Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at March 16, 2016

An abscess is a common but potentially serious condition that occurs when the body attempts to fight an infection by moving white blood cells into infected tissue, creating a buildup of pus. Treatment generally requires antibiotics and/or surgery to drain the abscess.


Definition & Facts

An abscess can be defined as pocket or collection of pus that has formed within an area of body tissue in response to the presence of an infection or a foreign substance. Pus is a foul-smelling white or yellow exudate comprised of live blood cells, dead cells and tissue, body fluid, and bacteria, and is the result of the body's attempt to fight off infection. A pus-filled abscess may be red, warm, and painfully inflamed. Abscesses are commonly found on the skin and in the mouth, but can occur in any solid body tissue.

Symptoms & Complaints

External abscesses are readily visible, easily identifiable, and generally very treatable. The initial symptoms include redness, heat, swelling, tenderness, and inflammation of the infected area, and as the abscess worsens the symptoms may include severe pain, loss of function in the infected area, fever, and chills.

External abscesses typically form just under the skin as boils or carbuncles, which are infections of one or more hair follicles, or in the mouth as a result of tooth infection or trauma or periodontal disease. Untreated external abscesses will increase in severity and size before bursting and draining, potentially leaving the area open to new infection and resulting in deep scarring.

Internal abscesses are not visible and are thus harder to identify, but initial signs include swelling, heat and pain in the infected area, fever, and a feeling of general illness. Internal abscesses may form in, on, or between organs, and can be both extremely dangerous and very challenging to treat. They can potentially interfere with the working of the effected organ or those around it, and could also pose the risk of sepsis or blood infection. Immediate medical treatment of any suspected internal abscess is crucial.


The most common cause of external abscesses is bacterial infection. Boils and carbuncles, the most frequently seen types of abscesses, are caused by Staphylococcus infection of one or more hair follicles. Staphylococcus is also responsible for the Bartholin's abscess, a common condition that affects Bartholin's gland located near the opening of the vagina.

Dental abscesses are commonly created by bacterial infections of the teeth and gums. These infections may be caused by deep cavities, gum disease, or loose or damaged teeth. Untreated tonsillitis or strep throat can lead to peritonsillar abscesses, pus-filled sores in the throat.

The perianal abscess, a common and painful problem that involves itching, discharge, and intense pain, is caused by blockage of the anal glands and requires surgery to both drain the abscess and repair the damage it created.

Internal abscesses are generally far more serious but much rarer than external ones, and are not always related to bacterial infection. Amoebic liver abscesses, very common in tropical areas with poor sanitation, are caused by a parasite. Spinal cord abscesses may be related to bacterial infection, but may also be caused by back injuries, trauma, or osetomyelitis.

Diagnosis & Tests

The tests used to diagnose abscesses depend on their location, type, and severity. External abscesses can often be diagnosed on inspection, though a sample of the pus may be collected and tested to determine the best form of treatment. Patients who have recurring abscesses may be asked to provide a urine sample for glucose testing. X-rays are used to diagnose dental abscesses, and peritonsillar abscesses may be identified and diagnosed with fine-needle aspiration, in which a needle is used to collect a sample of the pus.

Internal abscesses are more difficult to identify and may require extensive testing [[computed tomography (CT) scan|CT scan]s, magnetic resonance imaging or MRI scans, ultrasoundsl and standard X-rays may all be used in diagnosis.

The tests used for diagnosis depends to a large extent on the type and location of the suspected abscess. It's crucial to identify the size and location of the abscess as accurately as possible, particularly if surgery may be a necessary part of treatment.

Treatment & Therapy

Abscess treatment varies depending on the type, size, location, and cause of the abscess. Minor external abscesses may drain naturally with no medical treatment. More serious external abscesses may require antibiotics and a drainage procedure.

Drainage of external abscesses may be done using a topical or local anesthetic to temporarily numb the area. The procedure involves making a small incision to allow the pus to drain or be evacuated, then covering the area with a light dressing. For very deep abscesses, a gauze wick may be inserted.

Treatment of internal abscesses is a serious matter that generally involves both a major drainage procedure and a course of antibiotics. Depending on the type and location of the abscess, drainage may be done via a percutaneous procedure, in which a fine needle is inserted through the skin and used to drain the pus from the abscess.

A small drainage catheter may then be inserted and left in place for several days to be sure the abscess is entirely emptied. When percutaneous drainage isn't feasible, internal abscesses may require surgery. Depending on the type and location of the abscess, surgery could be relatively minor or very major, involving general anesthesia and a lengthy recovery period.

Prevention & Prophylaxis

External abscesses are frequently isolated incidents, but there are precautions anyone can take to avoid their formation. Eating a healthy diet, maintaining good physical hygiene, and not smoking are all important prevention tools.

Be particularly careful about shaving faces, legs, underarms, or any part of the body, and be certain to clean and disinfect any wounds, abrasions, or injuries to the skin as soon as possible to avoid infection. It's difficult to actually prevent internal abscesses, which are mostly triggered by other conditions, but maintaining good health, hygiene, diet, and lifestyle choices is important.

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