Skin abscess is a local purulent inflammation of the skin, characterized by the formation of a cavity limited by the so-called pyogenic membrane. Symptoms of an abscess are redness, swelling, and sometimes soreness, in place of which a pus accumulation then forms. All this may be accompanied by general symptoms of intoxication (fever, weakness, headaches). Diagnosis of skin abscess is carried out on the basis of examination of the patient, in some cases, basic studies (general blood and urine tests) are additionally prescribed. Local treatment is performed by a surgeon – the cavity is opened and treated with an antiseptic, in some cases general antibacterial therapy may be prescribed.
ICD-10
L02 Skin abscess, furuncle and carbuncle
General information
Skin abscess is usually an acute purulent inflammation affecting the skin on any area of the body. Unlike phlegmon, the abscess is limited, it is a cavity filled with pus and surrounded by a pyogenic membrane. In most cases, this shell reliably prevents the spread of infection to the surrounding tissues, but sometimes pathogens from the focus can get into the blood or lymph. This leads to more severe conditions – lymphangitis, lymphadenitis, metastatic abscesses of internal organs. In some areas of the body rich in vascular anastomoses, the appearance of ulcers is especially dangerous – for example, skin abscesses in the nasolabial triangle can lead to inflammation of the cavernous sinus, meningitis, brain abscess.
Causes
In the vast majority of cases, the causative agents are bacteria. They can penetrate into the skin when they are damaged, through microcracks, and are occasionally introduced there hematogenically from other inflammatory foci in the body. The type of bacteria that cause the appearance of a skin abscess can be different – Staphylococcus aureus, Pseudomonas aeruginosa and E. coli. Most often, the development of such a condition is caused not by one type of pathogen, but by their combination.
Of great importance in the development of skin abscess is a decrease in the activity of local protective factors – for example, with local hypothermia, diabetes mellitus, the presence of immunodeficiency, non-compliance with personal hygiene rules. After the penetration of bacteria into the skin, their reproduction begins with the formation of a pathological focus. All this is recognized by the immune system, which begins to react first with non-specific protection factors – blood vessels expand, blood flow to this area of the skin increases, the absorption of tissue fluid slows down.
These changes cause the first manifestations of skin abscess – redness, swelling, painful sensations. After that, immunocompetent cells – macrophages and neutrophils – arrive at the focus, which begin to phagocytize pathogens. As a result, pus is formed from a mixture of tissue fluid, living and dead neutrophils and bacteria – it stimulates skin fibroblasts, which form a membrane around the focus. The inflammation takes the form of a typical skin abscess.
Symptoms
The development of a skin abscess is characterized by a certain stage, the duration of each stage is quite different in different cases and depends on many factors – the state of immunity, the type of pathogen, the localization of inflammation. The initial stage begins with the development of redness of the skin area, the appearance of swelling, painful sensations. The temperature of the affected area is noticeably higher than that of the surrounding unchanged tissues.
The size of the redness gradually increases, in some cases reaching 3-4 centimeters – it depends on this stage what the diameter of the skin abscess will be in the future. General symptoms at this time, as a rule, are not observed. Then the production of pus begins – the center of the focus begins to turn yellow, softens, but soreness and swelling persist, sometimes there is a feeling of bursting in the affected area. This stage of the formation in most cases occurs 3-4 days after the manifestation of the first symptoms.
The spread of inflammation most often no longer occurs, so the size of the formation remains the same. Pus, in fact, is a mixture of toxic tissue breakdown products that are partially absorbed into the blood and lead to a deterioration in the general condition of a person – fever, weakness, impaired appetite, sometimes nausea and vomiting. The severity of these symptoms depends on the size of the skin abscess – the larger it is, the more difficult the patient feels, whereas with small ulcers, changes in the general condition of a person may not occur at all.
At the final stage of its development, in the absence of treatment, a skin abscess most often spontaneously opens, pus flows into the external environment. This reduces soreness and swelling, improves the general condition of a person. However, in some cases, it is at this stage that quite severe complications of a skin abscess may develop.
Complications
The most common complication is the spread of infection by lymphogenic route with the development of lymphangitis and regional lymphadenitis. Sometimes the opening of the cavity of the skin abscess may occur not in the external environment, but in the surrounding tissues, which leads to spilled purulent inflammation – panniculitis, phlegmon. The dissemination of bacteria by hematogenic means is not excluded – this can lead to metastatic purulent foci, and in particularly severe cases, to sepsis.
Diagnostics
In most cases, the diagnosis of “skin abscess” is not a problem, its manifestations are familiar enough to any dermatologist. Upon examination, it is possible to determine at what stage the development of the disease is. At the stage of the formation of a skin abscess, the focus of edema and redness will be determined, painful on palpation, dense to the touch. At the subsequent stage of development, the formation will already have a yellow “corolla”, it will become softer to the touch, but the soreness and elevated temperature of the focus will remain. In addition, objectively, fever and vomiting can be determined in the patient.
During the examination, it is also necessary to check the regional lymph nodes – they will almost always be enlarged, but painless. A sharp increase in their size in combination with soreness indicates the onset of lymphadenitis. A general blood test for skin abscess, as a rule, contains non-specific signs of inflammation in the body. These include leukocytosis, neutrophilic shift to the left, an increase in the rate of erythrocyte sedimentation. The combination of these manifestations makes it possible to refer the patient to a surgeon for the treatment of a skin abscess.
In some cases, as part of the diagnosis of a skin abscess, a microbiological examination of the pus is also performed – the pus is separated into nutrient media to identify the type of pathogen. This is necessary in order to choose the most effective antimicrobial drug for the treatment of this condition and its complications. However, such a study requires a lot of time (several days), therefore, in uncomplicated cases of skin abscess, it is practically not used, and antibacterial therapy is performed with broad-spectrum drugs.
Skin abscess treatment
Treatment includes both local measures and general antibacterial therapy. When treating a patient with the initial manifestations of the formation of a skin abscess, specialists in the field of dermatology and surgery most often recommend waiting (letting it “mature”). After the abscess is fully formed, the surgeon opens it, rinses the cavity with an antiseptic (for example, chlorhexidine), and installs drainage.
Antibacterial therapy is necessary for significant skin abscess sizes or severe general manifestations of the disease to prevent complications. It can include both broad-spectrum antibiotics and other antimicrobials (for example, sulfonamides).
Prognosis and prevention
The prognosis is usually favorable, but with a decrease in immunity or diabetes mellitus, complications of a skin abscess can pose a threat to health and even life. The prevention of the development of an abscess is the maintenance of the immune system at the proper level, proper personal hygiene, compliance with the rules of asepsis during injections, medical and cosmetic manipulations.
