Tag Archives: Incision and drainage

Straight, No Chaser: Abscesses (Boils)

September 29, 2016Infectious Disease, Skin/DermatologyFolliculitis, 844-SMA-TALK, Abscess, Behind the Curtain, Cellulitis, Incision and drainage, Methicillin-resistant Staphylococcus aureus, Staph, Staphylococcus aureus, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, streptococcusJeffrey Sterling, MD

Whether you call them boils, pus pockets or abscesses, they hurt. Abscesses are infections that localize and collect pus beneath the skin. Although previous Straight, No Chaser posts have addressed MRSA, this one will highlight your frequently asked questions about abscesses.

Why do I get an abscess?
Something causes an injury or sufficient irritation to your skin to allow bacteria to enter, and/or your lowered immunity can’t adequately fight back. Examples of circumstances causing skin infections that can develop into abscesses include ingrown hairs (folliculitis), insect bites and IV drug use. You are at increased risk for developing an abscess if you have diabetes, are obese, use IV drugs, have a weakened immune system or have an untreated skin infection (cellulitis).

What causes abscesses?
Bacteria such as Staphylococcus aureus (Staph) and Streptococcus are common causes of abscesses. I’ll remind you that MRSA stands for methicillin-resistant Staph Aureus; this is an indication that traditionally used antibiotics don’t work against this particular strain of bacteria. MRSA should be a reminder of the dangers of inappropriate antibiotic use.

How do I know if I have an abscess?
Trust me. You’ll know. Typically you’ll develop a skin infection first, which could simply include pus-filled bumps that worsen to become red, warm, swollen and tender. You may develop a fever, and you will have a significant amount of pain.
Can I treat these at home?
Generally not unless you’re a physician or have access to one at home… What you can do is prevent them. Stop picking at your skin; in fact, learn to keep your hands off your skin. Use clean equipment (e.g. razors, clippers) if you shave hair from your skin.
In terms of treating abscesses at home, it is not advisable for you to attempt to cut yourself or otherwise deal with these once one has formed. Abscesses often have deep tracks under the skin that need to be explored. Whatever you’re doing to delay getting evaluated is increasing the risk that things will worsen.

So how are abscesses treated?
There are two approaches to treating abscesses: “from the inside out” and “from the outside in.”

From the inside out refers to receiving antibiotics. Most abscess do respond promptly to antibiotics if you don’t wait too long to get them treated.
From the outside in refers to a procedure called incision and drainage (I & D). You’ll recognize this as your physician having to cut open the abscess, clean the area out and place gauze in the wound for a few days. Doing this in most cases eliminates the need to also take antibiotics. Unfortunately, I & Ds often must be done on higher risk abscesses, and in some instances, it’s necessary to have it done by a surgeon.

When should I see a doctor for one of these?
These generally aren’t getting better on their own. In particular, if you have one of the risk factors previously mentioned (diabetes, IV drug use, obesity, decreased immunity), the abscess is on or near your genitalia, is spreading fast or is extremely painful, you should be seen sooner rather than later.
Feel free to ask any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
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Straight, No Chaser: Abscesses (Boils)

July 22, 2014Skin/Dermatology, Infectious DiseaseSterlingMedicalAdvice.com, Straight No Chaser, streptococcus, Sterling Medical Advice, 844-SMA-TALK, Abscess, Cellulitis, Folliculitis, Incision and drainage, Methicillin-resistant Staphylococcus aureus, Staph, Staphylococcus aureusJeffrey Sterling, MD

So how are abscesses treated?
There are two approaches to treating abscesses: “from the inside out” and “from the outside in.”

From the inside out refers to receiving antibiotics. Most abscess do respond promptly to antibiotics if you don’t wait too long to get them treated.
From the outside in refers to a procedure called incision and drainage (I & D). You’ll recognize this as your physician having to cut open the abscess, clean the area out and place gauze in the wound for a few days. Doing this in most cases eliminates the need to also take antibiotics. Unfortunately, I & Ds often must be done on higher risk abscesses, and in some instances, it’s necessary to have it done by a surgeon.

Straight, No Chaser: Hangnails and Paronychia

June 21, 2014Skin/Dermatology844-SMA-TALK, Hangnails, Incision and drainage, Paronychia, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Aren’t hangnails annoying? Well, it gets worse. The things we do in an effort to get rid of them cause even bigger problems, and that’s the focus of this Straight, No Chaser.

We’ve previously discussed the dangers of human bites. Every time you nibble on your fingers or bite off a hangnail, you’re potentially planting the seeds of a bacterial, yeast or fungal infection in your finger (depending on what’s in your mouth or on your hands); such an infection is called a paronychia. Paronychia can be caused by other types of injuries to the area around your fingernails, such as the manicures you can’t do without (in this example, the specific problem is cutting or pushing back the cuticles).

You likely already know how these look. They resemble a less violent version of an ingrown toenail, with pain, redness and swelling at the involved area of the finger. More severe infections can also reveal pus-filled mini-abscesses and can cause changes to the color or shape of your nails. If you’re very unlucky or have a reduced immune system (e.g., diabetes, HIV, chronically on steroids) the infection can spread to your tendons, bones or bloodstream.

Given that treatment of these can involve use of antibiotics or the need for an incision and drainage procedure (as is done with other abscesses), you might want to avoid that pain and follow these tips for prevention and treatment.
To prevent paronychia:

Wash your hands to keep unwanted bacteria, yeast and fungi off your hands. That’s a pretty good start.
Don’t bite or pick your nails.
Use gloves when they’re available. If you’re working with detergents and chemicals, these substances damage the nails and fingers.
Speak up and forbid the use of any manicure tools that aren’t new or newly sterilized. If you don’t see the tools coming out of the bag, you’re introducing risk to your hands.

Say no to getting your cuticles cut. All that does is help unwanted microorganism enter your body. It’s even worse when blood is expressed from a cuticle cut.

In general, good nail care can prevent the hangnails that initiate many of these problems. Trim your fingernails every week and your toenails about once a month. Trim your fingernails with a slightly rounded edge, but your toenails should be cut more straight across. Always leave some of the edge of the nail (the white portion) intact. Use an emery board for smoothing the edges. You’re less likely to cause damage if you trim your nails while wet, such as after bathing or showering.

If you have pain, redness and swelling after manipulating a hangnail or biting your fingers or toes, soaking your nail in hot water two to three times a day can help reduce swelling and pain. If things don’t get better, or if you develop fever, chills, joint or muscle pain or see an extension of the area of redness, these are clear signs that you need to see your physician.

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what 844-SMA-TALK and http://www.SterlingMedicalAdvice.com(SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.