#EMConf: Cutaneous Abscess
Packing an abscess can be painful without change in outcome or rates or reaccumulation of infection. Consider packing for:
- Large abscess
- Areas where the skin close quick like the axilla.
Irrigation has no role in abscess management.
No role for needle aspiration in cutaneous abscess; effective in Peri-tonsillar abscess.
Antibiotics: For simple cutaneous abscess, I+D alone may be sufficient:
- consider adding MRSA coverage like Bactrim
- role for Keflex if there is surrounding cellulitis.
Ultrasound: Clinical exam has poor interrater reliability so ultrasound has been shown to be very useful and can change management.
Reference: Talan DA, et al. Trimethoprim–Sulfamethoxazole versus placebo for uncomplicated skin abscess. NEJM. 2016; 374(9):823-832.