Skin Abscess: Definition, Causes, Signs, Symptoms, Diagnosis, Treatment and Prevention

It is usually painful and appears as an inflamed area that is warm to the touch.

It is a localized collection of pus that usually develops in response to infection or the presence of other foreign materials under the skin. The skin surrounding an abscess often appears pink or red.

These bumps usually appear anywhere on the body; generally superficially. Skin abscesses are also known as boils, especially when they affect the deeper or subcutaneous layers of the skin.

Common sites affected by abscesses include the armpits (axillary area) and inner thigh (groin), called hidradenitis suppurativa , also known as acne inverse (AI).

Other types of abscess include the rectal area (perirectal abscess), the external vaginal area (Bartholin’s abscess), and along the tailbone (pilonidal abscess).

Abscesses can affect any organ, including the brain , kidneys, liver (liver abscess), stomach or intra-abdominal area, lungs, breast, neck, face, cheeks, multiple teeth or a single tooth (dental abscess), gums, throat or tonsils (peritonsillar abscess).

Abscesses can also occur anywhere on the body, such as the fingers and toes, eyes, shoulders, knees, or one foot / both feet.

An abscess is not the same as a cyst. Both are fluid-filled lumps, but an abscess becomes infected while a cyst is not. However, a cyst can become infected and turn into an abscess.

To cure skin abscesses, it is necessary to drain them to accelerate the improvement, since generally antibiotics as the only form of treatment do not cure abscesses.

Although an abscess sometimes opens and drains spontaneously, it often needs to be released by a healthcare professional (incision and drainage). Certain abscesses may require a surgical drainage procedure in an operating room.

What Causes an Abscess?

A painful abscess is usually due to an acute bacterial infection. An abscess can also develop around a foreign body, such as a splinter.

The most common causes of infectious abscesses are:

  • Staphylococcus aureus: the usual cause of boils (boils and carbuncles, the most common form of skin abscess), wound infection, or infected eczema.
  • Methicillin-resistant Staphylococcus aureus: which can cause recurrent abscesses.
  • Streptococcus pyogenes: the usual cause of cellulitis and erysipelas.
  • Mycobacterium tuberculosis (TB) and atypical mycobacterial infection.
  • Anaerobes, gram-negative organisms, rare bacterial infections and mixed infections.
  • Yeast infection, a kerion.
  • Serious viral infection: for example, herpes simplex.
  • Parasitic infestations or infections.

Infectious abscesses can affect healthy people, but are more common in the following circumstances:

  • Metabolic syndrome and obesity .
  • Smokers
  • Diabetes.
  • Immune compromise.
  • Intravenous drug users.

A sterile abscess can persist after an infection has cleared, as it contains dead or necrotic tissue and inflammatory cells.

A sterile abscess can occur after corticosteroid injection. This is more likely when the drug has spilled into subcutaneous fat.

A foreign body reaction or other hypersensitivity reaction to the injected material, such as bovine collagen, can also lead to abscess formation.

Certain inflammatory skin diseases can cause tissue destruction and abscess formation, in the absence of pathogens (infectious microbes).

These include:

  • Hidradenitis supurativa.
  • Acne conglobata and acne fulminans.
  • Skin illness.
  • Panniculitis (inflamed subcutaneous fat).

If the cause of an abscess is unknown, the following tests may be done:

  • Microscopy and Gram stain.
  • Bacterial culture (standard, anaerobic and at low temperature).
  • Adjacent tissue biopsy.

If a patient has had recurrent abscesses, consider nutritional deficiency, especially iron, immune deficiency, immune suppression from medications such as systemic steroids, diabetes, or poor circulation.

A major risk factor for developing skin abscesses includes a weakened immune system (either from chronic diseases or from medications), because the body’s ability to fight infection is diminished.

The following conditions are risk factors for developing abscesses and for getting recurrent or multiple abscesses:

  • Chronic steroid therapy.
  • Chemotherapy.
  • Diabetes.
  • Cancer.
  • Lupus.
  • Dialysis for kidney failure.
  • VIH / PAGE.
  • Crohn’s disease .
  • Ulcerative Colitis .
  • Severe burns
  • Severe trauma.
  • Intravenous (IV) drug use.
  • Injections into the skin from medical procedures, prescription drugs, or tattoos.
  • Alcoholism .

What are the symptoms and signs of skin abscess?

Symptoms of a skin abscess vary depending on the location of the abscess, but generally, people will experience the following:

Red painful mass, warm to the touch and tender.

As an abscess progresses, it can “signal” and reach a critical point. Pustular drainage and spontaneous rupture may occur.

Most abscesses will continue to get worse without proper care, incision, and drainage. The infection can potentially spread to deeper tissues and even the bloodstream.

If the infection spreads, you can develop:

  • Fever.
  • Sickness.
  • Vomiting
  • Increased pain
  • Increased redness of the skin.

When should someone seek medical attention for a skin abscess?

A skin abscess sometimes ruptures and drains spontaneously at home without further complications. A ruptured abscess can be good because pus is released and the body has a better chance of healing on its own.

However, in some cases, further evaluation by a physician is necessary to prevent progression and complications associated with ongoing infection.

