An abscess can develop in many different parts of the body. A small operation may be needed to drain the pus. You may also need to take antibiotic medicine.
What is an abscess and what causes it?
An abscess is a collection of pus. Pus is a thick fluid that usually contains white blood cells, dead tissue and germs (bacteria). The pus may be yellow or green and may have a bad smell.
The usual cause is an infection with bacteria. Certain bacteria are more likely to be 'pus-forming' as they make chemicals that can damage the body's tissues. These include Staphylococcus aureus and Streptococcus pyogenes.
The infection causes the immune system to set off white blood cells and chemicals to fight the bacteria. In this 'battle' some tissue dies. A cavity forms and fills with pus. The cavity becomes bigger if the infection continues and the pus can't get out.
What is the treatment for an abscess?
The main treatment is to drain away the pus. Usually this involves a small operation to make a cut in the skin and allow the pus to drain. A local anaesthetic may be used to numb the area but may not be necessary. A scar will form as the skin heals. If the abscess is deep, a small piece of gauze (antiseptic wick) may be put in the drainage hole. This stops the hole from sealing over before all of the pus has drained and the cavity has shrunk.
A more difficult operation is needed to drain the infection when it is inside the body. The techniques vary, depending on the site. Sometimes a tube will be left in the hole to drain the pus.
What happens if it isn't treated?
A skin abscess would normally eventually burst on to the skin surface and let out the pus. This may be after it becomes larger and more painful. So surgical drainage is usually best. However, a small boil may burst and heal without treatment.
An untreated abscess inside the body is usually very serious. You are likely to become very ill and treatment is usually needed.
What can be done to prevent them?
It is difficult to prevent inside the body as it usually happens in people who are ill with other problems.
It may be possible to prevent a skin abscess. 1 in 10 people with them develop another one within 12 months. Good personal hygiene will reduce the number of bacteria on the skin and prevent re-infection. A large number of bacteria are frequently present on sheets and clothes of people with boils. Carefully washing clothes and sheets, and not sharing clothes and towels, may reduce the chances of re-infection or the chances of spreading the infection to friends and family members.
Used dressings and gauze should be thrown away to avoid spreading the infection further. Frequent changing of dressings is recommended for the same reason.
They are more common in people who smoke or are obese, so stopping smoking or losing weight, may help to prevent boils. They are also more common in young people (aged under 30), people with diabetes and people who have taken an antibiotic in the previous six months.
Where do abscesses form?
Most abscesses form just under the skin. A boil is the most common example. In this case, a hair root becomes infected and develops into a small abscess. A gland just below the skin at the entrance to the vagina can become infected and develop into a Bartholin's abscess. Occasionally, women who are breastfeeding can develop an infection in the breast that becomes a breast abscess. The symptoms of a skin abscess include swelling, redness, pain and warmth over the affected area.
Inside the body
An abscess sometimes forms inside the body within an organ or in a space between organs. Various symptoms may occur, depending on the site of the abscess. This usually happens because of another condition. Infection in the liver, for example, can result in a liver abscess. An ultrasound scan or other types of scan can confirm the diagnosis. If infection occurs in the gums or teeth a dental abscess can develop.
Who develops abscesses?
Most skin abscesses occur in people who are otherwise well. There is often no underlying cause and usually no further problems occur once it has gone. Your doctor may check your urine for sugar, as abscesses tend to occur more often in people with diabetes. Recurring skin abscesses may be the first indication of a problem with your immune system.
An abscess inside the body usually occurs in people who are ill with other problems, or in people whose immune system is not working well. For example, a lung abscess may form following a bout of pneumonia; a brain abscess may form after a penetrating head wound (an injury in which the outer covering of the brain is pierced), etc.
Further reading and references
; NICE CKS, January 2017 (UK access only)
; DermNet NZ
; Incidence and recurrence of boils and abscesses within the first year: a cohort study in UK primary care. Br J Gen Pract. 2015 Oct65(639):e668-76. doi: 10.3399/bjgp15X686929.
; Do oral antibiotics after incision and drainage of simple abscesses improve cure rates? Ann Emerg Med. 2015 Jan65(1):112-3. doi: 10.1016/j.annemergmed.2014.08.007. Epub 2014 Sep 8.
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