Editing Abscess

{{short description|Localized collection of pus that has built up within the tissue of the body}}
{{About|the medical condition|the death metal band|Abscess (band)}}
{{cs1 config|name-list-style=vanc}}
{{Infobox medical condition (new)
| name = Abscess
| synonyms = {{Langx|la|Abscessus}}
| image = Five day old Abscess Extra Low Contrast B.jpg
| alt = 
| caption = Five-day-old inflamed epidermal inclusion cyst. The black spot is a keratin plug which connects with the underlying cyst.
| field = [[General surgery]], [[infectious disease (medical specialty)|infectious disease]], [[dermatology]]
| symptoms = Redness, pain, swelling<ref name=NEJM2014/>
| duration = 
| causes = [[Bacterial infection]] (often [[MRSA]])<ref name=NEJM2014/>
| risks = [[Intravenous drug use]]<ref name=Langrod2007/>
| diagnosis = [[Ultrasound]], [[CT scan]]<ref name=NEJM2014/><ref name=Rosen2014Chp137/>
| differential = [[Cellulitis]], [[sebaceous cyst]], [[necrotising fasciitis]]<ref name=Rosen2014Chp137/>
| treatment = [[Incision and drainage]], [[Antibiotics]]<ref name="ACEPfive"/>
| medication = 
| frequency = ~1% per year (United States)<ref name=Taira2009/>
| onset = Rapid
| deaths = 
}}

An '''abscess''' is a collection of [[pus]] that has built up within the [[tissue (biology)|tissue]] of the body, usually caused by bacterial infection.<ref>{{Cite web |title=Abscess |url=https://my.clevelandclinic.org/health/diseases/22876-abscess |access-date=2025-01-02 |website=[[Cleveland Clinic]] |quote=An abscess is a buildup of a pus that can affect any part of your body.}}</ref><ref>{{Cite web |last=Bush |first=Larry M. |date=Jul 2024 |title=Abscesses |url=https://www.msdmanuals.com/professional/infectious-diseases/biology-of-infectious-disease/abscesses |access-date=2025-01-02 |website=[[MSD Manual]] |quote=Abscesses are collections of pus in confined tissue spaces, usually caused by bacterial infection.}}</ref> Signs and symptoms of abscesses include redness, pain, warmth, and swelling.<ref name=NEJM2014/> The swelling may feel fluid-filled when pressed.<ref name=NEJM2014/> The area of redness often extends beyond the swelling.<ref name=El2009>{{cite book| vauthors = Elston DM |title=Infectious Diseases of the Skin.|date=2009|publisher=Manson Pub. |location=London |isbn=978-1-84076-514-4 |page=12 |url= https://books.google.com/books?id=esPkuOxZajYC&pg=PA12|url-status=live |archive-url=https://web.archive.org/web/20170906120647/https://books.google.com/books?id=esPkuOxZajYC&pg=PA12|archive-date=2017-09-06}}</ref> [[Carbuncle]]s and [[boil]]s are types of abscess that often involve [[hair follicle]]s, with carbuncles being larger.<ref name=Rosen2014Chp120>{{cite book| vauthors = Marx JA |title=Rosen's emergency medicine : concepts and clinical practice|date=2014|publisher=Elsevier/Saunders|location=Philadelphia, PA|isbn=978-1-900151-96-2 |pages=Chapter 120|edition=8th |chapter=Dermatologic Presentations}}</ref> A [[cyst]] is related to an abscess, but it contains a material other than pus, and a cyst has a clearly defined wall. Abscesses can also form internally on internal organs and after surgery.

They are usually caused by a [[bacterial infection]].<ref name=Cox2007>{{cite book| vauthors = Cox C, Turkington JS, Birck D |title=The encyclopedia of skin and skin disorders |date=2007 |publisher=Facts on File|location=New York, NY |isbn=978-0-8160-7509-6 |page=1 |url= https://books.google.com/books?id=GKVPHoIs8uIC&pg=PA1 |edition=3rd|url-status=live|archive-url=https://web.archive.org/web/20170906120647/https://books.google.com/books?id=GKVPHoIs8uIC&pg=PA1|archive-date=2017-09-06}}</ref> Often many different types of bacteria are involved in a single infection.<ref name=El2009/> In many areas of the world, the most common bacteria present is ''[[methicillin-resistant Staphylococcus aureus]]''.<ref name=NEJM2014/> Rarely, [[parasites]] can cause abscesses; this is more common in the [[developing world]].<ref name=Rosen2014Chp137/> Diagnosis of a skin abscess is usually made based on what it looks like and is confirmed by cutting it open.<ref name=NEJM2014/> [[Ultrasound]] imaging may be useful in cases in which the diagnosis is not clear.<ref name=NEJM2014/> In abscesses around the [[anus]], [[computer tomography]] (CT) may be important to look for deeper infection.<ref name=Rosen2014Chp137>{{cite book| vauthors = Marx JA |title=Rosen's emergency medicine : concepts and clinical practice|date=2014|publisher=Elsevier/Saunders|location=Philadelphia, PA|isbn=978-1-4557-0605-1 |pages=Chapter 137|edition=8th |chapter=Skin and Soft Tissue Infections}}</ref>

