An abscess is a place of accumulation of the creamy white, yellow, or greenish fluid, known as pus, surrounded by reddened tissue. It is the result of the body's inflammatory response to a foreign body or a bacterial, viral, parasitic, or fungal infection. An abscess usually dries out and resolves when it is drained of pus. The most common parts of the body affected by abscesses are the face, armpits, arms and legs, rectum, sebaceous glands (oil glands), and the breast during lactation.
Description
Most abscesses are septic, which means they are the result of an infection. Abscesses occur when white blood cells (WBCs) gather in response to an infection. They produce oxidants (for example, superoxide radical) and enzymes to digest the invading bacteria, viruses, parasites, or fungi. The infective agents are then broken down by the WBCs into small pieces that can be transported through the bloodstream and eliminated from the body. Unfortunately, the enzymes may also digest part of the body's tissues along with the infective agents. The resulting liquid of this digestion is pus, which contains the remains of the infective agents, tissue, white blood cells, and enzymes.
A sterile abscess is one that is not produced by an infection. It is caused by irritants, such as foreign bodies or injected drugs, and medications that have not been totally absorbed. Sterile abscesses quite often heal into hardened scar tissue.
Common types of abscesses:
Boils and carbuncles. Sebaceous glands and superficial skin are the places usually infected.
Dental abscess. An abscess that develops along the root of a tooth.
Pilonidal abscess. People who have a birth defect involving a tiny opening in the skin just above the anus may have fecal bacteria enter this opening, causing an infection and a subsequent abscess.
Retropharyngeal, parapharyngeal, peritonsillar abscess. As a result of throat infections like strep throat and tonsillitis, bacteria invade the deeper tissues of the throat and cause a parapharyngeal or peritonsillar abscess. A retropharyngeal abscess is a result of something usually blood-borne, and not from a direct spread of tonsillitis. These abscesses can compromise swallowing and even breathing.
Liver abscess. Bacteria, parasites, or amoeba from the intestines can spread through the blood to the liver and cause abscesses.
Psoas abscess. An abscess can develop in the psoas muscles, when an infection spreads from the appendix, the large intestine, or the fallopian tubes.
Butin abscess. Any blood-borne feeding off bacteria that stimulate pus production (pyogenic organisms). Can cause abscesses in possibly many sites.
Causes & symptoms
Many different agents cause abscesses. The most common are the pyogenic, or pus-forming bacteria, such as Staphylococcus aureus, which is nearly always the cause of abscesses directly under the skin. Abscesses are usually caused by organisms that normally inhabit nearby structures or that infect them. For example, abscesses around the anus may be caused by any of the numerous bacteria found within the large intestine. Brain abscesses and liver abscesses are caused by the bacteria, amoeba, and fungi that are able to travel there through circulation.
Symptoms of an abscess are the general signs of inflammation. Symptoms that identify superficial abscesses include heat, redness, swelling, and pain over the affected area. Abscesses in other places may produce only generalized symptoms, such as fever and discomfort. A sterile abscess may present as painful lump deep under the site of an injection. A severe infection may bring on fever, fatigue, weight loss, and chills. Recurrent abscesses may indicate undiscovered allergies or decreased immune functioning.
Diagnosis
A general physical examination and a detailed patient history are used to diagnose an abscess. Recent or chronic disease or dysfunction in an organ suggests it may be the site of an abscess. Pain and tenderness on physical examination are common findings. There may also be a leakage of pus from a sinus tract connected to an abscess deep in the body tissue.
Treatment
Bentonite clay packs with a small amount of goldenseal powder (Hydrastis canandensis) can be placed on the site of a superficial abscess and used to draw out the infection. Tea tree oil (Melaleuca spp.) and garlic (Allium sativa) directly applied to abscesses may also help to clear them.
Applications of a hot compress to the skin over the abscess will hasten the draining or the reabsorption of the abscess. Contrast hydrotherapy, using alternating hot and cold compresses, can also be used. Additionally, localized warm/hot soaks three to five times daily frequently brings an abscess to heal.
Homeopathic remedies that can be taken to help diminish abscess formation include belladonna, silica, Hepar sulphuris, and calendula. Also, acupuncture may be recommended to help treat pain caused by an abscess. In addition, vitamins A and C, beta-carotene, zinc, liquid chlorophyll, and garlic are useful as supportive daily nutrients to help clear up abscesses.
Allopathic treatment
Often, the pus of an abscess must be drained by a physician. Ordinarily, the body will handle the remaining infection. Sometimes antibiotics are prescribed. The doctor may often put a piece of cloth or rubber, called a drain, in the cavity of the abscess to prevent it from closing until all the pus has drained.
Expected results
Once the abscess is properly drained, it should clear up in a few days. Any underlying diseases will determine the overall outcome of the condition. Recurrent abscesses, especially those on the skin, return due to either defective/altered immunity, or staph overgrowth, where there is high bacterial colonization on the skin. The patient should consult a physician for treatment with which to wash the skin areas, and treatment to eradicate colonization.
If the abscess ruptures into neighboring areas or if the infectious agent spills into the bloodstream, serious consequences are likely. Abscesses in and around the nasal sinuses, face, ears, and scalp may spread the infection into the brain. Abscesses in the abdominal cavity, such as in the liver, may rupture into that cavity. Blood poisoning, or septicemia, is an infection that has spilled into the bloodstream and then spreads throughout the body. These are emergency situations where the patient needs to be seen by a physician as soon as possible.
It is important to take note that abscesses in the hand may be more serious than they might appear. Due to the intricate structure and the overriding importance of the hand, any hand infection must be treated promptly and competently.
Prevention
Infections that are treated early with heat, if superficial, or antibiotics, if deeper, will often resolve without the formation of an abscess. It is even better to avoid infections altogether by promptly cleaning and irrigating open injuries, particularly bites and puncture wounds.
BOOKS
Bennett, J. Claude and Fred Plum, ed. Cecil Textbook of Medicine. Philadelphia: W. B. Saunders Co., 1996.
Duke, James A., et al. The Green Pharmacy. Pennsylvania: Rodale, 1997.
Isselbacher, Kurt, et al, ed. Harrison's Principles of Internal Medicine. New York: McGraw–Hill, 1997.
Tierney, Jr., Lawrence M., et al, ed. Current Medical Diagnosis and Treatment. Connecticut: Appleton & Lange, 1996.
