on my skin in the groin area where my upper legs meet my body trunk. The boils break out on both sides. I have been treated with tetracycline 250 mg., three times a day; it seemed to help briefly but then the boils returned. I've also tried Gentatrim cream, which was of no help at all. Now I have a large boil on my chest. What can I do? - S.G., Netanya. Jerusalem dermatologist Dr. Julian Schamroth replies: Recurrent boils (the medical term for them is furunculosis) is a common condition caused by staphylococcus bacteria. About 30 percent to 50% of healthy adults harbor these bacteria, often in the groin or in the nose, and it is these "carriers" who are more likely to develop staph infections. Furuncles occur most often in the groin or on the buttocks, but can occur anywhere on the body. They are more frequent in diabetics and obese individuals. Treatment is relatively simple and involves oral as well as topical antibiotic therapy. Occasionally, the furuncles require lancing and drainage. What is more difficult, however, is the prevention of relapses. Attempts at eliminating the "carrier" status are not very effective - and even when successful, recolonization by the bacteria is common. Prevention of recurrences might require prophylactic topical and oral therapy for several months. Another condition that looks very much like furunculosis is hidradenitis suppurativa. This chronic, relapsing condition also tends to occur in the groin, but can also affect the armpits, the lower abdomen and the area beneath the breasts. Like furunculosis, the staphylococcus organism is frequently found in these lesions. Treatment of this condition ranges from intra-lesional cortisone injections, to oral antibiotic or hormonal therapy, to surgery. Ask your dermatologist whether the diagnosis of hidradenitis suppurativa has been considered and excluded. You should have a bacterial culture taken from the furuncle, as well as from the nose and normal skin in the groin to see whether you are a staph carrier. You should also request a long-term course (up to six months) of continual oral tetracycline therapy. I and members of my family often get flu-like symptoms, for which we don't usually go to our doctor. What are the symptoms of colds versus the flu? - I.J., Jerusalem Dr. David A. Lipschitz, a leading geriatrician at the University of Arkansas, author and columnist on health matters, answers: Despite vaccinations, influenza remains a serious health hazard. Flu brings several cardinal symptoms: sudden onset of high fever, generalized aches and pains, severe headache, a mild sore throat, stuffy nose and a persistent and troublesome cough. Flu is highly infectious and readily spreads from one person to another, whether by direct contact or through the air when an infected individual coughs or sneezes without covering his nose and mouth. Patients with influenza should not to go to work or school; they should wash hands regularly with soap and water or frequently use a gel antiseptic. When sneezing or coughing, always turn away and cover your mouth and nose. Flu is different from a viral sore throat or cold, which usually starts more gradually with a cough, sore throat and nasal stuffiness. In addition, there is generally the absence of fever, headaches or generalized aches and pains. Diagnosing the flu is easy for a doctor using a nasal swab for the flu virus. If you think you have the flu, get checked immediately. Starting antiviral therapy with Tamiflu or Relenza within 24 hours of diagnosis can markedly reduce the severity and length of the illness. Unfortunately, most patients who become ill call their physicians, who inappropriately prescribe an antibiotic. The vast majority of fevers, coughs, sore throats and sinus congestion are caused by viruses; therefore, antibiotic use, apart from being unnecessary, can lead to resistant bacteria and serious problems at a later date. Flu is not just a nuisance. It can sometimes bring about serious complications, especially in the young and the elderly, who may become dehydrated and confused and are prone to inhaling mucus into their lungs, which can lead to bacterial pneumonia. Far more dangerous are viral complications, which include encephalitis, myocarditis (damage to the heart muscle, which can lead to heart failure) and acute respiratory distress syndrome (which is associated with potentially fatal damage to the lungs). In many children and some adults, an ear infection can occur in patients who develop the flu. Rx for Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting. Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 91000, fax your question to Judy Siegel-Itzkovich at (02) 538-9527, or e-mail it to jsiegel@jpost.com, giving your initials, age and residence.