Definition & Overview

A skin abscess is described as a swollen area, usually warm to the touch, and painful. Also, the skin around it is red or pink in color. It is a mass of pus that forms due to an infection. It can appear on any part of the body but is more likely to form around the armpits, inner thigh, rectal and vaginal areas and the tailbone.

It is sometimes mistaken for a cyst since they’re both fluid-filled. Though it is made of pus, antibiotics normally can’t treat the symptom. The only way to treat an abscess is through incision and drainage.

Abscesses form due to the obstruction of oil or sweat glands, hair follicles inflammation, or minor punctures of the skin. Germs or bacteria end up getting into the skin or these glands and end up causing inflammation as the white blood cells surge to fight the infection. The abscess thus contains dead cells, bacteria and destroyed tissue and they grow causing pressure and pain around the area.

Initially, the abscess may appear to be hard as it forms. The incision and drainage method is not possible at this time. Antibiotics also won’t be effective since they won’t be able to penetrate the wall of the abscess. Once the abscess “comes to a head” or when it becomes softer and fluid, the incision and drainage method may be performed.

Who Should Undergo and Expected Results

An abscess is a tender mass that needs to be treated in the right environment. A visit to the doctor becomes necessary when the following symptoms show up:

  • You have a sore that is bigger than 1 cm or a half-inch in diameter
  • The sore continues to grow and becomes more painful
  • The sore is located near your rectal or groin area
  • You have a fever of 101.5F or higher especially if your immune system is compromised
  • You have a red streak leading away from the abscess
    Once the abscess has been drained and treated, the pain will likely to subside and the healing of the wound will commence shortly. Antibiotics should clear up any remaining infection and prevent a new one from settling in.

How Does the Procedure Work?

An abscess is often easily diagnosed when it is located in an obvious area but may need an imaging system to confirm the extent of damage especially if the abscess is large and deep. Once the doctor has assessed the situation, he may proceed with the incision and drainage by following these steps:

  • The procedure starts with the application of an antiseptic solution over the area to be incised and drained.

  • If the abscess is relatively small, a local anesthetic is applied to numb the area. However, if the abscess is large, a sedative may be prescribed to the patient.

  • When the patient is sedated, the doctor will cut open the abscess with a scalpel and drain all the pus and debris from it. In cases where there are multiple pockets of pus, each of them will be drained one at a time.

  • Once the draining of the pus is completed, the doctor may insert packing into the open cavity to minimize bleeding. The pus may continue to drain into this packing which is why the wound is to remain open for the next couple of days.

  • A bandage will cover the packing and the open wound. The patient will continue to take care of the open wound at home.

  • Pain medication may be prescribed as well as antibiotics to treat existing infection and prevent any infection from recurring.
    Though the procedure technically ends when the doctor has successfully drained the abscess, it is up to the patient to continue monitoring the open wound. If the wound continues to drain pus, the packing has to be removed and re-applied. The patient can either go back to the doctor or do it himself by following the doctor’s instructions. If the open cavity has totally emptied and no pus is leaking from it, the packing may be removed and the patient has to clean the area about 3-4 times a day, from 7 to 10 days, to allow the wound to heal properly.

If the patient experiences a fever after the procedure or there is redness and pain in the area, a follow-up visit to the doctor may be necessary.

Possible Complications and Risks

An abscess can become a serious condition if not treated immediately. If the abscess is small, like 1 cm or less, applying warm compress on it may help with the pain. However, never attempt to drain the abscess by yourself for you may push the abscess deeper into the tissues and you will end up worsening the situation. Do not attempt to pierce the abscess with a needle or anything sharp to drain it either because you may pierce a blood vessel or create further infection.

The incision and drainage method is rather a simple process especially if it involves relatively small abscesses. Complications may arise when the abscess is not totally drained as it can cause further and prolonged infection.

There is also a danger of infection if the patient makes a mistake with packing the open wound at home. Although instructions may have been left as to how to deal with draining the pus and putting in a new packing, someone who is not skilled may make the wrong move and end up worsening the condition.
The procedure may also result in the spraying of the pus on the doctor or nearby areas. Care, such as wearing masks and eye protection, should be taken to avoid this. Protective gauze should also cover the areas where the drainage can seep into, like the skin.

Scarring from the incision is relatively small and usually disappears over time. With large abscesses that tend to be deeper, scars may be more noticeable.

References:

  • Daum RS. Staphylococcus aureus. In: Long SS, ed. Principles and Practice of Pediatric Infectious Diseases. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 115.

  • Pasternack MS, Swartz MN. Cellulitis, necrotizing fasciitis, and subcutaneous tissue infections. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2009:chap 90.

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