abscess

introduction

An abscess is an encapsulated collection of pus in a non-preformed body cavity. This is caused by inflammatory melting of the tissue skin. The pus consists of:

  • bacteria
  • dead cells and
  • Immune defense cells (white blood cells)

The inflammatory reaction is caused by various bacteria, which are often part of the normal skin flora, and can penetrate through injuries in the skin and cause inflammatory reactions there. Due to the accumulation of pus, the abscess exerts pressure on the surrounding tissue, which can lead to pain.

Abscesses vary in size between small, barely visible, round knots and area-like areas that can be as big as a palm. If an abscess forms on a hair root, it is called a boil, and if several boils fuse together, it is called carbuncle.

In principle, abscesses can occur everywhere:

  • brain
  • liver
  • Anus ( anal abscess )
  • gums
  • face

However, they are most common in or under the skin, as they are usually the first to be confronted with potential pathogens. In contrast, an empyema is a collection of pus in an already preformed body cavity. (eg paranasal sinuses)

Symptoms of an abscess

The superficial abscess shows typical skin reactions, as common in an inflammatory reaction, with redness, swelling and overheating of the skin over the abscess. In some cases, the collection of pus is also recognizable as a white dot / white area. Often, there are also pain, especially on pressure (with anal abscesses while sitting or when defecating) strengthen. Depending on the size of the abscess, it can look almost exactly like a pimple.

Lower abscesses can initially run completely asymptomatic until they open up and it comes to the spread of the pathogens in the body. Then typical clinical symptoms with fever and general malaise appear, according to which one should consult a doctor at the latest at this time.

If the pathogens spread in the bloodstream, there is a risk of sepsis, which is associated with very severe general malaise and high fever. If left untreated, sepsis can lead to multiple organ failure and thus be fatal. This is why it is a very serious disease requiring rapid antibiotic therapy. Because of this, an abscess should always be treated early.

Clear signs of urgent treatment are:

  • fever
  • Increase in the size of the abscess
  • clear redness and
  • Pain in the abscess area

Often the terms "abscess" and "boils" are used as synonyms. But there are some clear distinctions. Read our article : Abscess or Boil

Itching in an abscess

The inflammatory reaction on the skin can cause redness and itching on the skin. In general, itching is not a leading symptom of the abscess, but rather rare. Pain, swelling, hypersensitivity and pus are more commonly described, as well as systemic symptoms such as fever, fatigue and headache and body aches.

Causes of an abscess

In abscesses bacteria accumulate.

The majority of abscesses arise without obvious cause. As a rule, bacteria are the triggering factors of an abscess. In response, the body activates the immune system and the white blood cells fight the pathogen causing the pus. Finally, the body forms one more capsule around the pus accumulation to prevent the abscess from spreading further in the body.

Often, genera of Staphylococcus aureus can be isolated from the abscess. But also streptococci, which belong to the normal skin flora, tuberculosis bacteria or fungi can cause inflammatory reactions and thus abscesses.

The pathogens can penetrate through the smallest injuries in the skin and lead to the formation of an abscess. But also

  • operations
  • Foreign body or
  • splash

can contribute to the formation of abscesses by the entry of pathogens into the skin. Abscesses occur less frequently in the context of chronic inflammatory diseases such as Crohn's disease.

In addition, there are a variety of factors that favor the development of an abscess. These include:

  • already damaged skin (eg eczema or psoriasis)
  • a weakened, body-own defense
  • Metabolic diseases such as diabetes mellitus
  • poor supply of wounds
  • poor body hygiene
  • tight-fitting, scuffing clothes
  • an inflammation of the glands in the anal canal (the procteal glands)

As a protective mechanism, the body builds a protective barrier around the abscess to curb the spread of the pathogens. This protective barrier consists of granulation tissue that contains numerous defense cells and is called an abscess membrane .

The pus within the abscess cavity consists essentially of dead cells, bacteria and defense cells ( neutrophilic granulocytes ). In addition to these ordinary abscesses, there are still the "cold abscesses". From these no pathogens can be isolated. Reasons for this abscess formation are not yet sufficiently explained.

