Definition

An abscess is a pouch filled with a collection of pus in a certain part of the body. A body part with an abscess will feel painful. Abscesses are typically caused by bacterial infections and can develop anywhere in the body. In general, abscesses are divided into two categories:

• Skin abscesses are abscesses that form beneath the skin
• Internal abscesses are those that develop within the body, in the internal organs, or in the spaces between organs

When the body becomes infected, the immune system attempts to fight the infection. White blood cells that gather in the infected area are primarily responsible for fighting the infection. Inflammation occurs as a result of white blood cell reactions to infection. Pus will develop during the inflammation process. Pus consists of both living and dead white blood cells, germs, and dead body tissues.

Skin abscesses are easily identified because they are typically reddish, bulging, and painful. Abscesses that form inside the body may go undetected and cause organ damage.

Causes

The majority of abscesses are caused by an infection with the bacterium Staphylococcus sp. When bacteria enter the body, the immune system activates white blood cells to fight the infection. This causes swelling, inflammation, and death of the tissue surrounding the infection site.

As a result of the inflammation, a cavity forms and fills with pus, forming an abscess. The pus consists of dead tissue, white blood cells, and bacteria. Abscesses can grow in size and become more painful as the infection spreads and more pus is produced.

Some strains of Staphylococcus sp. bacteria produce a toxin known as Panton-Valentine Leukocidin (PVL), which can kill white blood cells. This contributes to the development of recurring infections. To continue fighting the infection, the body needs to produce more white blood cells. In rare cases, abscesses can sometimes be caused by viruses, fungi, or parasites.

Skin abscesses

A skin abscess develops when there is an excess of bacteria under the skin. Skin abscesses can develop anywhere on the body, but they are more common in the armpits, hands, feet, genitals, and buttocks.

Bacteria can enter the skin and cause an abscess if there is a wound, no matter how small or hidden. Bacteria can also enter through the hair roots or clogged oil and sweat glands.

Internal abscesses

Internal abscesses are those that form inside the body's organs. An abscess inside the abdominal cavity, for example, can be caused by an injury, abdominal surgery, or an infection that spreads from the abdomen to the surrounding area, such as a lung abscess. A lung abscess can develop after a bacterial infection in the lungs, such as pneumonia.

Risk Factors

Factors that increase the risk of an abscess include:

• Having a weakened immune system, such as in HIV patients or those undergoing chemotherapy
• Suffering from diabetes
• Inflammation in one part of the body, such as hidradenitis suppurativa, which is inflammation in areas with hair and sweat glands, such as the armpits
• Being a carrier for the bacteria Staphylococcus sp

Symptoms

Skin abscesses

Signs and symptoms of a skin abscess include:

• Soft swelling under the skin
• Pain and tenderness in the affected area and beyond
• Feeling warm and reddish in color
• Visible accumulation of white or yellow pus under the skin
• Fever
• Chills

Boils are the most common example of skin abscesses.

Internal abscesses

Abscesses that form inside or between organs are more difficult to diagnose than skin abscesses because they cannot be seen directly and have atypical symptoms.

The symptoms of internal abscesses differ depending on their location. For example, a liver abscess may cause jaundice (yellowing of the skin and eyes), whereas a lung or lung-related abscess may cause coughing or shortness of breath.

Common symptoms of internal abscesses include:

• Discomfort in the area of the abscess
• Fever
• Excessive sweating
• Feeling unwell
• Pain in the affected area
• Chills
• Pain or swelling in the affected area
• Loss of appetite
• Weight loss

Diagnosis

Skin abscesses

If you have a skin abscess, your doctor will examine the affected area and inquire about the abscess' duration, any previous cuts or injuries to the abscess area, and any other symptoms you are experiencing.

A sample of pus from the abscess will be collected and sent to a laboratory for testing for the specific bacteria causing the abscess, which will help determine the best course of treatment.

If you have more than one skin abscess, you may be given a blood sugar test, which can indicate diabetes. People with diabetes are more likely to develop skin abscesses.

