Abscess

This article is about the medical condition. For the death metal band, see Abscess (band).
Abscess
Other namesLatin: Abscessus
Five-day-old inflamed epidermal inclusion cyst. The black spot is a keratin plug which connects with the underlying cyst.
SpecialtyGeneral surgery, infectious disease, dermatology
SymptomsRedness, pain, swelling[1]
Usual onsetRapid
CausesBacterial infection (often MRSA)[1]
Risk factorsIntravenous drug use[2]
Diagnostic methodUltrasound, CT scan[1][3]
Differential diagnosisCellulitis, sebaceous cyst, necrotising fasciitis[3]
TreatmentIncision and drainage, Antibiotics[4]
Frequency~1% per year (United States)[5]

An abscess is a collection of pus that has built up within the tissue of the body.[1] Signs and symptoms of abscesses include redness, pain, warmth, and swelling.[1] The swelling may feel fluid-filled when pressed.[1] The area of redness often extends beyond the swelling.[6] Carbuncles and boils are types of abscess that often involve hair follicles, with carbuncles being larger.[7] A cyst is related to an abscess, but it contains a material other than pus, and a cyst has a clearly defined wall. Abscesses can also form internally on internal organs and after surgery.

They are usually caused by a bacterial infection.[8] Often many different types of bacteria are involved in a single infection.[6] In many areas of the world, the most common bacteria present is methicillin-resistant Staphylococcus aureus.[1] Rarely, parasites can cause abscesses; this is more common in the developing world.[3] Diagnosis of a skin abscess is usually made based on what it looks like and is confirmed by cutting it open.[1] Ultrasound imaging may be useful in cases in which the diagnosis is not clear.[1] In abscesses around the anus, computer tomography (CT) may be important to look for deeper infection.[3]

Standard treatment for most skin or soft tissue abscesses is cutting it open and drainage.[4] There appears to be some benefit from also using antibiotics.[9] A small amount of evidence supports not packing the cavity that remains with gauze after drainage.[1] Closing this cavity right after draining it rather than leaving it open may speed healing without increasing the risk of the abscess returning.[10] Sucking out the pus with a needle is often not sufficient.[1]

Skin abscesses are common and have become more common in recent years.[1] Risk factors include intravenous drug use, with rates reported as high as 65% among users.[2] In 2005, 3.2 million people went to American emergency departments for abscesses.[5] In Australia, around 13,000 people were hospitalized in 2008 with the condition.[11]

  1. ^ a b c d e f g h i j k l Singer AJ, Talan DA (March 2014). "Management of skin abscesses in the era of methicillin-resistant Staphylococcus aureus" (PDF). The New England Journal of Medicine. 370 (11): 1039–1047. doi:10.1056/NEJMra1212788. PMID 24620867. Archived from the original (PDF) on 2014-10-30. Retrieved 2014-09-24.
  2. ^ a b Ruiz P, Strain EC, Langrod J (2007). The substance abuse handbook. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. p. 373. ISBN 978-0-7817-6045-4. Archived from the original on 2017-09-06.
  3. ^ a b c d Marx JA (2014). "Skin and Soft Tissue Infections". Rosen's emergency medicine : concepts and clinical practice (8th ed.). Philadelphia, PA: Elsevier/Saunders. pp. Chapter 137. ISBN 978-1-4557-0605-1.
  4. ^ a b American College of Emergency Physicians, "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation, American College of Emergency Physicians, archived from the original on March 7, 2014, retrieved January 24, 2014
  5. ^ a b Taira BR, Singer AJ, Thode HC, Lee CC (March 2009). "National epidemiology of cutaneous abscesses: 1996 to 2005". The American Journal of Emergency Medicine. 27 (3): 289–292. doi:10.1016/j.ajem.2008.02.027. PMID 19328372.
  6. ^ a b Elston DM (2009). Infectious Diseases of the Skin. London: Manson Pub. p. 12. ISBN 978-1-84076-514-4. Archived from the original on 2017-09-06.
  7. ^ Marx JA (2014). "Dermatologic Presentations". Rosen's emergency medicine : concepts and clinical practice (8th ed.). Philadelphia, PA: Elsevier/Saunders. pp. Chapter 120. ISBN 978-1-900151-96-2.
  8. ^ Cox C, Turkington JS, Birck D (2007). The encyclopedia of skin and skin disorders (3rd ed.). New York, NY: Facts on File. p. 1. ISBN 978-0-8160-7509-6. Archived from the original on 2017-09-06.
  9. ^ Vermandere M, Aertgeerts B, Agoritsas T, Liu C, Burgers J, Merglen A, et al. (February 2018). "Antibiotics after incision and drainage for uncomplicated skin abscesses: a clinical practice guideline". BMJ. 360: k243. doi:10.1136/bmj.k243. PMC 5799894. PMID 29437651.
  10. ^ Singer AJ, Thode HC, Chale S, Taira BR, Lee C (May 2011). "Primary closure of cutaneous abscesses: a systematic review" (PDF). The American Journal of Emergency Medicine. 29 (4): 361–366. doi:10.1016/j.ajem.2009.10.004. PMID 20825801. Archived from the original (PDF) on 2015-07-22.
  11. ^ Vaska VL, Nimmo GR, Jones M, Grimwood K, Paterson DL (January 2012). "Increases in Australian cutaneous abscess hospitalisations: 1999-2008". European Journal of Clinical Microbiology & Infectious Diseases. 31 (1): 93–96. doi:10.1007/s10096-011-1281-3. PMID 21553298. S2CID 20376537.