Illustration of an abscess

Figure abscess

abscess
(pus-filled capsule)

  1. Reddened swelling
  2. Epidermis -
    epidermis
  3. Pus -
    Pus
  4. Connective tissue capsule
  5. Bacteria -
    Bacteria
  6. Dead cells
  7. Immune defense cells -
    leukocytes
    White blood cells
    symptoms:
    Redness, swelling,
    overheat

diagnostics

As an abscess often causes pain, it usually leads the affected person quickly to the doctor. This can easily recognize an abscess and distinguish it from similar skin conditions. The first and probably most important evidence for the diagnosis of an abscess on the skin are the clinical symptoms described above. Since an abscess is always accompanied by a marked redness, it differs from pimples or boils.

Another important differentiation to the boil is that they always occur at hair roots and thus can be easily distinguished by a physician. In addition, an abscess is often accompanied by pain and possibly by fever.

Another essential part of abscess diagnostics is a blood test. In the laboratory one can detect an increase of inflammatory values ​​(the C-reactive protein = CRP and white blood cells = leucocytes ). In addition, in some cases it may be useful to take a swab from the affected skin site to find the pathogen that is present, so that you can then initiate a targeted therapy, if necessary.

Also in the imaging process:

  • Ultrasonic
  • Computed Tomography
  • MRI

the abscess cavity can be represented. Last but not least, the abscess shows the accumulation of pus, which shows typical pathogens in the microbiological laboratory.

Localization of an abscess

Abscesses can occur in principle everywhere, but are usually the most common under or in the skin, as it is often confronted with pathogens.

Abscess in the armpit / armpit

Abscesses can also form in the armpit. The disease, medically usually called axillary abscess, is a mostly painful inflammation in the armpits. There are different causes for the development of an abscess at this point into consideration.

In many cases, the abscess is preceded by inflammation of the sweat glands. But even an infection of the lymph nodes can lead to such an abscess. Notably, an abscess in the armpit usually causes a palpable and visible swelling under the skin. Large abscesses may cause motor impairment of the arm on the affected side.

In particular, the lifting of the arm can sometimes be carried out only under pain. An abscess in the armpit, depending on the individual course of the disease, can be treated conservatively with antibiotic drugs and ointments or surgically by clearing the pus under the skin.

In general, the prognosis for an abscess in the axillary region is very good, provided that a diagnosis and then an individually appropriate therapy are initiated quickly.

Abscess on the chest

Breast abscess is a painful complication of breast inflammation ( mastitis ). As with the inflammation of the chest, the causative agent is usually Staphylococcus aureus, which is usually transmitted from baby to mother during breastfeeding.

In addition to the typical signs of inflammation, which occur in the context of a breast abscess, such as weakness, redness, fever and pain occurs in an abscess and a noticeable swelling in the chest. It can also happen that the lifting of the arm on the affected side is only feasible in pain.

If a breast abscess is suspected, a gynecologist should be consulted for a quick assessment. In addition to a conservative therapy, in which antibiotic drugs are used, a breast abscess can also be treated surgically. Overall, abscesses of the breast have a good prognosis. Especially if a timely adequate therapy is carried out is to assume a rapid, complete healing.

Abscess in the groin

An abscess in the groin can occur for various reasons. Thus, an abscess may occur due to inflammation of the hair root or a drainage disorder of a sebaceous gland. In addition, a so-called subsidence abscess can occur. Such an abscess is an abscess that developed primarily in the area of ​​the spine and only secondarily migrated along a muscle into the pelvis or groin area.

An abscess in the groin may cause restricted hip movement and pain in the affected area. It can also cause visible swelling, redness and overheating of the region. The individual therapy depends on the cause and the size of the abscess.

An abscess in the groin should always be clarified by a doctor. Medically, a targeted antibiotic therapy against the causative agent can be performed. A surgical removal of the abscess is possible and necessary in many cases. When removing the abscess abscess, it is also necessary to consider removal of the primary abscess.

Abscess on the tonsils

In abscesses, which occur in the throat in the area of ​​the tonsils, it is usually about so-called peritonsillar abscesses . These can develop as part of an tonsillitis ( tonsillitis ) as a complication. As with tonsillitis itself, streptococci are the causative agents of the onset of the abscess. In rare cases, such an abscess may also arise as a result of almond removal. Especially if the tonsils have not been completely removed, an abscess is easily formed.