Standard treatment for most skin or soft tissue abscesses is cutting it open and drainage.<ref name="ACEPfive">{{Citation |author1 = American College of Emergency Physicians |author1-link = American College of Emergency Physicians |title = Five Things Physicians and Patients Should Question |publisher = American College of Emergency Physicians |work = [[Choosing Wisely]]: an initiative of the [[ABIM Foundation]] |url = http://www.choosingwisely.org/doctor-patient-lists/american-college-of-emergency-physicians/ |access-date = January 24, 2014 |url-status = live |archive-url = https://web.archive.org/web/20140307012443/http://www.choosingwisely.org/doctor-patient-lists/american-college-of-emergency-physicians/ |archive-date = March 7, 2014 }}</ref> There appears to be some benefit from also using [[antibiotic]]s.<ref>{{cite journal | vauthors = Vermandere M, Aertgeerts B, Agoritsas T, Liu C, Burgers J, Merglen A, Okwen PM, Lytvyn L, Chua S, Vandvik PO, Guyatt GH, Beltran-Arroyave C, Lavergne V, Speeckaert R, Steen FE, Arteaga V, Sender R, McLeod S, Sun X, Wang W, Siemieniuk RA | display-authors = 6 | title = Antibiotics after incision and drainage for uncomplicated skin abscesses: a clinical practice guideline | journal = BMJ | volume = 360 | pages = k243 | date = February 2018 | pmid = 29437651 | pmc = 5799894 | doi = 10.1136/bmj.k243 }}</ref> A small amount of evidence supports not packing the cavity that remains with [[Gauze sponge|gauze]] after drainage.<ref name=NEJM2014>{{cite journal | vauthors = Singer AJ, Talan DA | title = Management of skin abscesses in the era of methicillin-resistant Staphylococcus aureus | journal = The New England Journal of Medicine | volume = 370 | issue = 11 | pages = 1039–1047 | date = March 2014 | pmid = 24620867 | doi = 10.1056/NEJMra1212788 | url = http://enotes.us/SkinAbscess2014.pdf | url-status = dead | access-date = 2014-09-24 | archive-url = https://web.archive.org/web/20141030065311/http://enotes.us/SkinAbscess2014.pdf | archive-date = 2014-10-30 }}</ref> Closing this cavity right after draining it rather than leaving it open may speed healing without increasing the risk of the abscess returning.<ref name=Singer2011>{{cite journal | vauthors = Singer AJ, Thode HC, Chale S, Taira BR, Lee C | title = Primary closure of cutaneous abscesses: a systematic review | journal = The American Journal of Emergency Medicine | volume = 29 | issue = 4 | pages = 361–366 | date = May 2011 | pmid = 20825801 | doi = 10.1016/j.ajem.2009.10.004 | url = http://www.emottawa.ca/assets_secure/journal_club/Sept%2011_2_Singer%202011%20Am%20J%20of%20Emerg%20Med%20Primary%20closure%20of%20cutaneous%20abscesses.pdf | url-status = dead | archive-url = https://web.archive.org/web/20150722040008/http://www.emottawa.ca/assets_secure/journal_club/Sept%2011_2_Singer%202011%20Am%20J%20of%20Emerg%20Med%20Primary%20closure%20of%20cutaneous%20abscesses.pdf | archive-date = 2015-07-22 }}</ref> Sucking out the pus with a needle is often not sufficient.<ref name=NEJM2014/>

