Abscesses

“I think it’s an abscess”, pointing to the red, swollen area on his chin. “Not sure how I got it but its pretty sore and warm to touch so I thought I’d better come to see you.”

An abscess is an infection characterized by a collection of pus which is nothing more than a gathering of cell debris, bacteria, and white blood cells. They can happen inside a body cavity (for example an abscess can form around an infected appendix) or they happen commonly just under the skin. All it takes is a break in the skin, some bacteria (usually Staph) to enter and set up shop there and you have an abscess aka “boil”.

The signs and symptoms are typical of the 4 cardinal signs of inflammation: redness, swelling, pain, and warmth. Add the bacteria and you’ve taken that inflamed area to an infected area. Since that infection many times shows itself as a pus collection, the treatment is first and foremost surgical drainage. (As my old boss in surgical training used to say, “it’s a surgeon’s finest hour”) The surrounding area is numbed with local anesthesia and an incision is made directly over the abscess usually with a minor explosion of the pus (and relief by the patient!) But that’s not all…

It’s important to irrigate out the wound and then place a wick into that abscess cavity to keep it open and draining. Failure to do this or, worse yet, sewing up the incision, results in a re-infection and, therefore, a 2nd abscess. The wick usually needs to be changed a couple of times which we do here in the clinic at no extra charge to you, and once the wick is removed, we recommend salt water soaks.

If the patient has evidence of cellulitis (infection of the skin around the abscess) I recommend a course of Staph-directed antibiotics. Abscesses are not fun but they are easily treated with 1) incision and drainage and 2) keeping it draining with a wick and possibly antibiotics.