Skin Abscess | GVSC | Granville Medical Specialist Centre

What is an skin abscess?

An skin abscess is a pink or red skin mass. It is painful and warm upon touching. The middle of an abscess is full of pus and debris and it may rupture as time goes by. It is caused by infection and inflammation of the skin and subcutaneous tissue.

Skin abscesses can show up any place on your body. Common sites of skin abscess are in scalp, neck, trunk, buttock(buttock abscess), limbs, armpits (axillae), groin (groin abscess), areas around your anus (perianal abscess), scrotum (scrotal abscess) and vaginal opening (Bartholin gland abscess), and around the base of your spine (pilonidal abscess). Inflammation around a hair follicle can also lead to the formation of an abscess, and it is called a boil (furuncle). Infection and inflammation around teeth is called dental abscess.

Antibiotics alone for skin abscesses usually will not be successful. Spontaneous rupture and pus draining often occur on its own. In general, most abscesses must be opened and drained surgically in order for earlier recovery. They must be opened by a doctor in a procedure called "incision, drainage, and debridement", or ,in short, incision and drainage (I&D).

Causes of skin abscesses

Abscesses are caused by obstruction of oil (sebaceous) glands, obstruction of sweat glands, infection of hair follicles, minor skin breaks or minor skin punctures. Bacteria travels under the skin or into these glands, invade our healthy body tissue and cause an acute inflammatory reaction by our immunity system, resulting in a bacterial infection.

The middle of the abscess liquefies, containing dead cells, bacteria, inflammatory discharge , debris and forms a pus containing cavity. This pus containing cavity begins to grow, creating tension under the skin and further inflammation of the surrounding tissues. Increasing local pressure and inflammation eventually cause escalating pain.

Patients with impaired immunity get more abscesses. These patients may have steroid therapy, chemotherapy, diabetes, cancer, AIDS, Sickle cell disease, leukemia, peripheral vascular disease, inflammatory bowel diseases, alcoholic, IV drug addict, severe burns, severe trauma etc.

There are other risk factors for abscess formation. They include dirty environments, close contact with persons having certain types of skin infections, poor hygiene, and poor circulation.

Symptoms

Most often, an abscess is being noticed as a increasingly red, painful, tender and warm mass.

As some abscesses progress, open spontaneously (rupture), or erupt with pus coming out.
Without surgery, most will continue to get worse. The infection can spread to surrounding tissues under the skin and even into the bloodstream.
If the infection spreads into deeper tissue, patients may develop a fever and begin to feel ill. It may result in necrotizing fasciitis, a potentially deadly disease with bacteriae spreading quickly and deep below the skin.

Diagnosis

Experienced doctors or surgeons can make most of the diagnoses by detail clinical examination. Sometimes, when the abscess is around the anus or vagina, or it is too painful to touch, patient may need to undergo general anesthesia in order to assess the extent of the abscess completely.

Treatment

Traditional surgery

Most abscesses require a minor surgery called incision and drainage, and debridement. It can be done under local anesthesia, spinal anesthesia or general anesthesia, in the operating theatre in the clinic or in a hospital. Some skin abscess may need to debride more than once.

After incision and drainage, and debridement surgery, the wound usually needs to be cleansed by nurses or doctors every day until the wound heals completely. Smart patients can learn to do it on their own. Wound healing rate is usually less than 0.75mm/day. If you have a 2cm wound after incision and drainage, it may takes you about a month to heal.

Modern surgery / Delay primary wound closure / Seconday suturing

After initial incision and drainage plus vigorous debridement surgery, the unhealthy tissue is gone. The wound is cleansed with antiseptic solution for 1-2 days. If the wound condition is satisfactory, then the wound can be closed by delay primary wound closure or secondary suturing under local anesthesia, spinal anesthesia or general anesthesia. With this approach, patients with skin abscess can return to school or work in few days time after initially surgery and avoid unnecessary prolonged wound cleansing and dressing.