Abscess drainage - skin

About a skin abscess

A skin abscess is a pus-filled area of infection below the skin, for example a boil. It can vary in size from less than one inch to several inches. A skin abscess is painful and tender to touch. The skin may also look red and feel warm.

A skin abscess may burst through the skin or gradually subside without bursting. The infection can spread to the surrounding areas of your skin (cellulitis). You may feel unwell and have a fever.

Skin abscesses are commonly found on areas where there is hair including the face, neck, groin, armpit and bottom. You are more likely to get a skin abscess if you are obese, or have a skin condition or diabetes. 

Diagnosis of a skin abscess

A skin abscess is usually easy to see on your skin. Your GP will ask you about your symptoms and examine you. He or she will also ask you about your medical history. It's important that he or she excludes diabetes.

What are the alternatives to a skin abscess drainage?

Depending on how severe your abscess is, your GP may recommend a non-surgical treatment for you. Usually you will be given antibiotics to encourage healing. If you feel unwell or have a fever,  intravenous antibiotics (injected directly into your bloodstream) may be required, especially if you have other medical conditions such as diabetes. This will usually require admission to hospital.

If your abscess is large, or doesn’t respond quickly to non-surgical treatment, it will need to be drained under local or general anaesthesia.

Your GP will advise you on which treatment is most suitable for you.

Preparing for a skin abscess drainage

Skin abscess drainage is often done either by your GP or in hospital by a surgeon as an outpatient procedure. This means you have the procedure and can go home the same day. Your GP or surgeon will explain how to prepare for your procedure.

Skin abscess drainage is usually done under local anaesthesia but this will depend on its size and severity.

At the GP surgery or hospital your nurse may check your heart rate and blood pressure, and test your urine.

Your GP or surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

What happens during a skin abscess drainage

Skin abscess drainage usually takes between five and 15 minutes. It may take slightly longer if you need to have a general anaesthetic.

Your GP or surgeon will make a small cut in your abscess. This will allow all of the pus to drain out. He or she will make sure that the pus drains properly to prevent the abscess coming back, or the infection spreading. Your GP or surgeon will take a sample of the pus to find out what bacteria caused the abscess. This can help with treatment after the skin abscess is drained, such as when choosing the right antibiotic. Once the pus has been drained, your GP or surgeon will clean out the abscess with saline solution. This is a sterile salt solution that will help to ensure all the pus is removed. He or she may then pack the abscess with a dressing. This will allow further drainage of pus and is usually removed one to two days after the procedure.

Your wound will be covered with a sterile dressing.

What to expect afterwards

After a local anaesthetic it may take several hours before the feeling comes back into the treated area. Take special care not to bump or knock the area. Your nurse will give you some advice about caring for your healing wounds before you go home. You will usually be able to go home when you feel ready. You may be given a date for a follow-up appointment. This is usually with your GP but if the procedure was carried out in hospital and your abscess was large, your surgeon may want to review you. You may notice some pus and fluid escaping from the wound and soiling the dressing.

Recovering from a skin abscess drainage

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Your GP may prescribe antibiotics after your skin abscess drainage. You will also need to take antibiotics if the infection has spread, or if you have a weakened immune system or a fever.

Once the pus is drained, the abscess should heal within two weeks, depending on its size. You can often return to work if you have no problems with the dressing and depending on what type of job you do. This will also depend on the site of the abscess.

What are the risks?

As with every procedure, there are some risks associated with having a skin abscess drained. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your GP or surgeon to explain how these risks apply to you.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure.

You’re unlikely to get any side-effects after a skin abscess drainage but you may find there is some pain in the area that was drained.

Complications

Complications are when problems occur during or after the procedure.

Possible complications of skin abscess drainage include scarring from the abscess, which may vary depending on your skin type and the type of cut used.

If you notice redness and swelling or you have a fever, contact your GP. Your abscess may need to be drained again or you may need different antibiotics (eg for resistant bacteria).

I keep getting skin abscesses. What can I do to prevent them coming back?

Answer

There are a number of things you can do to prevent a skin abscess from coming back.

Explanation

Skin abscesses are often caused by bacteria called Staphylococcus aureus. The bacteria can enter the skin through a small scratch or a hair follicle. It's also common for the bacteria to grow in the nose.

There are reasons why you're more likely to develop a skin abscess. These include:

  • smoking
  • having a skin disorder
  • having a weakened immune system
  • having a chronic disease such as diabetes
  • obesity

See your GP if you have skin abscesses that keep coming back. He or she may take a sample of pus using a swab. This will be sent to a laboratory and the bacteria will be identified. Your GP may recommend that you use an antiseptic wash to clean the areas on your body where the bacteria tend to survive including your armpits, groin and scalp. You can also add an antiseptic to your bath. Wash your clothing frequently in hot water. Keep your hands clean and don't pick any sores on your skin.

Your GP may recommend that you take antibiotics for several months. If you have bacteria in your nose, your GP may also prescribe an antibiotic or antiseptic for you to apply to the inside of your nose.

What other conditions might look like an abscess?

Answer

You may other skin conditions that look like an abscess but have different underlying causes and treatments.

Explanation

There are a number of skin conditions that may be confused with skin abscesses. Some of these are described here. See your GP if you have any of the symptoms. He or she will be able to diagnose the problem and recommend appropriate treatment.

A carbuncle is a cluster of small abscesses that are deeper below the skin than a skin abscess. It's often swollen and tender and there is likely to be inflammation in the skin around the carbuncle. Carbuncles are commonly found on the back of the shoulders, thighs, hips and neck. There are often several openings that drain pus. If the carbuncle is large, it can cause you to feel tired, sick and have a fever. Treatment for carbuncles is similar to that for skin abscesses.

If you have severe (cystic) acne, it’s usually found only on the face and upper body. The spots are larger than in common acne and may be inflamed, giving the appearance of small abscesses.

You may notice round, raised lumps just under your skin. These could be epidermoid cysts that contain a fluid or semi-fluid substance. The cyst may become inflamed and tender and produce pus. Similar to skin abscesses, these can be cut into and removed under local anaesthesia.

You may have an infection of the hair follicles that are found at the base of hairs. This is called folliculitis. The infection develops into small, inflamed, raised spots, which may or may not contain pus. You can develop this infection anywhere on the body where there is hair.

Hidradenitis suppurativa is long-term inflammation of the sweat glands that causes painful, inflamed nodules and abscesses that don’t often contain bacteria. If you have inflammation in your armpits and groin only, this could be the cause. This is most common in people who are overweight and who smoke.

How can I minimise scarring caused by a skin abscess?

Answer

Scars are likely to form if your abscess has been cut and drained by a doctor or if it drained on its own. If the abscess is small, the cut required will be smaller so it’s better to seek treatment earlier.

Explanation

Scarring fades usually fades over several months, but it may take several years. Some people are prone to more pronounced scars (hypertrophic or keloid scars). The type of cut used may make a difference to the eventual scar.

Camouflage creams can be used to improve the appearance of your scarring. The waterproof camouflage creams last for about two to three days on the body. The creams blend to your skin colour to make your scars less noticeable. Skin camouflage can help to improve your confidence and self-esteem.

If you're interested in skin camouflage, speak to your GP. He or she can give you more information about organisations that can offer you help and advice, such as the British Association of Skin Camouflage, or the Red Cross skin camouflage service.

If you wish to remove your scars completely, plastic surgery may be an option. The cut from your skin abscess drainage should be completely healed before this is considered. Speak to your GP for more information.