What is a Skin Abscess?
An abscess is a skin and soft tissue infection that can occur on any part of the body, but most commonly occurs on the axillae, buttocks, and extremities. They are collections of bacteria and inflammatory cells (pus) that the body creates in response to bacterial invasion and growth.
These infections are opportunistic, meaning that bacteria enter through breaks in the skin (ie. Ingrown hair or small cut) and multiply, eventually forming a walled-off collection of pus and inflammatory cells. Initially they may present as a tender red nodule that may grow in size over time. Eventually, as fluid and bacteria collect, the central part of the lesion may form a head. Ruptured cysts on the back can often present as abscesses as well.
The proper treatment of an abscess is by a procedure called Incision and Drainage (I+D). This procedure is done in the office setting under local anesthesia. A bacterial culture is taken at this time to rule out any resistant strains of bacteria (MRSA). Antibiotics are often given following this procedure, but not always necessary.
Once the abscess is incised, the contents are drained, and sterile gauze is packed into the wound to allow drainage and prevent recollection of pus. This packing should be changed in the office every 2-3 days. The body begins to heal from the inside out and fill in the pocket where the abscess was. After about one week the packing is completely removed so the wound can heal completely.
- Keep area clean and dry. You may gently clean the area with soap and water, or with dilute hydrogen peroxide solution and a Q-tip (1:1 dilution). Apply a new bandage to the area, being cautious not to remove the sterile packing gauze.
- Return to the clinic in 2-3 days to have wound re-evaluated and packing changed.
- Extra Strength Tylenol (over the counter) can be taken for pain.
- It is not recommended to swim until the area has sealed
How Can I Prevent a Skin or Soft Tissue Abscess from Occurring in the Future?
- If working out at public facilities be sure to wipe down machines and exercise equipment before and after use.
- Change out of damp workout clothes ASAP and shower post workouts or heavy sweating.
- If a break in the skin occurs, or irritated/ingrown hair follicle, clean the area as soon as possible.
- Apply warm compress to areas that appear to be forming an abscess (3 times daily x 10 minutes) and see your Dermatologist as soon as possible.
What is MRSA?
This is an infection caused by “Staph” bacteria, which is resistant to many broad-spectrum antibiotics. Prior to the mid-1990’s MRSA was primarily just seen in the hospital setting. MRSA can be transmitted by direct skin to skin contact with infected persons or contaminated surfaces. The bacteria has a long lifespan and can live up to 9 weeks on a cotton towel, 203 days on a blanket, 8 weeks on a mop head, and 7 months on dust!!!
Today, it is especially important to practice good hygiene and cleanliness, since healthcare providers are seeing a growing number of MRSA infections in the general population. MRSA generally begins as a small red bump that turns into a painful abscess. Patients are diagnosed with MRSA after a culture is taken at a doctor’s office.
There are various ways MRSA infections can be treated, and the proper precautions should be taken to reduce bacterial spread to other individuals.
MRSA Treatment Options
- Incision and drainage (I &D) of the abscess and/or antibiotic therapy.
- Topical Mupirocin Ointment applied to the inside of the nose twice daily for the first five days of each month.
- 4 % Chlorhexidine Soap applied to the whole body for 5 days.
- Clindamycin 300 mg PO TID.
- Bactrim (Trimethoprim/sulfamethoxazole) 1 DS tablet BID.
- Tetracycline: Minocycline or Doxycycline 100 mg PO BID. Be sure to take medication either 1 hour before OR 2 hours after meal.
- Linezolid 600 mg PO BID.
- Rifampin 300 mg PO BID.
- Hand Washing throughout the day with soap and water or alcohol hand gel is extremely important.
- Diluted Bleach Soak: ¼ cup bleach added to each ¼ bathtub filled up. Twice a week for 3 months.
- Avoid sharing utensils or cups.
- Avoid sharing unwashed towels, washcloths, and clothing.
- Avoid sharing personal items such as deodorant, razors, and soap.
- Wash bed linens and pajamas regularly.
- Wash clothes in hot water with detergent, and dry in the dryer.
- Shower with soap daily.
- Keep any cuts covered with clean, dry bandages.
- Clean countertops and exposed surfaces with an all-purpose cleaner or a bleach preparation.
- Ensure areas such as light switches, doorknobs, faucet hands, and other high touch areas are cleaned daily.
- Use antibacterial wipes while out to clean off shopping cart/door handles, and public toilets.