Skin abscess or boil Part 2

Skin Abscess Diagnosis

The doctor will take a medical history and ask for information about the following:

  • How long the abscess has been present
  • If the patient recalls any injury to that area
  • What medicines the patient is taking and if there are any serious or chronic medical conditions
  • If the patient has any allergies
  • If the patient had a fever at home
  • The doctor will examine the abscess and surrounding areas. If it is near the anus or vagina, the doctor will perform a rectal or vaginal exam. If an arm or leg is involved, the doctor will feel for an enlarged lymph node either in the groin or under the arm.
  • Depending on the location and the extent of the abscess, the doctor may obtain wound cultures or blood tests and imaging studies, although these measures are often not needed.

Skin Abscess Treatment

Self-Care at Home

  • If the abscess is small (less than 1 cm or less than ½ inch across), applying warm compresses to the area for about 30 minutes, four times daily may help.
  • Do not attempt to drain the abscess by pressing on it. This can push the infected material into the deeper tissues.
  • Do not stick a needle or other sharp instrument into the abscess because it may injure an underlying blood vessel or cause the infection to spread.

Medical Treatment

Often, a skin abscess will not heal on its own without further intervention by your health-care provider. Initially, an abscess may feel firm and hardened (indurated), at which time incision and drainage may not be possible. However, once the abscess begins to “come to a head” and it becomes more soft and fluctuant, lancing it to evacuate the pus and relieve the pressure is the best course of action. Your health-care provider will open and drain the abscess (incision and drainage) using the following technique.

  • The area around the abscess will be numbed with local anesthetic.
    • It is often difficult to completely numb the area, but in general, local anesthesia can make the procedure almost painless.
    • A sedative may be given if the abscess is large.
    • The affected area will be covered with an antiseptic solution and sterile towels placed around it.
  • The health-care provider will cut open the abscess with a scalpel and drain all of the pus and debris. Sometimes, there will be multiple pockets of pus that must be identified and drained.
  • Once the sore has drained, the doctor may insert packing into the remaining cavity to minimize bleeding and to keep the wound open for a day or two so any remaining pus can continue to drain.
    • A bandage will then be placed over the packing, and the patient will be given instructions for home care.
    • Most people feel better immediately after the abscess is drained.
    • Your health-care provider may prescribe pain medication, depending upon the location, size, and extent of the abscess.
    • Antibiotics are generally not necessary; however, they may be prescribed if the abscess is associated with a surrounding skin infection. Antibiotics may also be prescribed, depending upon the location of an abscess and whether or not the individual has a compromised immune system.

Follow-up

  • Carefully follow any instructions regarding wound care recommended by your health-care provider.
    • Your health-care provider may have the patient or the caregiver remove the packing. If so, it is best removed while the area is moistened with water.
    • After the packing has been removed, soak or flush the area for 10 to 20 minutes, three to four times daily to allow the wound to heal properly.
  • Be sure to keep all follow-up appointments as your health-care provider may want you to return for a recheck of the wound. Sometimes the wound may require repacking if it continues to drain pus.
  • Report any fever or increased pain or redness to your health-care provider immediately.

Skin Abscess Prevention

  • Maintain good personal hygiene by washing the skin with soap and water regularly.
  • Take care to avoid cutting yourself when shaving your underarms or pubic area.
  • Seek medical attention for any puncture wounds:
    • Especially if the person thinks there may be some foreign material or debris inside the wound or under the skin
    • If the person has one of the listed medical conditions that may weaken the immune system
    • If the person is on steroids, chemotherapy, or dialysis.

Skin Abscess Prognosis

  • Once treated, the skin abscess should heal. The prognosis is generally excellent, but some individuals may suffer from repeated abscesses requiring medical attention.
  • Most people do not require antibiotics.
  • The pain should improve almost immediately after drainage and subside more each day.
  • Soak or wash the area daily until the wound heals — about seven to 10 days.
  • Usually you can remove the packing by the second day. It rarely needs to be replaced.
  • After the first two days, drainage from the abscess should be minimal to none. All sores should heal in 10 to 14 days.

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