Prep School Daily: Abscesses in Armageddon

Tuesday, October 12, 2021

Abscesses in Armageddon

An abscess is a pocket of pus, the blood cells, bacteria, and inflammatory fluid that accumulate as the body attempts to deal with the infection. Unlike boils, which develop around an infected hair follicle or perhaps even an ingrown hair, abscesses occur due to an infected wound or tooth or a cyst. Like boils, abscesses form a wall and do not have a good blood supply. The antibiotic circulating through the blood doesn’t penetrate far enough into the abscess to kill the bacteria within.[1] For this reason, oral antibiotics are generally ineffective in resolving the infection. Don’t waste them here.

Treatment

Abscesses can range in size from a small skin boil to very large. Regardless of size, the treatment is the same. The abscess must be drained.

The best way is to hasten the natural course of events by using warm, moist compresses over the abscess. If all goes well, this brings the pus to the surface where it forms a head, like a pimple, and then drains spontaneously. If the abscess fails to form the head and drain itself, it will have to be helped along.[2]

The procedure is as follows:

· Identify the head—the area closest to the surface. It may be obvious, but if it is not, try this approach. Make a paste of calamine lotion or bentonite clay and apply it evenly over the abscess. The spot that dries first is the place to make the (first) incision.[3]

· Numb the affected area with ice or lidocaine.[4] [5]

· Use the tip of a scalpel (no. 11, ideally) to pierce the skin or make an incision, depending on size, over the abscess. The pus should drain immediately. The incision may be only ¼” for a small abscess, up an inch for a larger one.[6]

· If the abscess is large, a second incision to form an X of the two incisions may need to be made. Irrigate the cavity with sterile water or saline (ideal) or clean water and probe to break down any internal septa (walls) that may have formed.[7]

· Large abscesses may need to be packed with gauze for several days. The gauze should be coated with sterile petroleum jelly, antibiotic ointment, or raw honey.[8] [9]

· Apply antibiotic ointment to the skin around the incision and bandage.[10]

Note that the incisions should not be sutured shut. The abscess must remain open so that it can drain. Otherwise the wound may seal itself over, the fluid will accumulate again, and the process will have to be repeated.

Triple antibiotic alternatives include lavender or tea tree essential oil and raw honey. [11]

An infected sebaceous cyst is a special kind of abscess. It occurs due to a blocked sebaceous gland and is most common on the back. A small bump may be present for months or years before suddenly enlarging and becoming painful.[12] In this case, initial treatment does involve antibiotics, usually flucloxacillin or cotrimoxazole. When the infection eases or before it even begins, the sac of the gland should be removed.[13] If the fibrous tissue inside the cyst is not removed, the cyst may recur.[14]