In addition to symptoms that can be explained by the bacterial infection, such as a weakened general condition and fever can also occur in an abscess in the tonsils swallowing and visible redness in the throat area. Depending on the size of the abscess, speaking may also be difficult for the individuals concerned.

If the treating physician has diagnosed such an abscess therapy should be initiated immediately. Usually, a targeted antibiotic therapy is started. In addition, the abscess is opened to drain the pus there. To prevent repeated abscesses, almond removal should be considered.

Abscess on the tooth

An abscess can also occur in the mouth area such as on the teeth. More specifically, the abscess occurs in the area of ​​the tooth root. The abscess is usually caused by bacteria. Thus, in most cases, in addition to the abscess, there is an advanced caries finding or other bacterial inflammation of the tooth or gum.

Noticeable is a tooth abscess caused by severe toothache. It can also cause the affected tooth to relax. At the same time, it can cause swelling, which is also visible from the outside.

Since it is a bacterial infection also fever can occur. The therapy of the abscess depends on the degree of progression of the disease. The primary therapy is done with antibiotics. In many cases, even a targeted antibiotic therapy can lead to a cure of the tooth.

In order to prevent a second abscess, it may be necessary to perform a root canal treatment and thus to restore the tooth. In case of an advanced abscess with destruction of the tooth and in severe cases even of the adjacent bone, complete removal of the tooth may be necessary.

Abscess on the leg

Abscesses can also form on the leg.
This affects more men than women, as a strong leg hair in conjunction with mechanical stress (rubbing the pants) promotes the development of an abscess.

Abscess on the face

For example, abscesses in the face can occur in men due to shaving injuries. Often bacteria are responsible, which belong to the normal Hautbesiedelung in the face area. In addition to the so-called streptococci, these include above all a certain subgroup of staphylococci, the so-called Staphylococcus aureus. Small injuries or abrasions of the skin on the face are a possible portal of entry for the disease-causing pathogens. These small skin irritations can develop very quickly, especially in the face. However, previous inflammations such as inflammation of the ear canal can lead to an abscess, in this case to an abscess formation in the ear.

  • Abscess on the face
  • Abscess on the forehead

Is an abscess contagious?

The abscess itself is not contagious. It is a purulent pimple with local inflammatory reaction and is caused by bacteria. Therefore, the pus that can escape from the abscess when it is opened is highly contagious. If left untreated, the pus can pass from the abscess into the bloodstream and lead to blood poisoning. But as long as you treat the abscess and no one has contact with the abscess and the pus, it is not contagious.

The therapy for an abscess

Most abscesses are treated surgically.

It is important to avoid squeezing abscesses to get rid of the pus, as this creates a high risk of germ transmission.

In principle, every abscess should be relieved. This means that as part of a more or less large operation, the abscess is opened and so the pus can drain. The exact procedure of the operation and also the type of anesthesia (general or local anesthesia) depend on:

  • Size and localization of the abscess
  • which pathogen it was caused
  • Pre-existing conditions of the patient

In general, the treatment is as follows: First, the doctor uses a scalpel to sever the skin and the tissue until the abscess is opened and the pus can drain ( incision ). As a rule, the abscess cavity is rinsed first, before a drainage is then inserted without endangering other surrounding tissue by an infection. When the pus is completely deflated, in a next step, the inflamed tissue must be removed and the resulting wound cleaned.

Normally, these two steps are performed as part of an intervention, but in the case of very large abscesses, a two-stage procedure (re-intervention) may occasionally be necessary. After the drainage the wound is not sewn up. One would like to prevent that possibly not completely removed pathogen or liquid encapsulate again and thus an abscess arises again. For this so-called secondary wound healing to take place, however, it is of utmost importance that the wound is cleaned at regular intervals and the bandages are changed regularly.

