Abscesses

In this article we will discuss about abscesses – what they are, what causes them, where can they appear and how do we treat them, as well as making some comparisons between abscesses and other types of skin conditions. While abscesses commonly appear on the skin, you should know that they can also form inside your body, due to some ongoing infectious process. If you want to learn more about how this can happen and what are some of the consequences of abscesses, you have come to the right place.

Skin Abscesses – definition

An abscess is a lump that develops beneath your skin surface containing pus or a white-ish, translucent fluid that is commonly a consequence of an infection in that spot. Because this is a skin condition, abscesses can form virtually anywhere on the body, but there are some areas that are more prone to developing abscesses, such as the face, chest, back, buttocks, as well as areas with significant hair growth (i.e. underarms or groin).

These liquid-filled-bumps are usually harmless and can go away by themselves or with the help of some creams, but in some more serious cases, drainage or laceration might be required. Given that abscesses are a consequence of an infection, identifying the cause and severity of the infection is necessary because if it’s serious and it’s left untreated, it can lead to life-threatening complications, just like any other infection.

What causes Abscesses?

When we discuss about skin abscesses, the most common abscesses causes are either infection with bacteria or infection of the hair follicles.

Infection with bacteria. Typically, abscesses are formed as a result of the infection of the skin with staphylococcal bacteria. You might be wondering how some bacteria can cause a buildup of fluid right beneath the skin. Well, it all goes down to the immune response of the body which triggers white blood cells to travel to the site and try to fight the bacterium and the infection. Because of this process, the skin of the affected area gets inflamed and the nearby tissue starts to die. As a result, beneath the skin appears a cavity that will soon start to fill with bacteria, dead tissue and white blood cells creating that liquid that we call pus. If you’re curious how exactly bacteria can penetrate the skin barrier, this usually happens through hair follicles (hence the high possibility of developing abscesses in the hairy areas of the body), cuts, wounds or lacerations of the skin. In addition, if you get stuck with a splinter or some other type of foreign object in the skin, you are also very likely to develop an abscess if you don’t address the issue fast enough.

Some of the most common bacteria that can cause abscesses to develop underneath the skin are Staphylococcus aureus (or staph), methicillin-resistant S. aureus (or MRSA which is basically staph that is resistant to some antibiotics), Streptococcus pyogenes or Mycobacterium tuberculosis.

Apart from bacteria, there are some other factors that can cause skin abscesses, such as viruses, fungi, parasites or anaerobic organisms. However, abscesses caused by these are way more less common than the ones caused by infection with bacteria.

Infection of the hair follicles. When hair follicles get infected, this process is known as folliculitis. Sometimes, folliculitis can cause abscesses, meaning that the follicles start to buildup pus. This happens when the hair in the follicle gets stuck and cannot puncture the skin to get out. This is also known as having ingrown hairs which can be the starting point for an infection. Shaving, waxing or swimming in a pool that has inadequate levels of chlorine can cause folliculitis.

Who is at risk of developing Skin Abscesses?

Considering the fact that abscesses are actually infections of the skin, people with a weak or compromised immune system are at a higher risk of getting infected. Some of the risk factors include:

• coming in close contact with someone who has a staph infection;
• having diabetes;
• being obese;
• having a chronic skin disease, such as acne, dermatitis or eczema;
• being HIV positive;
• smoking;
• using drugs intravenously;
• having a poor hygiene.

What are the symptoms of a Skin Abscess?

Abscess symptoms can vary depending on whether there is an infection or not and how advanced is the infectious process. An abscess in the skin usually appears as a lump that is round, swollen, red, firm and painful at touch. It also has pus inside, a white-translucent liquid and can have a point in the middle that represents the opening. All in all, it has a very similar appearance with a cyst. However, if the cause of the abscess is indeed an infection, some other symptoms (typical for infectious processes) can appear, such as fever, chills, inflammation, swollen lymph nodes, lesions of the skin and drainage of the fluid from the abscess. Abscesses that aren’t caused by infection with bacteria are usually less painful or even painless and don’t exhibit the symptoms of an infection.

How is a Skin Abscess diagnosed?

Usually, skin abscesses are not cause for a headache (literally and figuratively speaking). If the abscess is small and you don’t show any signs of an infection, the abscess can resorb and disappear by itself. If you show symptoms of an infections, such as swollen, hot, red skin in the area, fever, chills or any of the symptoms discussed before, you can still treat it at home with medication suggested by a healthcare professional. However, if you have a weak immune system, the abscess is large and doesn’t seem to get any better within two weeks, it becomes painful, extremely swollen or red, you should definitely go see a medical professional.