If you have recurring boils and abscesses, your doctor will order additional bacterial testing to determine whether the bacteria produce Panton-Valentine Leukocidin (PVL) toxin.

Internal abscesses

Abscesses that form inside the body are more difficult to detect than skin abscesses because they are not visible. Your doctor will ask you about your symptoms and overall health condition.

If necessary, you may be referred to a more comprehensive health facility for further examination.

Management

There are several ways to treat an abscess, depending on its type and size. Abscesses are treated primarily with antibiotics, drainage procedures, and surgery.

Skin abscesses

Some small skin abscesses may drain on their own and improve without the need for treatment. Warm compresses applied to the affected area can help reduce swelling and promote healing. To avoid spreading the infection, the compress cloth should be thoroughly washed after each use and not shared with others.

In larger or persistent skin abscesses, doctors may prescribe antibiotics to treat and prevent infection spread.

However, antibiotics alone are not always effective in treating a skin abscess, and the pus must be drained to cure the infection. If the pus is not drained, the abscess will expand and fill with pus until it bursts. This can be extremely painful and lead to the infection spreading or recurring.

Incision and Drainage

If the skin abscess needs to be drained, you will need to have minor surgery under local anesthesia to remove the pus. The doctor will also take a pus sample for laboratory testing.

Internal abscesses

In an internal abscess, the pus needs to be removed or drained. Drainage can be done surgically or by inserting a needle through the skin (percutaneous abscess drainage). The method used depends on the size and location of the abscess.

The drainage procedure will be combined with antibiotics to kill bacteria and prevent infection from spreading. Antibiotics are administered either orally or intravenously.

Percutaneous drainage

If the internal abscess is small, the doctor can remove it using a fine needle. The surgeon uses ultrasound to help guide the needle to the correct location.

The doctor may also make a small incision over the abscess to insert a drainage catheter. The catheter allows the pus to drain into a collection bag. This procedure can be performed under local or general anesthesia.

Percutaneous drainage, like any other incision and drainage procedure for a skin abscess, can leave a small scar.

Surgery

Surgery is necessary if:

• The internal abscess is too large to drain with a fine needle
• The needle cannot reach the abscess safely
• Needle drainage is not effective in removing all the pus

The type of surgery depends on the type and location of the internal abscess. The surgical procedure typically entails making a larger incision in the skin to drain the pus.

Complications

Skin abscesses can cause complications, including:

• Carbuncles or multiple abscesses forming
• Fever and swollen lymph nodes
• Endocarditis (inflammation of the heart muscle)
• Gangrene or tissue death in the abscess area
• Osteomyelitis (bone infection)
• Infections can spread throughout the body via blood vessels or lymph nodes and are potentially fatal. An infection that spreads throughout the body through the bloodstream is called sepsis
• Treatment is more difficult if the infection is caused by MRSA bacteria

Prevention 

Prevention of abscesses can be done through:

• Routine hand washing with soap and running water
• Not sharing towels and clothes with others
• Waiting for the skin abscess to completely heal before using public equipment or facilities such as gymnastic equipment, saunas, or swimming pools
• Do not squeeze the abscess with your hands because this will spread the bacteria to other areas of the skin
• To avoid spreading bacteria, dispose of any tissues used to clean the pus and wash your hands afterward
• To avoid injuring the skin, carefully shave the hair on your face, legs, armpits, or the area above your genitals
• If the wound is small, clean it thoroughly and treat it properly
• Seek medical attention right away if you have a puncture wound caused by a human, insect, or animal bite, especially if it contains suspected dirt or foreign material
• You are at risk of developing an abscess if you are taking steroids or chemotherapy
• Maintain a healthy and balanced diet
• Maintaining ideal body weight
• Quit smoking

Internal abscesses are difficult to prevent because complications from other medical conditions often cause them.

When to See a Doctor? 

If you have the abovementioned signs and symptoms of an abscess, see your doctor.

Seek immediate medical attention if you experience:

• Signs of serious illness, such as fever
• Recurrent abscesses
• Abscesses are associated with weakened immune systems and chronic illnesses such as diabetes

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