For abscesses that are not visible from the outside and inaccessible with a simple scalpel (for example abscesses in the abdominal cavity), the drainage must be performed either with sonographic or CT control to ensure that the needle inserted for relief also actually hits the abscess. Not infrequently, especially with advanced severity of abscesses (especially in sepsis), antibiotics are administered in addition to abscess drainage. Which means are used depends on:

  • Type of abscess
  • Type of pathogen
  • possibly all ergie gg. a specific preparation

Occasionally an abscess is still "immature, " meaning that the aching, newly developing cavity has not yet completely filled with pus. In order to accelerate the maturation of the abscess, ointments can be used, which increase the blood circulation and thereby the effectiveness of immune cells.

Pierce the abscess

Abscesses are punctured under sterile conditions, allowing the pus to drain.

The best treatment for an abscess is the surgical opening, the "pricking". An abscess is a collection of pus that has become isolated from the rest of the tissue and is mostly caused by bacteria such as staphylococci. Through the capsule, the inside of an abscess is poorly achieved by antibiotics, for this reason, an abscess should be opened and the pus drained.
Abscesses can form anywhere in the body, very large and difficult to reach abscesses may require surgery under general anesthesia. Superficial, easily accessible abscesses, for example, of the skin can also be pierced under local anesthesia.
When piercing an abscess, the capsule is first opened and then the contained pus is drained. The abscess cavity must then be rinsed with disinfectant rinsing liquid to remove even the last remains of pus. The empty capsular cavity is tamponated with superficial abscesses with antibacterial material, the open wound is not closed. This procedure of open wound treatment is necessary to avoid re-encapsulation of infected tissue.

The tamponade is removed daily at the beginning, the empty capsule cavity rinsed again and inserted a new tamponade. The open wound treatment is continued until a refilling of the abscess cavity is no longer expected.
In deep abscesses, for example, in the abdominal cavity, of course, no open wound treatment can be performed. Such an abscess is opened under general anesthesia and sucked the pus. After rinsing, a drainage system is inserted, which, by means of a gentle suction, directs wound fluid and pus from the inside of the body to the outside into a drainage bottle, thus keeping the empty abscess capsule clean.
In the case of large abscesses, concomitant antibiotic treatment must often be performed despite the surgical treatment. In the case of smaller abscesses, puncture and subsequently properly performed wound treatment is generally sufficient and the administration of antibiotics is unnecessary.
An abscess should not be stabbed or pushed by sufferers. There is a risk here that the bacteria settled in the pus spread to previously unaffected tissue or that the abscess capsule is not completely emptied, because a disinfecting rinse by the person concerned can not be performed properly. Germicidal transmission could cause further abscesses or lead to sepsis. Should an abscess open by itself, sufferers should also contact a doctor to have him do a conditioner and wound tamponade. Clean and hygienic work is very important in the abscess treatment.

Ointments against an abscess

For the treatment of abscess many salves are available, which are available for free sale in the pharmacy, but also various prescription preparations, these contain ammonium bituminosulfate, an ingredient of oil shale. These ointments work by increasing the circulation in the affected area, which helps to remove pathogens. A better removal of bacteria is also mediated by the absorption-promoting properties of these so-called train ointments. In addition, the ointments for abscess treatment inhibit the development and spread of inflammation as well as the development of pain. Drawing or drawing ointments are recommended in the early stages of abscesses as they can prevent the spread of pathogens in small pus accumulations.
However, large abscesses associated with severe redness, pain, and possibly even fever should not be treated by a single ointment alone, as the ointment will not be able to penetrate larger capsules. However, an ointment may be good for supporting the treatment of an abscess, as it softens the skin over the abscess and reduces the abscess capsule. The ointment should be applied thickly once a day to the abscess until the abscess is full and can then be pierced by the doctor. The ointment aids the "maturation" of the abscess, a process in which the tissue melts, the abscess contracts and the pus accumulates completely.
Ointment can be applied to small abscesses, boils (hair follicle inflammation) and carbuncles (multiple boils), acne and purulent nail bed infections, speeding up the healing process. Should the abscess increase under the treatment with Zugsalbe nevertheless, a rapid splitting of the Abszesses by the physician is the only lasting treatment method.