Consult a doctor if any of the following scenarios occur with an abscess:

  • The sore is more than 1 cm or ½ inch wide.
  • The sore does not heal or continues to enlarge and becomes more painful.
  • The person has an underlying disease such as: HIV / AIDS, or cancer.
  • Diabetes, sickle cell disease, or peripheral vascular disease.
  • The person is an IV drug addict.
  • The person is on steroid therapy, chemotherapy, other drugs that suppress the immune system, or dialysis.
  • The sore is at the top of the crease of the buttock, or is in or near the rectal or groin area.
  • The person has a fever of 100.4 F (38 C) or higher.
  • There is a concern that foreign material is inside a wound or under the skin.
  • The person is pregnant.
  • The abscess gets better, but then it comes back.

Go to a hospital emergency room if you have any of these conditions with an abscess:

  • Fever of 102 F (38.9 C) or higher, or vomiting, especially if the person has a chronic illness or takes steroids. , chemotherapy or other immunosuppressive drugs, or dialysis.
  • There is a red streak on the skin originating from the abscess.
  • Any facial abscess greater than 1 cm or ½ inch wide.

What specialists treat skin abscesses?

A primary care provider (PCP) can treat a skin abscess, such as a general practitioner, family medicine specialist, internist, or pediatrician.

One can also be seen by an emergency medicine specialist in a hospital emergency department.

If surgery is required, a general surgeon can treat an abscess. A dermatologist, who specializes in skin disorders, can also treat a skin abscess.

How does a doctor diagnose a skin abscess?

Depending on the location and extent of the abscess, the doctor may obtain wound cultures or blood tests and imaging studies, although these tests are often not necessary.

What are the medical treatments for skin abscesses?

Often times, a skin abscess does not heal on its own without the intervention of a healthcare provider. Initially, an abscess may feel firm and hardened (hardened), at which point incision and drainage may not be possible.

However, once the abscess begins to “get to the head” and becomes softer and fluid-filled, minor surgery to cast it to evacuate the pus and relieve pressure is the best course of action.

A doctor will open and drain the abscess (incision and drainage) using the following technique:

The area around the abscess will be numbed with local anesthesia.

It is often difficult to fully numb the area, but in general, local anesthesia can make the procedure almost painless.

A sedative may be given if the abscess is large.

The affected area will be covered with an antiseptic solution and sterile towels will be placed around it.

The doctor will cut the abscess with a scalpel and drain as much pus and debris as possible. Sometimes there will be multiple pockets of pus that need to be identified and drained.

After the sore has drained, the doctor may insert the gasket into the remaining cavity to minimize bleeding and keep the wound open for a day or two so the remaining pus can continue to drain.

A bandage will then be placed over the packaging and the patient will be given instructions for home care.

Most people feel better immediately after the abscess is drained.

A doctor may prescribe pain medication, depending on the location, size, and extent of the abscess.

Antibiotics are generally not necessary; however, they may be prescribed if the abscess is associated with an infection of the surrounding skin.

Antibiotics such as trimethoprim / sulfamethoxazole (Bactrim), cephalexin (Keflex), or azithromycin (Zithromax Z-pak) may also be prescribed, depending on the location of an abscess and whether or not the individual has a compromised immune system.

Follow-up for skin abscesses

Carefully follow all wound care instructions recommended by a healthcare provider.

A healthcare provider may ask the patient or caregiver to remove the packaging. If so, removal works best while the area is moistened with water.

After removing the packing, soak or rinse the area for 10-20 minutes, three to four times a day to allow the wound to heal properly.

Keep all follow-up appointments, as a healthcare provider may want one to come back for a wound check-up. Sometimes the wound may require re-packing if it continues to drain pus.

Report any fever or increased pain or redness immediately to a healthcare provider.

Are there home remedies for a skin abscess?

If the abscess is small (less than 1 cm or less than ½ inch wide), applying warm compresses to the area for about 30 minutes can help four times a day.

Once the abscess is drained, it should heal on its own, although this can take several weeks.

Do not insert a needle or other sharp instrument into the abscess because it can injure an underlying blood vessel or cause the infection to spread.

Is it possible to prevent a skin abscess?

  • Maintain good personal hygiene by washing your skin with soap and water regularly.
  • Take care to avoid cutting yourself when shaving your armpits or pubic area.

Seek medical attention for any puncture wound:

  • Especially if the person thinks there may be some foreign material or debris inside the wound or under the skin.
  • If the person has one of the listed medical conditions that can weaken the immune system.
  • If the person takes steroids, chemotherapy or other immunosuppressive drugs, or dialysis.

What is the prognosis for a skin abscess?

Once treated, the skin abscess should heal. The prognosis is generally excellent, but some people may develop recurrent abscesses that require medical attention.

Most people do not require antibiotics.

The pain should improve almost immediately after drainage and decrease more each day.

Soak or wash the area daily until the wound heals, about seven to 10 days.

Usually one can remove the packaging by the second day. It rarely needs to be replaced.

After the first two days, there should be little or no drainage from the abscess. Healing of the sores should occur in 10-14 days.