Skin abscesses are common and have become more common in recent years.<ref name=NEJM2014/> Risk factors include [[intravenous drug use]], with rates reported as high as 65% among users.<ref name=Langrod2007>{{cite book| vauthors = Ruiz P, Strain EC, Langrod J |title=The substance abuse handbook|date=2007|publisher=Wolters Kluwer Health/Lippincott Williams & Wilkins|location=Philadelphia|isbn=978-0-7817-6045-4 |page=373|url=https://books.google.com/books?id=6LkNShsAw78C&pg=PA373|url-status=live|archive-url=https://web.archive.org/web/20170906120647/https://books.google.com/books?id=6LkNShsAw78C&pg=PA373|archive-date=2017-09-06}}</ref> In 2005, 3.2 million people went to American emergency departments for abscesses.<ref name=Taira2009>{{cite journal | vauthors = Taira BR, Singer AJ, Thode HC, Lee CC | title = National epidemiology of cutaneous abscesses: 1996 to 2005 | journal = The American Journal of Emergency Medicine | volume = 27 | issue = 3 | pages = 289–292 | date = March 2009 | pmid = 19328372 | doi = 10.1016/j.ajem.2008.02.027 }}</ref> In Australia, around 13,000 people were hospitalized in 2008 with the condition.<ref name=Vas2012>{{cite journal | vauthors = Vaska VL, Nimmo GR, Jones M, Grimwood K, Paterson DL | title = Increases in Australian cutaneous abscess hospitalisations: 1999-2008 | journal = European Journal of Clinical Microbiology & Infectious Diseases | volume = 31 | issue = 1 | pages = 93–96 | date = January 2012 | pmid = 21553298 | doi = 10.1007/s10096-011-1281-3 | s2cid = 20376537 }}</ref>
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==Signs and symptoms==
[[File:Abszess.jpg|thumb|An abscess]]
Abscesses may occur in any kind of tissue but most frequently within the skin surface (where they may be superficial pustules known as [[boil]]s or deep skin abscesses), in the [[Lung abscess|lungs]], [[brain abscess|brain]], [[Dental abscess|teeth]], kidneys, and tonsils. Major complications may include spreading of the abscess material to adjacent or remote tissues, and extensive regional tissue death ([[gangrene]]).<ref>{{Cite web |title=Skin abscess: MedlinePlus Medical Encyclopedia |url=https://medlineplus.gov/ency/article/000863.htm |access-date=2023-07-19 |website=medlineplus.gov |language=en}}</ref>
[[File:ফোঁড়ার ছবি.jpg|thumb|A naturally drained abscess]]

The main symptoms and signs of a skin abscess are [[erythema|redness]], heat, swelling, pain, and loss of function. There may also be high temperature (fever) and chills.<ref name="NHS_abscess"/> If superficial, abscesses may be fluctuant when [[palpation|palpated]]; this wave-like motion is caused by movement of the pus inside the abscess.<ref>{{cite book|title=Churchill Livingstone medical dictionary.|year=2008|publisher=Churchill Livingstone|location=Edinburgh|isbn=978-0-08-098245-8 |edition=16th}}</ref>

An internal abscess is more difficult to identify and depend on the location of the abscess and the type of infection. General signs include pain in the affected area, a high temperature, and generally feeling unwell.<ref name=":1" />
Internal abscesses rarely heal themselves, so prompt medical attention is indicated if such an abscess is suspected. An abscess can potentially be fatal depending on where it is located.<ref>{{cite book| vauthors = Ferri FF |title=Ferri's Clinical Advisor 2015 E-Book: 5 Books in 1|date=2014|publisher=Elsevier Health Sciences|isbn=978-0-323-08430-7 |page=20|url=https://books.google.com/books?id=icTsAwAAQBAJ&pg=PA20|language=en}}</ref><ref>{{cite book| vauthors = Fischer JE, Bland KI, Callery MP |title=Mastery of Surgery|date=2006|publisher=Lippincott Williams & Wilkins|isbn=978-0-7817-7165-8 |page=1033|url=https://books.google.com/books?id=PgUFJg_-f4YC&pg=PA1033|language=en}}</ref>

==Causes==
Risk factors for abscess formation include [[intravenous drug use]].<ref name=Kha2008>{{cite journal | vauthors = Khalil PN, Huber-Wagner S, Altheim S, Bürklein D, Siebeck M, Hallfeldt K, Mutschler W, Kanz GG | display-authors = 6 | title = Diagnostic and treatment options for skin and soft tissue abscesses in injecting drug users with consideration of the natural history and concomitant risk factors | journal = European Journal of Medical Research | volume = 13 | issue = 9 | pages = 415–424 | date = September 2008 | pmid = 18948233 }}</ref> Another possible risk factor is a prior history of disc [[hernia]]tion or other spinal abnormality,<ref name=Kraeutler2014>{{cite journal | vauthors = Kraeutler MJ, Bozzay JD, Walker MP, John K | title = Spinal subdural abscess following epidural steroid injection | journal = Journal of Neurosurgery. Spine | volume = 22 | issue = 1 | pages = 90–93 | date = January 2015 | pmid = 25343407 | doi = 10.3171/2014.9.SPINE14159 | doi-access = free }}</ref> though this has not been proven.

