Technique of incision and drainage for skin abscess
- Kathleen A Downey, MD
Kathleen A Downey, MD
- Associate Clinical Professor of Family Medicine
- University of Cincinnati
- Theresa Becker, DO
Theresa Becker, DO
- Assistant Professor of Pediatrics
- Harvard Medical School
- Medical Director, Pediatric Programs Lahey Beverly
- Executive Network Director
- Division of Emergency Medicine
- Section Editors
- Anne M Stack, MD
Anne M Stack, MD
- Section Editor — Pediatric Procedures
- Associate Professor, Department of Pediatrics
- Harvard Medical School
- Sheldon L Kaplan, MD
Sheldon L Kaplan, MD
- Editor-in-Chief — Pediatrics
- Section Editor — Pediatric Infectious Diseases
- Professor and Vice Chairman for Clinical Affairs
- Baylor College of Medicine
- Allan B Wolfson, MD
Allan B Wolfson, MD
- Section Editor — Adult Procedures
- Professor of Emergency Medicine
- University of Pittsburgh
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
The differential diagnosis and procedure for incision and drainage of skin abscesses will be reviewed here. The epidemiology, microbiology, treatment, and prevention of skin abscess are discussed separately. (See "Cellulitis and skin abscess in adults: Treatment" and "Suspected Staphylococcus aureus and streptococcal skin and soft tissue infections in children >28 days: Evaluation and management", section on 'Purulent/fluctuant SSTI'.)
Skin abscesses can be differentiated from folliculitis, furuncles, and carbuncles as follows:
Folliculitis — Folliculitis is a superficial bacterial infection of the hair follicles with purulent material in the epidermis (picture 1).
Furuncle — A furuncle is a well-circumscribed, painful, suppurative inflammatory nodule involving hair follicles that usually arises from preexisting folliculitis. A furuncle can occur at any site that contains hair follicles, especially in regions that are subject to friction and maceration (eg, face, neck, axillae, groin, thighs, and buttocks). The lesion may extend into the dermis and subcutaneous tissues and often serves as a nidus for cellulitis and skin abscess.
Carbuncle — A carbuncle is a coalescence of several inflamed follicles into a single inflammatory mass with purulent drainage from multiple follicles (picture 2).
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- Skin abscess
- DIFFERENTIAL DIAGNOSIS
- Evaluation for abscess using ultrasound
- Patient counseling
- Sedation and analgesia
- - Local anesthesia
- Probing and irrigation
- Packing or drain placement
- - Indications
- - Technique
- Antibiotic therapy
- Tetanus prophylaxis
- WOUND CARE AND INSTRUCTIONS
- ADDITIONAL RESOURCES
- SUMMARY AND RECOMMENDATIONS