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Abscesses

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Related Terms
  • Acquired immunodeficiency syndrome, AIDS, anorectal, bacteria, bacterium, Bartholin's gland, boil, carbuncle, cystic acne, diabetes, endocarditis, Entamoeba histolytica, epidural, furuncle, furunculosis, groin, Hirradenitis suppurativa, HIV, human immunodeficiency virus, immune, inflammation, meningitis, methicillin-resistant, MRSA, neutrophils, nosocomial, parasite, peritonsillar, pilonidal cyst, pneumonia, pus, pustule, pyogenic, Staph., Staphylococcus aureus,steroids, subcutaneous, sweat gland, vagina.

Background
  • An abscess is a collection of pus in any part of the body that is surrounded by swelling and inflammation. An abscess may develop, enlarge, or subside, depending upon the degree of infection by microorganisms, such as bacteria. Abscesses may develop in any organ and in the soft tissues beneath the skin in any area.
  • Common sites of abscesses include the breasts, gums, and peri-rectal area. Less common sites include the brain and liver. Common sites for abscesses under the skin include the armpit and the groin. These two areas have a large number of lymph glands, which are responsible for fighting infection.
  • Boil: A boil, also referred to as a skin abscess, is a localized infection deep in the skin. A boil generally starts as a reddened, tender area. Over time, the area becomes firm and hard. Eventually, the center of the abscess softens and becomes filled with infection-fighting white blood cells that the body sends from the blood stream to stop the infection. This collection of white blood cells, bacteria, and proteins is known as pus. Finally, the pus forms a head, which can be drained out through the surface of the skin using pressure or surgical methods. Most boils run their course within four to ten days.
  • Furuncle or carbuncle: Furuncles or carbuncles are abscesses in the skin caused by the bacterium Staphylococcus aureus. A furuncle can have one or more openings onto the skin and may be associated with a fever or chills.
  • Cystic acne: Cystic acne is a type of abscess that is formed when oil ducts become clogged and infected. Cystic acne affects deeper skin tissue than inflammation on the skin commonly seen in acne. Cystic acne is most common on the face and typically occurs in the teenage years.
  • Hidradenitis suppurativa: Hirradenitis suppurativa is a condition in which there are multiple abscesses that form under the arm pits and often in the groin area. These areas are a result of local inflammation of the sweat glands. This form of skin infection is difficult to treat with antibiotics alone and typically requires a surgical procedure to remove the involved sweat glands in order to stop the skin inflammation.
  • Pilonidal cyst: Pilonidal cyst is a unique kind of abscess that occurs at the bottom of the tailbone. Pilonidal cysts often begin as tiny areas of infection in the base of the hair follicle (the area of skin from which hair grows). With irritation from direct pressure, over time the inflamed area enlarges to become a firm, painful, tender nodule making it difficult and uncomfortable to sit. These frequently form after long trips that involve prolonged sitting. Pilonidal cysts are more common in men than in women.
  • Other abscesses: Other types of abscesses include amebic liver abscesses (collection of pus in the liver caused by the intestinal parasite Entamoeba histolytica), anorectal (anal or rectal) abscesses, Bartholin's (glands located on either side of the vagina) abscesses, brain abscesses, epidural (outer covering of the brain and spinal cord) abscesses, peritonsillar (beside the tonsils) abscesses, pyogenic (puss generating) liver abscesses, skin abscesses, spinal cord abscesses, subcutaneous (under the skin) abscesses, and tooth abscesses.

Risk factors and causes
  • Abscesses can be caused by minor breaks and punctures of the skin, obstruction of sweat glands and oil (sebaceous) glands, and inflammation of hair follicles. They contain dead cells, bacteria, and other debris, which causes inflammation and pain.
  • Infection: The bacterium Staphylococcus aureus can enter through a cut, scratch, or other break in the skin. These bacteria, which normally inhabit the skin and sometimes the throat and nasal passages, are responsible for a number of serious diseases, including pneumonia, meningitis (inflammation of the membranes surrounding the brain), urinary tract infections, and endocarditis (inflammation of the lining of the heart). They're also a major cause of hospital-acquired infections (called nosocomial infections) and food-borne illnesses.
  • Fungal infections sometimes cause abscesses, while amoebae (single-celled protozoal parasites) are a major cause of liver abscesses.
  • Individuals with weakened immune systems, such as with acquired immunodeficiency syndrome (AIDS), may be more prone to abscesses or may have more severe ones.
  • Tight clothing: The constant irritation from tight clothing can cause breaks in the skin, making it easier for bacteria to enter the body and cause abscesses.
  • Other skin conditions: Skin problems, such as acne and dermatitis, make individuals more susceptible to boils and carbuncles. Skin conditions can damage the skin's protective barrier. Infected hairs and skin injury, such as scrapes and cuts, can also lead to abscesses or boils.
  • Immune-suppressing medications: Many medications can suppress the normal immune system and increase the risk of developing boils. These medications include steroid medications, such as prednisone (Deltasone®) and prednisolone (Prelone®), and medications used for cancer chemotherapy, such as methotrexate (Rheumatrex®), etoposide (Veepesid®), and doxorubicin (Adriamycin®).'