Abscesses are caused by [[bacterial infection]], parasites, or foreign substances.
Bacterial infection is the most common cause, particularly [[Staphylococcus aureus]]. The more invasive ''[[methicillin-resistant Staphylococcus aureus]]'' (MRSA) may also be a source of infection, though is much rarer.<ref name="Gale1999">{{cite book| vauthors = Oldendorf D |title=The Gale Encyclopedia of Medicine |date=1999 |publisher=Gale Research |location=Detroit, MI |isbn=978-0-7876-1868-1 }}</ref> Among spinal subdural abscesses, methicillin-sensitive ''Staphylococcus aureus'' is the most common organism involved.<ref name=Kraeutler2014/>

Rarely [[parasites]] can cause abscesses and this is more common in the developing world.<ref name=Rosen2014Chp137/> Specific parasites known to do this include [[dracunculiasis]] and [[myiasis]].<ref name=Rosen2014Chp137/>

=== Anorectal abscess ===
{{main|Anorectal abscess}}
Anorectal abscesses can be caused by non-specific obstruction and ensuing infection of the glandular crypts inside of the [[anus]] or [[rectum]]. Other causes include [[cancer]], trauma, or [[inflammatory bowel diseases]].<ref name="h230">{{cite web | last=Sigmon | first=David F. | last2=Emmanuel | first2=Bishoy | last3=Tuma | first3=Faiz | title=Perianal Abscess | publisher=StatPearls Publishing | date=2023-06-12 | pmid=29083652 | url=https://www.ncbi.nlm.nih.gov/books/NBK459167/ | access-date=2024-07-28}}</ref>

{{Anchor|Incisional abscess}}

===Incisional abscess===
An ''incisional abscess'' is one that develops as a complication secondary to a [[surgical incision]]. It presents as redness and warmth at the margins of the incision with purulent drainage from it.<ref name="Duff2009">{{cite journal| vauthors = Duff P |title=Diagnosis and Management of Postoperative Infection|journal=The Global Library of Women's Medicine|year=2009|issn=1756-2228|doi=10.3843/GLOWM.10032|url=http://www.glowm.com/section_view/heading/Diagnosis%20and%20Management%20of%20Postoperative%20Infection/item/32|url-status=live|archive-url=https://web.archive.org/web/20140714154331/http://www.glowm.com/section_view/heading/Diagnosis%20and%20Management%20of%20Postoperative%20Infection/item/32|archive-date=2014-07-14|url-access=subscription}}</ref> If the diagnosis is uncertain, the wound should be aspirated with a needle, with aspiration of pus confirming the diagnosis and availing for [[Gram stain]] and [[bacterial culture]].<ref name="Duff2009"/>

=== Internal abscess ===
Abscesses can form inside the body. The cause can be from trauma, surgery, an infection, or a pre-existing condition.<ref name=":1">{{Cite web |title=Intra-Abdominal Abscesses - Intra-Abdominal Abscesses |url=https://www.merckmanuals.com/en-ca/professional/gastrointestinal-disorders/acute-abdomen-and-surgical-gastroenterology/intra-abdominal-abscesses |access-date=2024-11-22 |website=Merck Manual Professional Edition |language=en-CA}}</ref>

==Pathophysiology==
An abscess is a [[immune system|defensive reaction]] of the tissue to prevent the spread of infectious materials to other parts of the body.<ref>{{Cite web |title=abscess |url=https://www.vetneuro.com/index.php/resources/reference/glossary/63-abscess |access-date=2023-07-12 |website=www.vetneuro.com}}</ref><ref name=":0">{{Cite journal |title=A Brief Study on Abscess: A Review |url=https://www.easpublisher.com/journal-details/easjpp/57/434 |journal=EAS Journal of Pharmacy and Pharmacology |volume=3 |issue=5}}</ref>

Organisms or foreign materials destroy the local [[cell (biology)|cells]], which results in the release of [[cytokine]]s. The cytokines trigger an [[inflammation|inflammatory response]], which draws large numbers of [[white blood cell]]s to the area and increases the regional blood flow.<ref name=":0" />

The final structure of the abscess is an abscess wall, or capsule, that is formed by the adjacent healthy cells in an attempt to keep the pus from infecting neighboring structures. However, such encapsulation tends to prevent immune cells from attacking bacteria in the pus, or from reaching the causative organism or foreign object.<ref name=":0" />
<gallery mode="packed" heights="180">
File:Blausen 0007 Abscess.png|A diagram of an abscess
file:Pyemic abscesses of kidney.jpg|[[Pyaemia|Pyemic]] abscesses of a [[kidney]]
</gallery>

