#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. 
  • Hemostasis

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.