What to Do About Skin Abscesses

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Skin abscesses are more common than you might think, and are usually caused by bacteria that live on the skin or adjacent mucous membranes (like in the nose). More often than not, the staphylococcus aureus bacteria is the most common culprit. In many cases, the cause of abscess is a staph aureus bacteria called MRSA that has become resistant to some antibiotics.

What’s in a name? A skin abscess is a collection of pus that develops under the skin. A common skin abscess that you might have heard of is a boil. A boil (also known as a furuncle) is an infection of the hair follicle that causes a painful pus-filled bump on your skin. I know, I know, these sound gross, but they are actually very common!

How do I treat it? There is good news! For most of the small boils and abscesses, a warm towel compress may be all you need for the pus to drain on its own. In some cases, if a compress doesn’t work, you might need to visit your doctor. During this visit, your doctor might numb the abscess and drain it, a procedure known as “incision and drainage” or “I and D.” This drainage, or pus, may be cultured in the lab to help guide potential antibiotic use.

After drainage, do I need antibiotics? Antibiotics are recommended for abscesses larger than at the time they were drained. In fact, people treated with Bactrim (sulfamethoxazole/trimethoprim 160 mg/800 mg) twice daily for 7 days had a higher cure rate than those who didn’t take antibiotics after incision and drainage.

Wait, but what if I have a sulfa allergy? If you have a sulfa allergy, you most likely won’t be able to take Bactrim, but there are alternatives. Other good options are clindamycin, and minocycline. An expensive brand name medication, Zyvox, is available now as generic linezolid but it’s still pricey. Taking linezolid twice daily is also an option.

Dr O.

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