==Diagnosis==
[[File:UOTW 66 - Ultrasound of the Week 1.webm|thumb|Ultrasound showing dark (hypoechoic) area involving skin and subcutaneous tissue with moving internal debris in keeping with abscess<ref>{{cite web|title=UOTW#66 – Ultrasound of the Week|url=https://www.ultrasoundoftheweek.com/uotw-66/|website=Ultrasound of the Week|access-date=27 May 2017|date=7 January 2016|url-status=live|archive-url=https://web.archive.org/web/20161102223449/http://www.ultrasoundoftheweek.com/uotw-66/|archive-date=2 November 2016}}</ref>]]

[[File:Ultrasound image of breast 110323101432 1023060.jpg|Ultrasound image showing an  abscess, appearing as a mushroom-shaped dark (hypoechoic) area within the fibroglandular tissue of the breast|thumb]]

An abscess is a localized collection of pus (purulent inflammatory tissue) caused by suppuration buried in a tissue, an organ, or a confined space, lined by the pyogenic membrane.<ref>Robins/8th/68</ref> [[Ultrasound]] imaging can help in a diagnosis.<ref>{{cite journal | vauthors = Barbic D, Chenkin J, Cho DD, Jelic T, Scheuermeyer FX | title = In patients presenting to the emergency department with skin and soft tissue infections what is the diagnostic accuracy of point-of-care ultrasonography for the diagnosis of abscess compared to the current standard of care? A systematic review and meta-analysis | journal = BMJ Open | volume = 7 | issue = 1 | pages = e013688 | date = January 2017 | pmid = 28073795 | pmc = 5253602 | doi = 10.1136/bmjopen-2016-013688 }}</ref>

===Classification===
Abscesses may be classified as either ''skin abscesses'' or ''internal abscesses''. Skin abscesses are common; internal abscesses tend to be harder to diagnose, and more serious.<ref name="NHS_abscess">{{cite web | publisher = United Kingdom National Health Service | url = http://www.nhs.uk/Conditions/Abscess/Pages/Introduction.aspx | title = Abscess | archive-url = https://web.archive.org/web/20141030070952/http://www.nhs.uk/Conditions/Abscess/Pages/Introduction.aspx | archive-date=2014-10-30 }}</ref> Skin abscesses are also called cutaneous or subcutaneous abscesses.<ref name="Medline_abscess">{{cite web | website = Medline Plus | url = https://www.nlm.nih.gov/medlineplus/ency/article/001353.htm | title = Abscess | archive-url = https://web.archive.org/web/20160407011259/https://www.nlm.nih.gov/medlineplus/ency/article/001353.htm |archive-date=2016-04-07 }}</ref>

===IV drug use===
For those with a history of intravenous drug use, an [[X-ray]] is recommended before treatment to verify that no needle fragments are present.<ref name=Kha2008/> If there is also a fever present in this population, [[infectious endocarditis]] should be considered.<ref name=Kha2008/>

===Differential===
Abscesses should be differentiated from [[empyema]]s, which are accumulations of pus in a preexisting, rather than a newly formed, anatomical cavity.<ref>{{Cite web |last=Gaillard |first=Frank |title=Abscess {{!}} Radiology Reference Article {{!}} Radiopaedia.org |url=https://radiopaedia.org/articles/abscess?lang=us |access-date=2024-06-20 |website=Radiopaedia |language=en-US |doi=10.53347/rid-6723}}</ref>

Other conditions that can cause similar symptoms include: [[cellulitis]], a [[sebaceous cyst]], and [[necrotising fasciitis]].<ref name=Rosen2014Chp137/> Cellulitis typically also has an erythematous reaction, but does not confer any purulent drainage.<ref name="Duff2009"/>

==Treatment==
The standard treatment for an uncomplicated skin or soft tissue abscess is the act of opening and draining.<ref name="ACEPfive"/> There does not appear to be any benefit from also using [[antibiotic]]s in most cases.<ref name=NEJM2014/> A small amount of evidence did not find a benefit from packing the abscess with gauze.<ref name=NEJM2014/>

===Incision and drainage===
{{Main|Incision and drainage}}
[[Image:Cleaned abscess day 5.jpg|thumb|right|Abscess five days after incision and drainage]]
[[File:HumeralAbscess.jpg|thumb|Abscess following [[curettage]]]]
The abscess should be inspected to identify if foreign objects are a cause, which may require their removal. If foreign objects are not the cause, incising and draining the abscess is standard treatment.<ref name="ACEPfive"/><ref>{{cite book |title=Surgery: Facts and Figures | vauthors = Green J, Wajed S |year=2000 |publisher=Cambridge University Press |isbn= 978-1-900151-96-2}}</ref>