Diagnosis
  • Skin abscesses, boils, and related conditions are diagnosed by visual inspection. Often, a sample of fluid will be taken from the abscess and tested to see what bacteria are causing the problem.

Complications
  • Scarring of the skin can occur with boils and other skin abscesses. Scarring depends upon the size of the cyst or abscess. Most scars are minimal and fade over time.
  • Rarely, bacteria from a boil may enter the bloodstream and travel to other parts of the body. The spreading infection, commonly known as septicemia (blood poisoning), can rapidly become life-threatening.
  • Initially, blood poisoning causes signs and symptoms such as chills, a spiking fever, a rapid heart rate, and a feeling of being extremely ill. But the condition can quickly progress to shock, which is marked by falling blood pressure and body temperature, confusion, clotting abnormalities and bleeding into the skin. Blood poisoning is a medical emergency and can be fatal if left untreated.
  • Another potentially serious problem is the emergence of a drug resistant strain of Staphylococcus aureus. Once mainly confined to hospitals, methicillin-resistant Staphylococcus aureus (MRSA) now affects increasing numbers of military recruits, prison inmates, athletes, and even children. According to the U.S. Centers for Disease Control and Prevention (CDC), about one percent of Americans carry MRSA on their bodies. A healthy immune system can fight off most infections caused by the bacteria. However, individuals with impaired immunity, such as those with health conditions (including diabetes and human immunodeficiency virus or HIV) and those on certain medications (such as steroids and cancer chemotherapy), may have weakened immune systems and be susceptible to MRSA infections.
  • MRSA is highly contagious and spreads rapidly in crowded or un-hygienic situations or where athletic equipment or towels are shared. Although it responds well to several antibiotics, MRSA is resistant to penicillin and can be very difficult to treat.

Treatment
  • Self treatment: Most simple boils can be treated at home. Ideally, the treatment should begin as soon as a boil is noticed. Early treatment may prevent later complications. The primary treatment for most boils is heat application, usually with hot soaks or hot packs. Hot soaks or hot packs are generally either hot towels or heated pack containing sodium acetate and water. The heated pack, which is purchased at a pharmacy or retail outlet, is placed in a microwave for a few minutes to retain enough heat for application to the affected site. Heat application increases the circulation to the area and allows the body to better fight off the infection by bringing antibodies and white blood cells to the site of infection.
  • As long as the boil is small and firm, opening the area and draining the boil is not helpful, even if the area is painful. However, once the boil becomes soft or forms a pustule (a small collection of pus in the top layer of skin or beneath it), it can be ready to drain. Once drained, pain relief can be dramatic and immediate. It is not recommended to drain a boil or carbuncle, as infection may develop. Healthcare professionals recommended seeing a doctor for the lancing of a skin abscess. Most small boils, such as those that form around hairs, drain on their own or with application of a hot, wet washcloth.
  • Soaking the abscess in a tub of hot water is often recommended by healthcare providers. This works well if the abscess is on the hand or lower arm. Soaking in hot water mixed with Epsom® salts can also be used. Make sure the water is hot, but not so hot that it burns the skin. In abscesses on the face and under the arms, hold a hot, wet wash cloth over the abscess. Soaking at least three to four times a day, 10-15 minutes each time, is recommended by healthcare providers.
  • Medical treatment: A doctor should be seen if the abscess or boil becomes extremely painful, very large, has not healed in two weeks, or is accompanied by a fever. Doctors should see individuals with frequent boils or those with red lines radiating from the boil, which may be a sign that the infection has entered the bloodstream. On occasion, and especially with larger boils, the larger boil will need to be drained or lanced by a healthcare provider. Frequently, these larger boils contain several pockets of pus that must be opened and drained.
  • Antibiotics: Antibiotics, such as amoxicillin (Amoxil®) and tetracycline (Vibramycin®), are often used to eliminate the bacterial infection.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
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