Abscess

Abscess Overview
A skin abscess is a tender mass generally surrounded by a colored area from pink to deep red. Abscesses are often easy to feel by touching. The vast majority of them are caused by infections. Inside, they are full of pus, bacteria and debris. Painful and warm to touch, abscesses can show up any place on your body. The most common sites on the skin in your armpits (axillae), areas around your anus and vagina (Bartholin gland abscess), the base of your spine (pilonidal abscess), around a tooth (dental abscess), and in your groin. Inflammation around a hair follicle can also lead to the formation of an abscess, which is called a boil (furuncle). Unlike other infections, antibiotics alone will not usually cure an abscess. In general an abscess must open and drain in order for it to improve. Sometimes draining occurs on its own, but generally it must be opened with the help of a warm compress or by a doctor in a procedure called incision and drainage (I&D).


What causes Abscess?
When our normal skin barrier is broken, even from minor trauma, or small tears, or inflammation, bacteria can enter the skin. An abscess can form as your body's defences try to kill these germs with your inflammatory response (white blood cells; pus). Obstruction in a sweat or oil (sabaceous) gland, or a hair follicle or a pre-existing cyst can also trigger an abscess. The middle of the abscess liquefies and contains dead cells, bacteria, and other debris. This area begins to grow, creating tension under the skin and further inflammation of the surrounding tissues. Pressure and inflammation cause the pain.

People with weakened immune systems get certain abscesses more often. Those with any of the following are all at risk for having more severe abscesses. This is because the body has a decreased ability to ward off infections.
Chronic steroid therapy
Chemotherapy
Diabetes
Cancer
AIDS
Sickle cell disease
Peripheral vascular disorders
Crohn's disease
Ulcerative colitis
Severe burns
Severe trauma
Alcoholism or IV drug abuse

Other risk factors for abscess include exposure to dirty environments, exposure to persons with certain types of skin infections, poor hygiene, and poor circulation.


Symptoms for Abscess:
Most often, an abscess becomes a painful, compressible mass that is red, warm to touch, and tender. As some abscesses progress, they may "point" and come to a head so you can see the material inside and then spontaneously open (rupture). Most will continue to get worse without care. The infection can spread to the tissues under the skin and even into the bloodstream. If the infection spreads into deeper tissue, you may develop a fever and begin to feel ill.


Abscess Treatment:
Self-Care at Home- If the abscess is small (less than 1 cm or less than a half-inch across), applying warm compresses to the area for about 30 minutes 4 times daily may help. Do not attempt to drain the abscess by squeezing or pressing on it. This can push the infected material into the deeper tissues. Do not stick a needle or other sharp instrument into the abscess center, because you may injure an underlying blood vessel or cause the infection to spread.

When to Seek Medical Care- Call your doctor if any of the following occur with an abscess:
You have a sore larger than 1 cm or a half-inch across.
The sore continues to enlarge or becomes more painful.
The sore is on or near your rectal or groin area.
You develop a fever.
You notice red streaks, which can mean the infection is spreading.
You have any of the medical conditions listed above.

Go to a hospital’s Emergency Department if any of these conditions occur with an abscess:
Fever of 102°F or higher, especially if you have a chronic disease or are on steroids, chemotherapy, or dialysis.
A red streak leading away from the sore or with tender lymph nodes (lumps) in an area anywhere between the abscess and your chest area (for example, an abscess on your leg can cause swollen lymph nodes in your groin area)
Any facial abscess larger than 1 cm or a half-inch across


Exams and Tests:
The doctor will take a medical history and may ask you:
How long the abscess has been present
If you recall any injury to that area
What medicines you may be taking
If you have any allergies
If you have had a fever at home
The doctor will examine the abscess and surrounding areas. If it is near your anus, the doctor will perform a rectal exam. If an arm or leg is involved, the doctor will feel for a lymph gland either in your groin or under your arm.


Medical Treatment:
The doctor may open and drain the abscess.
The area around the abscess will be numbed with medication. It is often difficult to completely numb the area, but local anaesthesia can make the procedure almost painless.
The area will be covered with an antiseptic solution and sterile towels placed around it.
The doctor will cut open the abscess and totally drain it of pus and debris.
Once the sore has drained, the doctor may insert some packing into the remaining cavity to allow the infection to continue to drain. It may be kept open for a day or two.
A bandage will then be placed over the packing, and you will be given instructions about home care.
Most people feel better immediately after the abscess is drained.
If you are still experiencing pain, the doctor may prescribe pain pills for home use over the next 1-2 days.
You are usually sent home with oral antibiotics.


Next Steps: Follow-up
Follow carefully any instructions your doctor gives you.
The doctor may have you remove the packing yourself with instructions on the best way to do this. This may include soaking or flushing.
Be sure to keep all follow-up appointments.
Report any fever, redness, swelling, or increased pain to your doctor immediately.


Prevention for Abscess:
Maintain good personal hygiene by washing your skin with soap and water regularly.
Take care to avoid nicking yourself when shaving your underarms or pubic area.
Seek immediate medical attention for any puncture wounds, especially if:
You think there may be some debris in the wound.
The puncture wound was caused by a bite - human, insect or animal.
You have one of the listed medical conditions.
You are on steroids or chemotherapy.


Outlook:
Once treated, the abscess should heal.
Many people require antibiotics, but you may not. The pain often improves immediately and subsides more each day. Wound care instructions from your doctor may include wound repacking, soaking, washing, or bandaging for about 7 to 10 days. This usually depends on the size and severity of the abscess. After the first 2 days, drainage from the abscess should be minimal to none. All sores should heal in 10-14 days.