=== Antibiotics ===
Most people who have an uncomplicated skin abscess should not use antibiotics.<ref name="ACEPfive"/> Antibiotics in addition to standard incision and drainage is recommended in persons with severe abscesses, many sites of infection, rapid disease progression, the presence of [[cellulitis]], symptoms indicating bacterial illness throughout the body, or a health condition causing [[immunosuppression]].<ref name=NEJM2014/> People who are very young or very old may also need antibiotics.<ref name=NEJM2014/> If the abscess does not heal only with incision and drainage, or if the abscess is in a place that is difficult to drain such as the face, hands, or genitals, then antibiotics may be indicated.<ref name=NEJM2014/>

In those cases of abscess which do require antibiotic treatment, ''[[Staphylococcus aureus]]'' bacteria is a common cause and an anti-staphylococcus antibiotic such as [[flucloxacillin]] or [[dicloxacillin]] is used. The [[Infectious Diseases Society of America]] advises that the draining of an abscess is not enough to address community-acquired [[Methicillin-resistant Staphylococcus aureus|methicillin-resistant ''Staphylococcus aureus'']] (MRSA), and in those cases, traditional antibiotics may be ineffective.<ref name=NEJM2014/> Alternative antibiotics effective against community-acquired MRSA often include [[clindamycin]], [[doxycycline]], [[minocycline]], and [[trimethoprim-sulfamethoxazole]].<ref name=NEJM2014/> The [[American College of Emergency Physicians]] advises that typical cases of abscess from MRSA get no benefit from having antibiotic treatment in addition to the standard treatment.<ref name="ACEPfive"/>

[[Cell culture|Culturing the wound]] is not needed if standard follow-up care can be provided after the incision and drainage.<ref name="ACEPfive"/> Performing a wound culture is unnecessary because it rarely gives information which can be used to guide treatment.<ref name="ACEPfive"/>

===Packing===
In North America, after drainage, an abscess cavity is usually packed, often with special iodoform-treated cloth. This is done to absorb and neutralize any remaining exudate as well as to promote draining and prevent premature closure. Prolonged draining is thought to promote healing. The hypothesis is that though the heart's pumping action can deliver immune and regenerative cells to the edge of an injury, an abscess is by definition a void in which no blood vessels are present. Packing is thought to provide a wicking action that continuously draws beneficial factors and cells from the body into the void that must be healed. Discharge is then absorbed by cutaneous bandages and further wicking promoted by changing these bandages regularly. However, evidence from emergency medicine literature reports that packing wounds after draining, especially smaller wounds, causes pain to the person and does not decrease the rate of recurrence, nor bring faster healing, or fewer physician visits.<ref>{{cite journal | vauthors = Bergstrom KG | title = News, views, and reviews. Less may be more for MRSA: the latest on antibiotics, the utility of packing an abscess, and decolonization strategies | journal = Journal of Drugs in Dermatology | volume = 13 | issue = 1 | pages = 89–92 | date = January 2014 | pmid = 24385125 }}</ref>

===Loop drainage===
More recently, several North American hospitals have opted for less-invasive loop drainage over standard drainage and wound packing. In one study of 143 pediatric outcomes, a failure rate of 1.4% was reported in the loop group versus 10.5% in the packing group (P<.030),<ref>{{cite journal | vauthors = Ladde JG, Baker S, Rodgers CN, Papa L | title = The LOOP technique: a novel incision and drainage technique in the treatment of skin abscesses in a pediatric ED | journal = The American Journal of Emergency Medicine | volume = 33 | issue = 2 | pages = 271–276 | date = February 2015 | pmid = 25435407 | doi = 10.1016/j.ajem.2014.10.014 }}</ref> while a separate study reported a 5.5% failure rate among the loop group.<ref>{{cite journal | vauthors = Tsoraides SS, Pearl RH, Stanfill AB, Wallace LJ, Vegunta RK | title = Incision and loop drainage: a minimally invasive technique for subcutaneous abscess management in children | journal = Journal of Pediatric Surgery | volume = 45 | issue = 3 | pages = 606–609 | date = March 2010 | pmid = 20223328 | doi = 10.1016/j.jpedsurg.2009.06.013 }}</ref>

