Abscess…not as simple as you may think

September 26, 2008

One of the most terrifying incidences of my childhood that I remember is the one when I developed an abscess. I didn’t bang into anything, nor did I fall down; I didn’t even prick myself and wasn’t suffering from any illness either. How this ugly looking bump on my armpit arose is still a mystery. This was mistake to be a normal boil but soon it was detected to contain a liquefied centre and that was when my parents told me not to touch it at all. My parents complacence soon changed to a feeling of urgency when they identified that the bump was not a boil but an abscess. They rushed with me to the nearest clinic where our family doctor operated on me to treat the abscess.

‘Operation’ is how I would define the crucifying experience of the pricks made by the doc on my arm pit to as if he was punishing not the abscess but me on developing one. I still remember the cries and howls I illustrated as a mark of hatred and disgust for the doc. But today I understand the science behind the management of abscesses and hence want to discuss the same with you all so that you are aware of the devil and can prevent it or manage it better if it attacks you.

What is an abscess

An abscess is a tender, easily pressed mass generally surrounded by a colored area from pink to deep red. The middle of an abscess is full of pus and debris.

Painful and warm to touch, abscesses can show up any place on your body. The most common sites are in your armpits (axillae), areas around your anus and vagina (Bartholin gland abscess), the base of your spine (pilonidal abscess), around a tooth ( dental abscess ), and in your groin. Inflammation around a hair follicle can also lead to the formation of an abscess, which is called a boil ( furuncle ).

An abscess ( Latin : abscessus) is a collection of pus (dead neutrophils ) that has accumulated in a cavity formed by the tissue on the basis of an infectious process (usually caused by bacteria or parasites ) or other foreign materials (e.g. splinters, bullet wounds, or injecting needles). It is a defensive reaction of the tissue to prevent the spread of infectious materials to other parts of the body.

The organisms or foreign materials kill the local cells , resulting in the release of toxins . The toxins trigger an inflammatory response , which draws large numbers of white blood cells to the area and increases the regional blood flow.

The final structure of the abscess is an abscess wall, or capsule, that is formed by the adjacent healthy cells in an attempt to keep the pus from infecting neighboring structures. However, such encapsulation tends to prevent immune cells from attacking bacteria in the pus, or from reaching the causative organism or foreign object.

Abscesses require prompt attention

The cardinal symptoms and signs of any kind of inflammatory process are redness (rubor), heat (calor), swelling (tumor), pain (dolor) and loss of function. Abscesses may occur in any kind of solid tissue but most frequently on skin surface (where they may be superficial pustules ( boils ) or deep skin abscesses), in the lungs, brain , teeth , kidneys and tonsils. Major complications are spreading of the abscess material to adjacent or remote tissues and extensive regional tissue death ( gangrene ). Abscesses in most parts of the body rarely heal themselves, so prompt medical attention is indicated at the first suspicion of an abscess. An abscess could potentially be fatal (although this is rare) if it compresses vital structures such as the trachea in the context of a deep neck abscess.

Causes

Abscesses are caused by obstruction of oil (sebaceous) glands or sweat glands, inflammation of hair follicles, or from minor breaks and punctures of the skin. Germs get under the skin or into these glands, which causes an inflammatory response as your body’s defenses try to kill these germs.

The middle of the abscess liquefies and contains dead cells, bacteria, and other debris. This area begins to grow, creating tension under the skin and further inflammation of the surrounding tissues. Pressure and inflammation cause the pain.

People with weakened immune systems get certain abscesses more often. Those with any of the following are all at

An abscess can worsen

  • Most often, an abscess becomes a painful, compressible mass that is red, warm to touch, and tender.
  • As some abscesses progress, they may “point” and come to a head so you can see the material inside and then spontaneously open (rupture).
  • Most will continue to get worse without care. The infection can spread to the tissues under the skin and even into the bloodstream.
  • If the infection spreads into deeper tissue, you may develop a fever and begin to feel ill.

Treatment

  1. If the abscess is small (less than 1 cm or less than a half-inch across), applying warm compresses to the area for about 30 minutes 4 times daily can help.
  2. Do not attempt to drain the abscess by pressing on it. This can push the infected material into the deeper tissues.
  3. Do not stick a needle or other sharp instrument into the abscess center because you may injure an underlying blood vessel or cause the infection to spread.
  4. Consult a doctor

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