When visiting a doctor, they will perform a visual examination of the abscess. They might also collect a small amount of pus from the abscess to test for bacteria and if you have a history of repeated skin abscesses that could be caused by an underlying condition, the doctor might ask for a urine and/or blood sample.  

How is a Skin Abscess treated?

Abscess treatment plans depend on the severity of the abscess. If the abscess is small, usually it drains itself naturally, drying up and disappearing without intervention or treatment. An abscess home remedy can be applying a hot cloth to the area of the abscess. The heat will help with the infection, making it easier for the immune system to fight it because it increases the blood flow, which means that more white blood cells will arrive at the site. Beware though to use a clean cloth, sterile if possible and to dispose of it in a safe manner after using it in order to prevent further infections.

However, the bigger the abscess gets and the more uncomfortable the symptoms, antibiotics and drainage of the fluid are recommended. The antibiotics are prescribed by your doctor in order to get rid of the bacterial infection and also for preventing it to spread further more. If antibiotics alone are not helpful enough, the pus can continue to accumulate in the cavity of the abscess up to a point that it bursts. This can be quite painful and it can also mean that the infection can spread and the abscess can reappear.   

Abscess Surgery – Abscess removal

If you reach the stage where the skin abscess needs to be drained, this can be achieved by having a surgeon perform a small operation under local anesthetic (meaning you are awake and functional, but the area where the abscess is, is numbed so you won’t feel a thing). What the procedure entails is that the surgeon will cut the abscess in order to drain the pus (to let it all out). Once the pus is drained, the cavity of the abscess will be cleaned with a saline solution that is sterile. After this, the area where the abscess was will be left open and secured with a wound dressing meant to help drain out any of the pus that will potentially be produced after the intervention. Depending on the depth of the abscess, an antiseptic wick can be used to keep the wound open. This whole process can sometimes take some time and require multiple changes of the dressings of the wound until the skin is completely healed.

A very important thing to take into consideration is that drainage of an abscess should always be performed by a healthcare professional in a sterile setting, using sterile utensils. Skin abscesses are essentially skin infections that can spread or get infected with other bacteria and this can only lead to complications.

Complications of a Skin Abscess

Given the fact that we are talking about an infection, leaving a skin abscess untreated can determine the infection to spread into the bloodstream and lymphatic system, which in turn can have life-threatening consequences. Some of the other serious complications can be sepsis, spread of the infection to the spinal cord, endocarditis (infection of the heart), gangrene (the death of the tissue in the area where the abscess is) or even osteomyelitis (bone infection).

Can I prevent a Skin Abscess?

There isn’t a definite answer of yes or no. Sometimes it’s not easy to prevent it but with that being said, there are ways to lower the chance of getting a staph infection that can eventually lead to the development of an abscess. In order to do so you should maintain a good hygiene, to wash your hands properly and regularly, to clean any cuts or lacerations, however small and to bandage and cover your wounds.

Abscess versus other Skin conditions

We know now what an abscess is, but skin conditions come in many forms and sometimes it’s very easy to get them mixed up. For this reason, we will analyze in the paragraphs that follow the differences between abscesses and some skin conditions that are very similar.

Abscess vs Boil

Boils are infections of the superficial layer of the skin that accumulates a small quantity of fluid. The main differences between an abscess and a boil are that abscesses affect bigger areas of skin and they also affect the deeper layers of the skin tissue. The similarities these two conditions share are in the symptoms department. The affected areas are red, swollen, can be tender at touch and can also be accompanied by fever. Moreover, the main cause for either of the two is infection with staph.

Abscess vs Furuncle

Furuncles are usually called boils. However, one thing that is particular about furuncles is that the term refers to the infection of a hair follicle. Basically, a furuncle is an abscess or a boil affecting hair follicles (at least the terms are used interchangeably). The mechanism is: bacteria enters the follicle causing the immune system to raise the alarms and send white blood cells at the site to fight the infection. In doing so, dead cells and white blood cells form a liquid called pus that fills up the follicle until it gets inflamed and sometimes painful. However, one difference between abscess and furuncle is the depth of the area affected – abscesses affect deeper layer of the skin, while furuncle affect the more superficial layers, the ones that contain the hair follicle. The symptoms can also vary, abscesses taking longer to show any signs.

Abscess vs Cyst

There are a few differences between an abscess and a cyst. A cyst is a cavity containing pus or fluid that can have a lump-like feeling. This cavity or sac is usually surrounded by abnormal cells. There are many types of cysts (i.e. ovarian cysts, breast cysts, Baker’s cyst etc.) and most of them are non-cancerous, even though some can be malignant. We can see by now that there is a big difference in the way abscesses and cysts present themselves. Moreover, cysts usually grow slower and are not painful until they get bigger, while abscesses can be painful quickly, as well as cause the skin to get inflamed, red and swollen. However, one thing these two conditions have in common is the fact that they can develop in different parts of the body.