===Primary closure===
Closing an abscess immediately after draining it appears to speed healing without increasing the risk of recurrence.<ref name=Singer2011/> This may not apply to anorectal abscesses as while they may heal faster, there may be a higher rate of recurrence than those left open.<ref name="pmid6397949">{{cite journal | vauthors = Kronborg O, Olsen H | title = Incision and drainage v. incision, curettage and suture under antibiotic cover in anorectal abscess. A randomized study with 3-year follow-up | journal = Acta Chirurgica Scandinavica | volume = 150 | issue = 8 | pages = 689–692 | year = 1984 | pmid = 6397949 }}</ref>

=== Appendiceal abscess ===
Appendiceal abscess are complications of appendicitis where there is an infected mass on the appendix. This condition is estimated to occur in 2–10% of appendicitis cases and is usually treated by surgical removal of the appendix (appendicectomy).<ref>{{Cite journal |last=Cheng |first=Yao |last2=Xiong |first2=Xianze |last3=Lu |first3=Jiong |last4=Wu |first4=Sijia |last5=Zhou |first5=Rongxing |last6=Cheng |first6=Nansheng |date=2017-06-02 |title=Early versus delayed appendicectomy for appendiceal phlegmon or abscess |url=https://pubmed.ncbi.nlm.nih.gov/28574593 |journal=The Cochrane Database of Systematic Reviews |volume=6 |issue=6 |pages=CD011670 |doi=10.1002/14651858.CD011670.pub2 |issn=1469-493X |pmc=6481778 |pmid=28574593}}</ref>

==Prognosis==
Even without treatment, skin abscesses rarely result in death, as they will naturally break through the skin.<ref name=Rosen2014Chp137/> Other types of abscess are more dangerous. Brain abscesses may be fatal if untreated. When treated, the mortality rate reduces to 5–10%, but is higher if the abscess ruptures.<ref>{{cite book  | vauthors = Bokhari MR, Mesfin FB | chapter = Brain Abscess|date=2019| chapter-url=http://www.ncbi.nlm.nih.gov/books/NBK441841/ | title = StatPearls|publisher=StatPearls Publishing|pmid=28722871|access-date=2019-07-28}}</ref>

==Epidemiology==
Skin abscesses are common and have become more common in recent years.<ref name=NEJM2014/> Risk factors include [[intravenous drug use]], with rates reported as high as 65% among users.<ref name=Langrod2007/> In 2005, in the United States 3.2 million people went to the emergency department for an abscess.<ref name=Taira2009/> In Australia around 13,000 people were hospitalized in 2008 for the disease.<ref name=Vas2012/>

==Society and culture==
The [[Latin]] medical [[aphorism]] "''[[ubi pus, ibi evacua]]''" expresses "where there is pus, there evacuate it" and is classical advice in the culture of Western medicine.<ref>{{Citation |last=Mourits |first=Maarten P. |title=Orbital Cellulitis |date=2023 |work=Surgery in and around the Orbit: CrossRoads |pages=309–315 |editor-last=Gooris |editor-first=Peter J.J. |place=Cham |publisher=Springer International Publishing |language=en |doi=10.1007/978-3-031-40697-3_19 |isbn=978-3-031-40697-3 |editor2-last=Mourits |editor2-first=Maarten P. |editor3-last=Bergsma |editor3-first=J.Eelco|doi-access=free }}</ref>

[[Needle exchange programmes]] often administer or provide referrals for abscess treatment to [[injection drug users]] as part of a [[harm reduction]] public health strategy.<ref>{{cite journal | vauthors = Tomolillo CM, Crothers LJ, Aberson CL | title = The damage done: a study of injection drug use, injection related abscesses and needle exchange regulation | journal = Substance Use & Misuse | volume = 42 | issue = 10 | pages = 1603–1611 | date = 2007 | pmid = 17918030 | doi = 10.1080/10826080701204763 | s2cid = 20795955 }}</ref><ref>{{cite journal | vauthors = Fink DS, Lindsay SP, Slymen DJ, Kral AH, Bluthenthal RN | title = Abscess and self-treatment among injection drug users at four California syringe exchanges and their surrounding communities | journal = Substance Use & Misuse | volume = 48 | issue = 7 | pages = 523–531 | date = May 2013 | pmid = 23581506 | pmc = 4334130 | doi = 10.3109/10826084.2013.787094 }}</ref>

===Etymology===
An abscess is so called "abscess" because there is an ''abscessus'' (a going away or departure) of portions of the animal tissue from each other to make room for the suppurated matter lodged between them.<ref>Collier's New Encyclopedia, 'Abscess'.</ref>

The word carbuncle is believed to have originated from the Latin: ''carbunculus'', originally a small coal; diminutive of ''carbon-'', ''carbo'': charcoal or ember, but also a [[carbuncle (gemstone)|carbuncle stone]], "precious stones of a red or fiery colour", usually [[garnet]]s.<ref>[[OED]], "Carbuncle": 1 stone, 3 medical</ref>

