An abscess is a collection of pus built up in a confined space. There is usually some heat, pain, redness and swelling (calor, dolor, rubor, and tumor) over the area. Small abscess will sometimes resolve on their own. Larger abscesses often have to be treated with antibiotics or drainage. If abscess are not treated they can get large, rupture, or cause infection in the blood or spread along the skin.
There are several different kinds of skin abscesses. We will separate the different kinds out by location for ease.
All over the skin
The most common kind seems to be infected sebaceous cysts. This happens when a hair follicle gland gets clogged. This will form a cyst which often gets bigger with time. Sometimes, one of these will get infected and has to be drained. After this is drained, it is typically removed a month or two later to prevent it from coming back. Actively infected sebaceous cysts can’t be successfully removed most of the time.
Armpits/groins/under the breast
There is a type of infection called Hidradenitis Suppurativa. This is an infection of the sweat glands in these areas. They will sometimes appear as pimples but will often become larger over time and may develop tracts that burrow deeper in the skin. These sometimes need to be drained or treated with antibiotics. If it is a chronic condition, the area may have to be removed.
Tailbone
An abscess on the tailbone or above the anus is typically a pilonidal cyst. On close inspection, one can note small divots between the butt cheeks in the middle. Hairs get stuck in them and will then create an infection which typically will grow upward and create a painful lump. These usually have to be drained. Once someone starts having problems with this, they often have to be excised in order to prevent future infections. There are a lot of techniques used to excise and treat these, so you should talk with your surgeon about how she or he recommends treating your specific case.
Anus
These are typically peri-rectal abscesses. A perirectal abscess develops due to a blocked gland at the junction between the rectum and anus. This will then create a painful lump (or just pain) next to the anus. With time, this can grow quite large. These typically have to be drained. The nice thing about drainage is that patients feel better within minutes of it being drained. If the wound chronically drains, there might be a connection between the wound and the rectum which requires opening the area.
Breast
Breast abscesses are divided between those in patients who are nursing and those who aren’t. In patients who are nursing, it develops from a mastitis (breast infection). In patients who aren’t nursing, it typically is from a blocked gland. Breast abscesses can be treated with aspiration (sucking the pus out and flushing with local anesthetic) or incision and drainage. You should ask your surgeon which treatment he or she recommends.
Incisional abscesses
This in an infection that develops at the site of an incision typically between 5 and 10 days after surgery. You should talk with your surgeon if this occurs. Your wound may need to be opened or you may need antibiotics for it. Sometimes the abscess may be caused by a piece of mesh, suture, or other foreign material.
There are several other kinds of abscesses, however these are the most common ones that we see in our practice. If you think you may have one of these, please call to schedule an appointment. Most patients can be seen within 24 hours if needed by our practice during the week. If we are able to see you, this can save a lot of money compared to going to the emergency department and allow you to have a specific time to be seen (minimal wait). If a provider isn’t available, you may need to go to the Emergency Room for evaluation.