Different types of Abscesses

We’ve talked about abscesses that develop under the skin (abscesses under the skin), but there are also some other types of abscesses that can develop internally. As we continue, we will explain some of the more common abscesses that can affect someone’s functionality.

• Abscess in the mouth. If you’re wondering “what is abscesses in mouth” then you need to know that there are at least two types of abscess that can develop in the mouth (abscess mouth): dental abscess and gum abscess. Firstly, let’s talk about the latter. Gum abscesses are also known as periodontal abscesses and they are caused by bacteria that generates an infection of the space between the gum and the teeth. Suffering from periodontitis disease can be a risk factor for gum abscesses as this is an inflammatory condition caused by accumulation of plaque which is basically bacteria on your teeth. The symptoms of gum abscesses can be quite disruptive to one’s life: severe pain, swelling, sensitivity to heat or cold, loosening of the teeth, drainage of the pus or even fever.   
• Dental abscess. Dental abscess can refer to the infection and accumulation of pus inside the teeth or in the dental bone. An abscessed tooth can be a nuisance because its symptoms can be quite intense. These symptoms include: pain while chewing, swollen gums, aching of the jaw, throbbing pain in the tooth, pain that can radiate to the ear or the neck, loosening of the tooth, sensitivity to heat or cold, fever. We can see that the symptoms can be quite severe, affecting the root canal as well (abscess root canal). As far as abscess tooth treatment goes, your doctor will usually attempt to remove bacteria from the canals of the affected tooth, by cleaning them and the filling and sealing the empty spaces (abscess tooth drainage; abscess tooth removal). After some time, you will go in to visit your doctor again to get a crown installed that will restore the functionality of your tooth.

• Abscess in the neck. Neck abscesses are infections that develop in between the structures of the neck. They are also known as cervical abscesses or deep neck infections. While the pus or fluid accumulates in the cavity of the abscess, the soft tissues in the area expand and start to upset other structures in the neck, such as the throat, tongue or even the trachea. You may be wondering how does your neck get infected, right? Well, usually a neck abscess develops during or after catching a cold, having tonsillitis, sinus infections or ear infections. The symptoms are the same as with any type of abscess and treatment includes antibiotic medications and, if necessary, drainage.

• Abscess in the abdomen. Abdominal abscess (abscess stomach) are the accumulation of pus inside de abdominal cavity, usually around the liver, kidneys, pancreas. These can have multiple causes, such as: the appendix bursting, leaking of the intestine, perforation of a diverticulum, an ovary bursting, infection of the gallbladder or parasite infestation.
• Abscess in the kidneys. Renal abscess (abscesses on kidneys), also known as perirenal abscess is a cavity of pus that forms inside the kidney tissue. What usually causes renal abscesses is bacteria travelling from another part of the body (for example if you have a urinary tract infection – UTI) into the kidney. If you have kidney disease or inflammation diabetes, surgery of the urinary tract or reproductive organs, this can also contribute to the development of kidney abscesses.
• Breast abscess. Subareolar breast abscess (abscesses under breasts) is a breast infection that usually affects breastfeeding people, as well as people who don’t breastfeed. These abscesses develop just under the areola which is the colored skin circling the nipple. This usually happens as a result of coming in contact with bacteria in that spot or can be caused by the blockage of a duct or gland. The symptoms typically include pain and tenderness of the area as well as pus leaking from the abscess. If it’s not treated, a fistula can form meaning that the lactating ducts and the skin will connect. Also, nipple inversion can also be a consequence of a breast abscess left untreated.
• Abscesses under armpit. Abscesses that develop under the armpit are just like any other abscesses, but the problem with these is that they can be a consequence of a long term skin condition known as hidradenitis suppurativa. This condition develops in the areas that have hair follicles and sweat glands. The cause is not known and it is quite rare. The lumps that develop are very painful and can easily get infected.
• Abscess in the lymph nodes. Abscess in a lymph node (abscess lymph node) is usually a consequence of an infection left untreated for too long. It requires antibiotics or drainage.

Conclusion

Abscesses are cavities with fluid that can develop beneath the skin or inside the different tissues in the body. The main cause for abscesses is bacterial infection that can be treated with at home remedies, antibiotics or drainage, depending on the severity of the infection. While the symptoms are manageable for some types of abscesses, for others they can be quite uncomfortable and if left untreated, the infection can become life-threatening. Don’t hesitate to consult a medical professional if your symptoms persist.