What is an Abscess?
An abscess is a swollen area within body tissue, containing an accumulation of pus. Painful and warm to touch, abscesses can show up at any place on your body. Most common sites are breast, armpits, gums and peri-rectal area. Rare sites are the liver and the brain.
What Causes an Abscess?
Abscesses are caused by obstruction of oil (sebaceous) glands or sweat glands, inflammation of hair follicles, or minor breaks and punctures of the skin. Germs get under the skin or into these glands, which causes an inflammatory response as your body’s defenses try to kill these germs.
Staphylococcus aureus is the most common bacteria causing abscess. Bacteria, viruses, fungi, or protozoans can all lead to abscesses.
When an area of our body gets infected, our immune system tries to fight with it. White blood cells go to the infected area and fight with the bacteria. This results in pus formation which is a combination of bacteria, dead cells, and white blood cells. If not removed or treated there are chances that the bacteria would spread and cause inflammation in other places too.
They can be broadly classified as the following
- External Abscesses: External abscesses commonly occur on the back of the neck or on the face. They also frequently form on moist parts of the body, such as the armpit or groin. Abscesses in hair follicles may result in a condition called folliculitis. An abscess at the base of an eyelash is called a sty.
- Dental Abscesses: A dental abscess or gumboil is an accumulation of pus in the gums or jaw tissues surrounding a tooth. It is usually formed as a result of infection by bacteria.
- Internal Abscesses: Abscesses may form in any organ of the body. Abscesses that develop inside the tummy (abdomen) are caused by an infection reaching tissue deeper within the body. This can occur as a result of an injury, abdominal surgery, an infection spreading from a nearby area. A lung abscess can form after a bacterial infection in your lungs, such as pneumonia. Abscesses inside your body may not be obvious and can damage organs including brain, lungs and others.
Who is at Risk for Developing an Abscess?
Things that can increase the likelihood of developing an abscess are having a weak immune system (this could be because of HIV or chemotherapy), having diabetes, having an underlying inflammatory condition, being a carrier of Staphylococcal bacteria. Other risk factors include sickle cell disease, leukemia, peripheral vascular disorders, Crohn’s disease, alcohol and IV drug abuse etc. However, many abscesses develop in people who are otherwise healthy.
Diagnosis of an Abscess
An abscess can be diagnosed by any of the three methods mentioned below:
- Physical examination: If you have swelling, redness, pain, redness, and fluctuance on the skin.
- Needle aspiration: This procedure can help the clinician in making a diagnosis of a localized abscess.
- Bedside ultrasound: This is a very useful tool for identification of localized fluid under the skin that may represent isolated areas of infection.
Self Care at Home for Treating Abscess
Applying warm compress for about 30 minutes four times a day may help. Never attempt to squeeze or press on an abscess at home; this can push the infected material into deeper tissues. Do not stick a needle or other sharp instrument into the abscess center.
Treating an Abscess
An abscess that is diagnosed by one of the above ways is appropriate for incision and drainage, if it is larger than approximately 5 mm and found in an accessible location. Incision and drainage is the primary therapy for cutaneous abscess management. Cutaneous abscesses can be found in any part of the body, but most common sites are axial, buttocks, and extremities.
Extremely large and deep abscesses in areas difficult to anesthetize may be more appropriate to treat in an operative setting. Abscesses of palm, soles, or nasolabial folds can be associated with complications and may require consultation with an appropriate specialist. Inputs from a cosmetic surgeon may be required for areas with cosmetic concerns.
Abscess Drainage Procedure
After informed consent is signed, anesthesia is applied. An incision is made directly over the center of the abscess. Purulent drainage begins when the abscess cavity has been accessed entirely. Sterile saline solution is used after the drainage has been removed. The wound is then gently packed.
Abscess Drainage Aftercare
Most incision and drainage procedures don’t require antibiotic therapy. Extensive cellulitis may require antibiotics. The patient should be up to date with his/her tetanus immunizations. All abscesses should have packing removed in a few days. The patient should be given written instructions to look for the signs that will require a visit to the physician.
Complications Following Abscess Drainage
The complications include pain during the procedure. Other complications include progression to cellulitis, development of fever, signs of clinical worsening etc.
These situations may require another incision and drainage or use of antibiotics. However, most of the drainage processes do not require a repeat and can be managed easily by dressing changes and local wound care.
Lastly, after 2 days of drainage, the drainage should be minimal to none from the site. All sores should heal within 10-14 days.
