Skin Abscess

SkinAbscess

Definitions

  • Cellulitis (see Cellulitis, Cellulitis): skin infection of deeper dermis and subcutaneous fat (resulting from bacterial breach of the skin) characterized by erythema, warmth, and edema without an underlying suppurative focus
  • Erysipelas (see Erysipelas, Erysipelas): skin infection of upper dermis and superficial lymphatics (resulting from bacterial breach of the skin) characterized by erythema, warmth, and edema without an underlying suppurative focus
  • Impetigo (see Impetigo, Impetigo): infection of superficial layers of the epidermis
  • Necrotizing Fasciitis (see Necrotizing Fasciitis, Necrotizing Fasciitis): deep-seated infection of subcutaneous tissue (involving fascia and fat), which may spare the skin
  • Furuncle (Boil): infection of hair follicle where purulent material extends through the dermis into the subcutaneous tissue, forming a small abscess
  • Carbuncle: coalescence of several inflamed follicles into a single inflammatory mass with purulent drainage from multiple follicles
  • Skin Abscess: collection of pus within dermis and deeper skin tissues

SKIN INFECTIONS


Predisposing Factors


Microbiology


Diagnosis

Complete Blood Count (CBC) (see Complete Blood Count, Complete Blood Count)

Blood Culture (see Blood Culture, Blood Culture)

  • xxxx

Ultrasound

  • Useful to Localize a Defined Pocket of Abscess Fluid
    • Studies Indicate that MRSA Can Be Suspected Based on Ultrasound Characteristics of a Skin Abscess (Acad Emerg Med, 2014) [MEDLINE]

Culture of Abscess Drainage Material

  • Indicated

Clinical Manifestations

Dermatologic Manifestations

Painful/Tender, Erythematous Fluctuant Skin Nodule

  • May have central pustule
  • May be surrounded by a rim of erythematous edema

Other Manifestations

Sepsis (see Sepsis, Sepsis)

  • xxx

Treatment

Small Furuncle

  • Warm Compress: when used alone, may promote drainage

Skin Abscess or Medium-Large Furuncle/Carbuncle

  • Incision and Drainage (I+D)
  • Indications for Concomitant Antibiotic Therapy (Based on Infectious Disease Society America/IDSA guidelines)
    • Abscess Present in Difficult to Drain Area: face, hand, genitals
    • Associated Septic Phlebitis
    • Comorbid Disease
    • Extreme of Age
    • Immunosuppression
    • Lack of Clinical Response to Incision and Drainage (I+D) Alone
    • Rapid Progression with Associated Cellulitis
    • Severe or Extensive Disease with Multiple Sites of Infection
    • Systemic Toxicity
  • Clinical Efficacy
    • Trial of Sulfamethoxazole-Trimethoprim for Skin Abscess (NEJM, 2016) MEDLINE]: in skin abscesses at least 2 cm in size which were drained, sulfamethazole-trimethoprim increased cure rate at 7 and 14 days
      • Wound Cultures were Positive for MRSA in 45% of Cases
      • Abscess Size of At Least 2 cm is Considered a Useful Threshold Regarding Deciding on Antibiotic Use as Adjunctive Therapy for Skin Abscess

References

  • Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2014 Jul 15;59(2):e10-52. doi: 10.1093/cid/ciu444 [MEDLINE]
  • Management of Skin Abscesses in the Era of Methicillin-Resistant Staphylococcus aureus. N Engl J Med 2014; 370:1039-1047March 13, 2014DOI: 10.1056/NEJMra1212788 [MEDLINE]
  • The Massachusetts abscess rule: a clinical decision rule using ultrasound to identify methicillin-resistant Staphylococcus aureus in skin abscesses. Acad Emerg Med. 2014 May;21(5):558-67. doi: 10.1111/acem.12379 [MEDLINE]
  • Trimethoprim-Sulfamethoxazole versus Placebo for Uncomplicated Skin Abscess. N Engl J Med. 2016;374(9):823 [MEDLINE]