==Other types==
The following types of abscess are listed in the medical dictionary:<ref>{{cite web |url=http://www.theodora.com/medical_dictionary/a_adaxial.html#abscess |title=Abscess |work=Medical Dictionary – Dictionary of Medicine and Human Biology |access-date=2013-01-24 |url-status=live |archive-url=https://web.archive.org/web/20130205032049/http://www.theodora.com/medical_dictionary/a_adaxial.html#abscess |archive-date=2013-02-05 }}</ref>
{{columns-list|colwidth=22em|
* acute abscess
* [[alveolar abscess]]
* amebic abscess
* apical abscess
* appendiceal abscess
* [[Bartholin abscess]]
* Bezold abscess
* bicameral abscess
* bone abscess
* [[brain abscess]]
* [[Brodie abscess]]
* bursal abscess
* caseous abscess
* [[caseous lymphadenitis]]
* cheesy abscess
* cholangitic abscess
* chronic abscess
* [[collar stud abscess]]
* [[cold abscess]]
* crypt abscesses
* [[dental abscess]]
** periapical abscess
** [[periodontal abscess]]
*** apical periodontal abscess
*** lateral periodontal abscess
*** root abscess
** gingival abscess
** lateral alveolar abscess
** [[Pericoronitis|pericoronal abscess]]
** [[Combined periodontic-endodontic lesions|combined periodontic-endodontic abscess]]
* diffuse abscess
* Douglas abscess
* dry abscess
* [[Abscess of thymus|Dubois abscesses]]
* embolic abscess
* fecal abscess
* follicular abscess
* gas abscess
* gravitation abscess
* gummatous abscess
* [[hidradenitis suppurativa]]
* hematogenous abscess
* hot abscess
* hypostatic abscess
* ischiorectal abscess
* mastoid abscess
* metastatic abscess
* migrating abscess
* miliary abscess
* Munro abscess
* orbital abscess
* [[Brain abscess|otitic abscess]]
* palatal abscess
* [[pancreatic abscess]]
* parafrenal abscess
* parametric abscess
* paranephric abscess
* parapharyngeal abscess
* parotid
* Pautrier
* [[Pelvic abscess]]
* perforating
* periappendiceal
* periarticular
* pericemental
* perinephric
* perirectal
* [[peritonsillar abscess]]
* periureteral abscess
* phlegmonous abscess
* Pott abscess
* premammary abscess (including [[subareolar abscess]])
* psoas abscess
* pulp abscess
* pyemic abscess
* radicular abscess
* residual abscess
* retrobulbar abscess
* retrocecal abscess
* [[retropharyngeal abscess]]
* ring abscess
* satellite abscess
* septicemic abscess
* stellate abscess
* stercoral abscess
* sterile abscess
* stitch abscess
* subdiaphragmatic abscess
* subepidermal abscess
* [[Liver abscess|subhepatic abscess]]
* subperiosteal abscess
* subphrenic abscess
* subungual abscess
* sudoriferous abscess
* suture abscess
* thymic abscesses
* Tornwaldt abscess
* tropical abscess
* [[tubo-ovarian abscess]]
* verminous abscess
* wandering abscess
* worm abscess
}}

== References ==
{{Reflist}}

== External links ==
{{wiktionary}}
{{Commons category}}
* {{MedlinePlusEncyclopedia|001353|Abscess}}
* {{MedlinePlusEncyclopedia|000863|Skin Abscess}}
* {{Cite Collier's|wstitle=Abscess |short=x}}
* {{Cite EB1911|wstitle=Abscess |short=x}}
* {{cite web | url = https://medlineplus.gov/abscess.html | publisher = U.S. National Library of Medicine | work = MedlinePlus | title = Abscess }}

{{Medical condition classification and resources
| DiseasesDB     =
| ICD11          = {{ICD11|1B75}}
| ICD10          = {{ICD10|L02}}
| ICD9           = {{ICD9|682.9}}, {{ICD9|324.1}}
| ICDO           =
| OMIM           =
| MedlinePlus    = 001353
| eMedicineSubj  =
| eMedicineTopic =
| MeshID         = D000038
}}
{{Diseases of the skin and appendages by morphology}}
{{Bacterial cutaneous infections}}

{{Authority control}}

[[Category:General surgery]]
[[Category:Cutaneous lesion]]
[[Category:Wikipedia medicine articles ready to translate]]
[[Category:Wikipedia emergency medicine articles ready to translate]]