Painful and warm to touch, abscesses can show up any place on your body. The most common sites in the head and neck occur around the ears or ear lobe, on the face (commonly as a complication of simple acne especially when trying to pop a zit) or the nose (for similar reasons) and the neck skin (commonly as a complication of shaving with resulting ingrown hair follicles). Inflammation around a hair follicle can lead to the formation of an abscess, which is called a boil (furuncle).
An abscess is a tender mass generally surrounded by a colored area from pink to deep red. Abscesses are often easy to feel by touching because they feel like there is fluid within similarly to pressing against a balloon filled with water. The middle of an abscess is full of pus and debris. The area over an abscess is very commonly painful to the touch and increasingly more painful when pressure is applied over it.
Unlike other infections, antibiotics alone will not usually cure an abscess. In general an abscess must be opened and drained in order for it to improve by first removing its infected microbial content. Sometimes draining occurs on its own as the infection proceeds to the surface, but generally it must be opened by the Ear Nose and Throat specialist in a procedure called incision and drainage (I&D).
Skin abscesses are commonly caused by obstruction of oil (sebaceous) glands or sweat glands, inflammation of hair follicles, or minor breaks and punctures of the skin. Germs get underneath the skin surface or into these glands, which causes an inflammatory response as your body’s defenses try to kill these germs.
The middle of the abscess liquefies (turns into liquid) and contains dead cells, bacteria, and other debris. This area begins to grow, creating tension under the skin and further inflammation of the surrounding tissues. Pressure and inflammation cause the pain. The common signs of inflammation are redness, pain, swelling and warmth over the infected site.
People with weakened immune systems get certain abscesses more often. Those with any of the following are all at risk for having more severe abscesses. This is because the body has a decreased ability to ward off infections. People with reduced immune defenses include those with the following conditions:
- Chronic steroid therapy
- Sickle cell disease
- Peripheral vascular disorders
- Crohn’s disease
- Ulcerative colitis
- Severe burns
- Severe trauma
- Alcoholism or IV drug abuse
- Other risk factors for abscess include exposure to dirty environments, exposure to persons with certain types of skin infections, poor hygiene, and poor circulation.
Most often, an abscess becomes a painful, compressible mass that is red, warm to touch, and tender.
As some abscesses progress, they may “point” and come to a head so you can see the material inside which can spontaneously open (rupture or drain).
Most will continue to get worse without care. The infection can spread to the tissues under the skin and even into the bloodstream.
If the infection spreads into deeper tissue, you may develop a fever and begin to feel ill. Certain areas are more dangerous especially when abscesses form in the neck. Deeper penetration of the bacteria can result in a quick spread into the chest cavity and can be life threatening. Also, abscesses and infections in a triangular area around the nose and upper lip can easily spread into the brain and can also be life threatening.
Abscess Treatment: Self-Care at Home
- If the abscess is small (less than 1 cm or less than a half-inch across), applying warm compresses to the area for about 30 minutes 4 times daily can help.
- Do NOT attempt to drain the abscess by pressing on it. This can push the infected material into the deeper tissues and cause a backflow of the bacteria into veins that can carry the microbes into more distant sites in the body.
- Do NOT stick a needle or other sharp instrument into the abscess center because you may injure an underlying blood vessel or cause the infection to spread.
When to call us
Call us if any of the following occur with an abscess:
- You have a sore larger than 1 cm or a half-inch across.
- The sore continues to enlarge or becomes more painful.
- You are running a temperature of 101.5°F or higher.
- You have a red streak going away from the abscess (this may be an ominous indication of the spread of the infection).
- The abscess does not resolve with topical treatment using over the counter antibiotics creams or ointments.
- Abscesses in the facial area require the expertise of a facial plastic surgeon to maintain a cosmetically pleasing result and prevent complications
- We may open and drain the abscess using a needle or by making a small incision over the skin. This is done under local anesthesia.
- The area around the abscess will be numbed with medication (anesthesia).
- It is often difficult to completely numb the area, but in general local anesthesia can make the procedure almost painless.
- You may be given some type of sedative if the abscess is large or has spread to surrounding structures.
- The area will be covered with an antiseptic solution and sterile towels placed around it.
- Our facial plastic surgeon will cut open the abscess and totally drain it of pus and debris.
- The cavity of the abscess is often scraped with a special curette to force its sides to stick to one another so that it does not come back.
- Once the sore has drained, the doctor may insert some packing material into the remaining cavity to minimize any bleeding and keep it open for a day or two.
- A bandage will then be placed over the packing, and you will be given instructions about home care.
- Most people feel better immediately after the abscess is drained.
- If you are still experiencing pain, our doctor may prescribe pain pills for home use over the next 1-2 days.
Next Steps: Follow-up
- Follow carefully any instructions your doctor gives you.
- Our doctor may have you remove the packing yourself with instructions on the best way to do this. This may include soaking or flushing.
- Be sure to keep all follow-up appointments.
- Report any fever, redness, swelling, or increased pain to your doctor
AVOID POPPING PIMPLES ON YOUR FACE
this is a dangerous habit that may lead to spread of infection within the skull.
The Danger Triangle
The danger triangle of the face discussed above consists of the area from the corners of the mouth to the bridge of the nose, including the nose and maxilla. Due to the special nature of the blood supply to the human nose and surrounding area, it is possible (although very rare) for retrograde infections from the nasal area to spread to the brain causing cavernous sinus thrombosis, meningitis or brain abscess.
This is possible because of venous communication (via the ophthalmic veins) between the facial vein and the cavernous sinus. The cavernous sinus lies within the cranial cavity, between layers of the meninges and is a major conduit of venous drainage from the brain.