Is it an abscess?

ABSCESS

An abscess is a pocket of pus that can form in different parts of the body. There are many forms of abscesses and they can form almost anywhere in or on the body. An abscess is the body’s way of trying to heal and fight off an infection. When bacteria gets in a skin opening like a cut, the immune system sends white blood cells to the site of infection. It is the very same white blood cells that collect around the bacteria and make pus. The buildup of white blood cells causes a pocket to form where pus collects creating an abscess. It turns into a collection of living and dead white blood cells, bacteria, fluid, and dead tissue that will need to be drained out. This area grows creating pressure under the skin causing further inflammation of surrounding tissue. This pressure and inflammation cause the tenderness with surrounding pink to deep red tissue.

The most common sites are the skin in the armpit, areas around the anus and vagina, the base of the spine or more commonly known as pilonidal abscess, around a tooth known as dental abscess, and in the groin area. Inflammation and infection around a hair follicle can lead to the formation of an abscess called a boil or a carbuncle when a cluster of boils forms a connected area of infection under the skin.

RISK FACTORS

Immunocompromised people can get abscesses more often or more severe abscesses as their bodies have a reduced capacity to ward off infections. This includes people who have diabetes, cancer, AIDS, sickle cell disease, peripheral vascular disorders, Crohn’s disease, ulcerative colitis, poor blood circulation, extensive burns, severe trauma, alcoholism or IV drug abuse, those who are on continued steroid therapy, chemotherapy, and those who are obese.

Other factors include prolonged exposure to dirty environments, contagious skin infections, poor hygiene, smoking, and a sedentary lifestyle.

CAUSES

They are mainly caused by an infection usually caused by Staphylococcus bacteria. Staph bacteria normally live on the skin without it causing an infection. However, staph can get into the skin through an opening in the skin barrier from minor trauma or small skin tears, or along a hair follicle causing the inflammation and formation of abscess. Staphylococcus aureus and MRSA (methicillin-resistant staph aureus) are the most common bacteria causing abscesses. A blockage in the sweat or sebaceous gland, or inflammation of a pre-existing cyst can also trigger an abscess.

SYMPTOMS

• Painful, fluctuant, or compressible mass that is red, tender, and warm to touch
• As an abscess progresses, it may “point” and have a head where pus is more evident and can spontaneously rupture at one point
• Most abscesses continue to get worse without treatment and this infection can spread to the tissues and even into the bloodstream
• Once spread deeper into the skin, fevers can develop and begin a systemic infection
• Deep skin abscesses can cause fevers, chills, fatigue, body aches and pains, night sweats, loss of appetite and even weight loss

DIAGNOSIS

A skin abscess can be diagnosed by the doctor in a physical examination and assessment of medical history. Sample collection of the pus may be done for testing to know which type of bacteria is causing the abscess and can help decide which antibiotics to use and the course of treatment.

Deeper abscesses and internal abscesses can be diagnosed with imaging including an ultrasound, a CT scan, or an MRI.

TREATMENT

There are some minor abscesses that go away by themselves but most of the time, a visit to the doctor’s office for appropriate treatment is necessary. While most infections are treated with antibiotics alone, some abscesses will require more than antibacterial treatment. Generally, the treatment of choice is incision and drainage. Spontaneous drainage can occur on its own especially when on antibiotics, but complete resolution will require complete drainage of pus, bacteria, and debris with the help of sterile equipment and specialized antibacterial and/or healing dressings to keep the abscess from recurring and letting the skin heal from inside out.

PREVENTION

• Keep skin clean and dry.
• Frequent hand washing.
• Not sharing hygiene products including towels, razors, toothbrushes, etc.
• Careful shaving and avoiding cutting the skin open.
• Maintaining good nutrition and a healthy balanced diet with consideration of chronic conditions.
• Quitting smoking.
• Keeping good dental hygiene.

If you think you’re developing an abscess or a suspicious lump you are unsure of, we recommend you see your healthcare provider for early diagnosis and treatment as necessary.

Author

Jenna Wishnew Dr Wishnew is a Board Certified General Surgeon practicing in the North Texas area She specializes in general surgery, gastroparesis, wound care, vein concerns and robotic surgery.