dermatologic disorders
Cutaneous Abscess
Treatment of Cutaneous Abscess
Incision and drainage Sometimes antibiotics Some small abscesses resolve without treatment, coming to a point and draining. Warm compresses help accelerate the process. Incision and drainage are indicated when significant pain, tenderness, and swelling are present; it is unnecessary to await fluctuance. Under sterile conditions, local anesthesia is given as either alidocaineinjection or a freezing spray. Patients with large, extremely painful abscesses may benefit from IV sedation and analgesia during drainage. A single puncture with the tip of a scalpel is often sufficient to open the abscess. After the pus drains, the cavity should be bluntly probed with a gloved finger or curette to clear loculations. Irrigation with normal saline is optional. Packing the cavity loosely with a gauze wick reduces the dead space and prevents formation of a seroma. The wick is typically removed 24 to 48 hours later. However, data suggest that routine irrigation or packing for abscesses < 5 cm in diameter is unnecessary ( Treatment references , Antibiotics have traditionally been considered unnecessary unless the patient has signs of systemic infection, cellulitis, multiple abscesses, immunocompromise, or a facial abscess in the area drained by the cavernous sinus. In these cases, empiric therapy should be started with a MRSA and purulent or complicated cellulitis (eg, sulfamethoxazole/ 1.Chinnock B, Hendey GW:Irrigation of cutaneous abscesses does not improve treatment success.Ann Emerg Med67(3):379-383, 2016. doi: 10.1016/j.annemergmed.2015.08.007 2.O'Malley GF, Dominici P, Giraldo P, et al:Routine packing of simple cutaneous abscesses is painful and probably unnecessary.Acad Emerg Med16(5):470-473, 2009. doi: 10.1111/j.1553-2712.2009.00409.x 3.Talan DA, Mower WR, Krishnadasan A:Trimethoprim-sulfamethoxazole versus placebo for uncomplicated skin abscess.N Engl J Med374(9):823-832, 2016. doi: 10.1056/NEJMoa1507476 