Brief overview
- Treatment: Opening of the abscess by the physician, administration of antibiotics
- Description: Encapsulated collection of pus in the tissue.
- Symptoms: Very varied, including: Redness, pain, swelling
- Causes and risk factors: Mostly bacteria that enter the body via wounds, operations, injections or other infection routes
- Diagnostics: Examination of the affected body region; if necessary, blood tests and imaging examination methods
How to treat an abscess?
Normally, the immune system disposes of dead body cells and pathogens. However, an abscess (boil) is difficult for immune cells to reach. For an abscess to heal, it is important for a doctor to open it from the outside (for example, cut it open) and drain it as soon as possible.
Abscess surgery
In abscess surgery, the doctor opens or splits an abscess as gently as possible through an incision and, in the best case, removes the entire contents. Depending on the extent and severity of the abscess, a general practitioner or a surgeon is responsible for the operation.
For some boils it is enough to lance them. This applies, for example, to very superficial abscesses of the skin. In the case of larger or deeper abscesses, on the other hand, the doctor makes sure that he completely empties the pus cavity and that the abscess cavity does not close up again (open wound healing). In this way, the abscess has the opportunity to heal from the inside out after it has been opened.
After abscess surgery in the anal region, the doctor recommends that the patient clean the wound with clean water (shower) in the morning and evening and after defecation.
How long you are sick or on sick leave after abscess surgery depends, among other things, on the location of the abscess and how long it takes to heal. The same applies to the duration of pain after abscess surgery.
Abscess treatment with antibiotics
A bacterium can be clearly identified by analyzing sample material from the abscess, which the physician obtains during abscess surgery. This analysis takes several days.
Commonly used antibiotics in abscess treatment are clindamycin, penicillins, cephalosporins, doxycycline or vancomycin. In severely ill patients, therapy may be extended to include carbapenems or linezolid.
Other remedies against abscesses
Draw ointments applied to inflamed and purulent skin areas such as an abscess at the root of the hair (boils) stimulate blood circulation and thus have a contracting effect. In some cases, those affected hope that home remedies will provide quick help against abscesses. For example, an overlay with a paste of linseed and water is said to help against abscesses. In addition, tea tree oil or calendula applied externally are said to help with an abscess.
Home remedies have their limits. If the symptoms persist over a longer period of time, do not get better or even get worse, you should always consult a doctor.
Never open and squeeze abscesses yourself!
You should never treat or open an abscess (for example, on the anus) yourself – the risk of injuring tissue and spreading the infection is too great.
What is an abscess?
An abscess is an encapsulated collection of pus in tissue (for example, under the skin). In principle, abscesses occur in all parts of the body.
In addition, abscesses occur, for example, along the spine (more precisely on the vertebrae).
Encapsulation makes it more difficult for the infection to spread. At the same time, however, fresh cells of the immune system have difficulty reaching the focus of inflammation. That is why it is important to have a purulent abscess opened and drained by a doctor.
Depending on where an abscess is located, medical professionals use different terms. These include:
- Brodie abscess: This is a special form of chronic, suppurative inflammation of the bone and bone marrow (pyogenic osteomyelitis). Such an abscess occurs mainly in children with a good immune system and few infectious germs.
- Fossa canina abscess: This abscess occurs in inflammatory processes at the roots of the upper incisors.
- Otogenic abscess: accumulation of pus due to inflammation inside the ear (inner ear).
- Parapharyngeal abscess: abscess at the side of the throat
- Periodontal abscess: Acute aggravation of an existing inflammation of the periodontium (periodontitis).
- Peritonsillar abscess: a collection of pus in the tissue surrounding the palatine tonsils.
- Perityphlitic abscess: a collection of pus in the area surrounding the appendix at the end of the human appendix. Such an abscess usually occurs in association with appendicitis (perforating appendicitis).
- Pulmonary abscess: abscess in the lungs
- Subareolar abscess: abscess under the areola surrounding the nipple.
- Submandibular abscess: This inflammatory reaction usually originates from the lower molars.
- Subperiosteal abscess: a boil under the periosteum (periosteum)
How do I recognize an abscess?