Zinc ointment against an abscess

The zinc ointment has been used for a long time for the treatment of wounds, as it has anti-inflammatory, disinfectant and wound healing promoting. It is used especially on the edges of wounds or itchy and weeping spots. On open wounds it is rather not used, since it dries up the wounds. It is recommended for the treatment of rashes, lichen, acne and burns. Since the abscess in the acute case is an open festering wound, it should not be treated with zinc ointment in this condition, but better consult a doctor. As long as the abscess is closed, zinc ointment can be used.

Prognosis at an abscess

The prognosis of an abscess is usually very good with appropriate therapy.

Abscesses usually heal very well when the right treatment is done. However, one has to realize that the time to complete healing can sometimes take several weeks and requires discipline, as the wound must be cleaned regularly and the dressing must be renewed. It is important to stay patient during this time and not strain the wound too much, as this in turn can get germs into it.

If the abscess has not been treated properly or if it could not be completely removed, there is a risk that an abscess may re-emerge at the same site after some time. Of course, the exact prognosis of an abscess depends not only on the correct treatment, but also on its size and localization.

If an abscess, despite adequate therapy, does not heal properly or always returns, it may be indicative of an immune deficiency or diabetes mellitus and should be clarified by a doctor. Thus, the thorough removal and pathogen-specific antibiotic therapy is very important in order to treat the abscess sufficiently. Nevertheless, some forms of abscess can bring dangerous complications. All the more important is the specific treatment of the abscess.

Duration until healing

The duration of healing depends on the size, location and treatment of the abscess. The bigger the abscess, the longer it takes to regrow, if it had to be surgically removed. A small abscess can only be dried out by applying a train ointment within days to weeks. A large abscess usually needs to be operated on, opening the abscess and removing inflamed tissue. This must then grow together again. That too will take a few weeks.

Depending on the location of the abscess, it is also harder to treat it, which is why it takes longer to heal it. For example, removing an abscess on the face is more difficult than on the buttocks. Finally, it depends on how and if you can treat the abscess. Without treatment there is a risk that the abscess spreads, it comes to a blood poisoning or the abscess comes again and again. Of course, this significantly increases the healing time.

If the abscess is favorable, not too large and can be surgically completely removed, chances are it will heal without complications. This can take several weeks. When treating the wound, it is important to rinse the site well daily and change the dressing daily to prevent an abscess from forming again. If the abscess can not be completely removed due to its size and location, it will drain for 6-8 weeks. The abscess can still heal without complications, but the disease duration is extended to weeks to months. In general, an abscess is a lengthy illness that requires good hygiene to prevent it from getting back to you.

prophylaxis

In general, however, it helps to pay attention to a thorough body hygiene and to wear air permeable, not too tight clothing. In addition, a balanced diet is important for the prevention of anal abscess, as a firm bowel movement can contribute to an inflammatory reaction of the proctal glands.

It is difficult to protect yourself from abscesses, because you often can not influence the development. Syringe abscesses can be avoided by proper disinfection before the intervention. Even passed abscesses can be avoided by careful and specific treatment of the underlying disease. It is particularly important that the infections of the Pneumatisationsräume in the head are well and adequately treated, as brain abscesses can bring serious consequences and in some cases, lethal, ie fatal, end.

Abscess with fistulas

An abscess arises from the inflammation of the scent glands ( proctodeal glands ), which are located between the inner and outer sphincter muscles in the area of ​​the anal canal. Your gland ducts open into the anal canal. The inflammation swells the tissue and the secretion can no longer flow through the excretory ducts. As a result, a collection of pus forms and a pus filled in the area of ​​the anus develops.

In the fistula, a fistula pass through the muscles through to the anal canal and the pus is released into the anal canal. Only when the fistula tract is blocked, it comes to the same symptoms as an abscess. This can be relapsing. That is, the fistula is usually invisible, but can often lead to acute bursting pus with pain through blockage of the fistula.

Summary

Nobody is safe from a single abscess formation. The abscess is an infection that occurs in most people once in a lifetime and can usually be treated simply and without consequences. However, as an abscess can lead to blood poisoning or spread to other organs, it should always be treated carefully and as early as possible. This avoids complications and surgical interventions. In addition, sufficient hygienic measures and disinfection should prevent the formation of avoidable abscesses.

Big Abscess in the ER (December 2019).


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