Cellulitis (see Cellulitis, [[Cellulitis]]): skin infection of deeper dermis and subcutaneous fat (resulting from bacterial breach of the skin) characterized by erythema, warmth, and edema without an underlying suppurative focus
Erysipelas (see Erysipelas, [[Erysipelas]]): skin infection of upper dermis and superficial lymphatics (resulting from bacterial breach of the skin) characterized by erythema, warmth, and edema without an underlying suppurative focus
Impetigo (see Impetigo, [[Impetigo]]): infection of superficial layers of the epidermis
Necrotizing Soft Tissue Infection (see Necrotizing Soft Tissue Infection, [[Necrotizing Soft Tissue Infection]]): all of these are characterized by fulminant tissue destruction, systemic toxicity, and high mortality rates
Necrotizing Cellulitis
Meleney’s Synergistic Gangrene
Clostridial Anaerobic Necrotizing Cellulitis
Non-Clostridial Anaerobic Necrotizing Cellulitis
Necrotizing Fasciitis: deep-seated infection of subcutaneous tissue (involving fascia and fat), which may spare the skin
Clostridial Myonecrosis (Gas Gangrene) (see Clostridial Myonecrosis, [[Clostridial Myonecrosis]]): life-threatening muscle infection which develops either contiguously from a site of trauma or via hematogenous spread from the gastrointestinal tract to the muscle
Furuncle (Boil): infection of hair follicle where purulent material extends through the dermis into the subcutaneous tissue, forming a small abscess
Carbuncle: coalescence of several inflamed follicles into a single inflammatory mass with purulent drainage from multiple follicles
Skin Abscess: collection of pus within dermis and deeper skin tissues
Intravenous Drug Abuse (IVDA) (see Intravenous Drug Abuse, [[Intravenous Drug Abuse]]): particularly “skin popping”
Nasal Carriage of Staphylococcus Aureus (see Staphylococcus Aureus, [[Staphylococcus Aureus]]): may be the only risk factor present in a normal patient who develops skin abscess
Skin Barrier Breach
Microbiology
General Comments
Approximately 7% of Cases are Polymicrobial
Staphylococcus Aureus (see Staphylococcus Aureus, [[Staphylococcus Aureus]]: most common etiology
Warm Compress: when used alone, may promote drainage
Skin Abscess or Medium-Large Furuncle/Carbuncle
Incision and Drainage (I+D)
Indications for Concomitant Antibiotic Therapy (Based on Infectious Disease Society America/IDSA guidelines)
Abscess Present in Difficult to Drain Area: face, hand, genitals
Associated Septic Phlebitis
Comorbid Disease
Extreme of Age
Immunosuppression
Lack of Clinical Response to Incision and Drainage (I+D) Alone
Rapid Progression with Associated Cellulitis
Severe or Extensive Disease with Multiple Sites of Infection
Systemic Toxicity
Clinical Efficacy
Trial of Sulfamethoxazole-Trimethoprim for Skin Abscess (NEJM, 2016)MEDLINE]: in skin abscesses at least 2 cm in size which were drained, sulfamethazole-trimethoprim increased cure rate at 7 and 14 days
Wound Cultures were Positive for MRSA in 45% of Cases
Abscess Size of At Least 2 cm is Considered a Useful Threshold Regarding Deciding on Antibiotic Use as Adjunctive Therapy for Skin Abscess
References
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2014 Jul 15;59(2):e10-52. doi: 10.1093/cid/ciu444 [MEDLINE]
Management of Skin Abscesses in the Era of Methicillin-Resistant Staphylococcus aureus. N Engl J Med 2014; 370:1039-1047March 13, 2014DOI: 10.1056/NEJMra1212788 [MEDLINE]
The Massachusetts abscess rule: a clinical decision rule using ultrasound to identify methicillin-resistant Staphylococcus aureus in skin abscesses. Acad Emerg Med. 2014 May;21(5):558-67. doi: 10.1111/acem.12379 [MEDLINE]
Trimethoprim-Sulfamethoxazole versus Placebo for Uncomplicated Skin Abscess. N Engl J Med. 2016;374(9):823 [MEDLINE]