The possible symptoms of an abscess are very diverse. Since an abscess is associated with inflammation, common signs of inflammation can be found:
- Redness
- Swelling
- Overheating
- Pain
The type of pus, its odor, and its color vary depending on which bacterium caused the infection.
What are the causes of an abscess?
An abscess is usually caused by bacteria that invade the body. Other pathogens include parasites such as amoebae.
External injuries
Surgeries
Surgeries also provide pathogens with possible access to the body. If there is a particularly high risk of infection, the surgeon often places a drain. All fluids flow out through it immediately. This prevents pus from accumulating. High-risk patients are also given an antibiotic to nip potential foci of infection in the bud.
Other tissue damage
Weakened immune system
A weakened immune system also makes a person susceptible to an abscess. Such an immune deficiency is the result of an HIV infection, for example, but also of any other infection. Chemotherapy for cancer also weakens the immune system.
Common sites of abscesses
Abscess in the abdominal cavity
Abscesses in the abdominal cavity often occur due to injuries or operations on the intestine. Countless bacteria live in the intestine and play an important role in digestion (intestinal flora). In a healthy intestine, the wall is impermeable to germs.
An accumulation of pus develops especially under the diaphragm (subphrenic abscess), under the liver (subhepatic abscess), directly on the intestinal loops or between the rectum and bladder/vagina (Douglas abscess).
Abscesses of the internal organs
An accumulation of pus develops especially under the diaphragm (subphrenic abscess), under the liver (subhepatic abscess), directly on the intestinal loops or between the rectum and bladder/vagina (Douglas abscess).
Abscesses of the internal organs
Abscess on the face
An abscess on the face often forms with severe acne – When bacteria invade sebaceous glands and thickened sebum moves the exit of the sebaceous gland, a pimple forms. If the bacteria get deeper into the tissues, various foci of inflammation may merge and a boil forms in the facial skin.
Abscesses in the mouth
The oral cavity is also heavily colonized with bacteria. Damage to the teeth and mucous membrane allows them to penetrate deep into the tissue, causing inflammation. When the inflammatory reaction becomes encapsulated, a painful abscess forms in the mucosa of the oral cavity. Depending on how deep the abscess lies in the tissue, it is referred to as a mucous or submucous abscess.
Abscess on the coccyx
Abscess at a hair root (furuncle)
An abscess in the area of a hair root is called a furuncle. These abscesses or boils thus occur on hairy parts of the body, armpit (axilla), head or scalp and intimate/genital area. A painful, bulging knot is formed. If several hair follicles are affected, it is called a carbuncle.
Abscess of the breast
Abscesses due to syringes
If a syringe is not sufficiently disinfected, there is a risk that bacteria will penetrate into deeper tissue layers (syringe abscess), for example, when a vaccination is administered with the needle. A so-called gluteal abscess is caused, for example, by a needle puncture in the pomus muscle (gluteus).
How is an abscess diagnosed?
As part of the diagnostic process, the physician may perform blood tests or an ultrasound and puncture the abscess.
Blood tests
In liver abscesses, liver function is disturbed. This is indicated by worsened liver values.
Other blood values may also indicate an inflammatory process. For example, elevated levels of white blood cells and C-reactive protein (CRP for short) usually indicate inflammation in the body.
Imaging procedures
What is the prognosis for an abscess?
It is unlikely that an abscess will disappear on its own. However, if a doctor recognizes and drains the boil early, it usually heals without consequences.
If an abscess remains untreated, the infection may spread to the entire body – dangerous and possibly life-threatening blood poisoning (sepsis) develops, and the patient must go to the emergency room.
The prognosis for an abscess also depends on the overall condition of the patient. The weaker the patient and his immune system are, the more difficult the fight against the boil will be.
Further information
Guidelines:
- S3 Guideline “Odontogenic Infections” of the German Society for Oral and Maxillofacial Surgery and the German Society for Dental, Oral and Maxillofacial Medicine: https://www.awmf.org/uploads/tx_szleitlinien/007-006l_S3_Odontogene_Infektionen_2017-12-abgelaufen.pdf (Status: 2016, valid until September 2021, currently being revised)
