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Boils — A Dermatologist’s Detective Story

man at dermatologist
By Debra Jaliman, MDJuly 13, 2011
From the WebMD Archives

Most people have had boils at one point or other in their lives. It’s an unsightly and painful condition, usually caused by a staphylococcus infection, but one that’s routinely treated with antibiotics. Occasionally the boil gets so big it forms an abscess that has to be drained, which is why people with boils should not wait to see a doctor. On the whole, though, dermatologists see boils all the time, and we don’t regard them as particularly difficult to treat.

M. was the exception (in medicine, there’s always an exception). She was an attractive woman, physically very fit, who was frustrated by a recurring case of boils on her buttocks and hip. She had already been treated by another doctor, who had prescribed the usual oral antibiotics that are the standard treatment. The boils had gone away for a short while, only to return with a vengeance. The boils weren’t just ugly, they really hurt, making sitting very uncomfortable for poor M.

When she came to my office, I decided to treat her with an oral antibiotic, an anti-bacterial cleanser once a day in the shower, and an antibiotic ointment in her nostrils in case she was a staph carrier. It seemed to work beautifully for a while, for the boils cleared up completely.

And then they came back in another location.

This time I sat down with M. and went through every detail of her life, trying to figure out the source of her infection. Midway through the conversation, I asked her how she kept so slim, and she replied, “Yoga, at least a couple of times a week, Pilates, cardio, you name it.” Did she shower at the gym after every class, I asked. Sometimes people pick up staph bacteria from gym equipment or yoga mats, and unless they shower immediately after the class, they risk infection. But M. took her own yoga mat to the gym and cleaned off the equipment with an anti-bacterial wipe. Did she wash her gym clothes every day? “Absolutely!”

And then it hit me. “Do you put your clean gym clothes into the same bag every time?” I asked. Yes, she did. I had her bring in the bag the very next day. We swabbed the inside all over and sent it off to the laboratory to be cultured. A week later (that’s how long a culture usually takes), we had our answer: M.’s gym bag was teeming with staph bacteria from her sweaty gym clothes, That’s why we were having such difficulty eradicating the boils; she was constantly getting re-infected.

M. threw away her gym bag, went on antibiotics again, and a few days later her boils were gone. They haven’t returned since.

The moral of this story is that bacteria can lurk in places you never expect, so if you have a recurrent skin infection, some detective work may be in order.

While we’re on the subject of skin infections linked to gyms, I have to point out that it is vital to shower immediately after exercising, because bacteria thrive in warm, moist environments. Wear loose gym clothes made from natural fibers, preferably 100% cotton. Tight Lycra shorts are not a good idea, especially for men who wear them to indoor cycling classes. I see plenty of male patients who developed staph or fungal infections (jock itch) as a result.

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