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cutaneous_abscess [2012/10/16 14:40] (current)
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 +======Cutaneous Abscess======
 +
 +**Related Terms:​** ​ Cutaneous abscess, [[lymphedema]],​ [[glossary:​infection]],​ boils, pustule, Osteomyelitis,​ Tissue death, gangrene, perineal, anaerobes, aerobes, Subcutaneous abscess, ultrasound, Staphylococcus aureus
 +
 +**Discussion**
 +
 +Another type of [[glossary:​skin]] infection that occurs in the dermal layers. ​ As with other infections, those of us with lymphedema are cautioned that they must be treated quickly and effectively. ​ Because of the immunocompromised condition of our lymphedematous limb, even a simple cutaneous abscess can spread rapipdly and become a life threatening infection,​. ​ It generally presents as a red, pus filled spot.
 +
 +**Causes**
 +
 +These abscess occur after a bacterial infection, a minor wound or injury (even a pin prick)
 +
 +For abscesses on the trunk, extremities,​ axillae, or head and neck, the most common organisms are Staphylococcus aureus and streptococci. In recent years, methicillin-resistant S. aureus (MRSA) has become a more common cause.(1)
 +
 +Abscesses in the perineal (ie, inguinal, vaginal, buttock, perirectal) region contain organisms found in the stool, commonly anaerobes or a combination of aerobes and anaerobes. (1)
 +
 +**Symptoms**
 +
 +Symptoms of cutaneous abscess includes: Fever or chills, ​ in some cases, ​ Local swelling, hardening of tissue (induration), ​ Skin lesion, ​ Open or closed sore, omed nodule, ​ Red,  May drain fluid, Tender and warm affected area (surrounding tissue), ​
 +
 +Local cellulitis, lymphangitis,​ regional lymphadenopathy,​ fever, and leukocytosis are variable accompanying features.
 +
 +**Diagnosis**
 +
 +Diagnosis is usually done through physical examination while the above symptoms may help to confirm it.  Also, the doctor may order blood tests, especially in immunocompromised patients to determine whether or not the bacteria has spread into the blood stream. ​
 +
 +**Complications**
 +
 +For lymphedema patients, the most serious potential complication is that of the infection changing from a small localized site into a serious all over infection ro in spreading to the lymphedematous limb.
 +
 +• Other complications can include: spread of infection through the bloodstream,​ causing, ​ Abscess formation on the joints or other locations, Endocarditis,​ Many new abscesses ("​seeding"​ of infection), Osteomyelitis,​ Tissue death (gangrene)
 +
 +**Treatment**
 +
 +DO NOT SQUEEZE OR PUSH  THE ABSCESS
 +
 +Treatment may include moist heat such in a warm compress, topical antibiotics on the site itself, oral antibiotics – especially for immuno compromised patients, ​
 +
 +Your physician may also chose to open up or drain the abscess. ​  
 +
 +If the abscess is serious and/or if it causes severe pain, an analgesic may be prescribe, otherwise, over the counter pain medication should be sufficient.
 +
 +Antibiotics are generally not used unless the patient is immuniocompromised or has signs of cellulitis, multiple abscesses or a facial abscess. ​
 +
 +**Prognosis**
 +
 +If caught early and treated effectively the prognosis is excellent.
 +
 +**Prevention**
 +
 +It is almost impossible to really ever prevent abscesses/ ​ however, the risk can be greatly reduced through proper hygene, wearing of protective gloves while gardening or doing shop work.
 +
 +[[My Life with Lymphedema and Lymphoma|Pat]]
 +
 +Feb. 4, 2012
 +
 +(1) [[http://​www.merckmanuals.com/​professional/​dermatologic_disorders/​bacterial_skin_infections/​cutaneous_abscess.html|Cutaneous Abscess Merck Manual]]
 +
 +======Abstracts and Studies======
 +
 +**A new simulation model for skin abscess identification and management. ​
 +August 2010**
 +
 +Heiner JD.
 +Source
 +Department of Emergency Medicine, Madigan Army Medical Center, Fort Lewis, WA 98431, USA. [[jasonheiner@hotmail.com]]
 +
 +**Abstract**
 +
 +INTRODUCTION:​
 +Cutaneous abscesses are common, and emergency physicians in training must develop competency withabscess identification and management through incision and drainage. Although simulation models can enable proficiency in such skills, current abscess models described in the literature suffer from limitations. The author presents a novelabscess management training simulator evaluated by physicians.
 +
 +METHODS:
 +An artificial abscess wall tunneled near the surface of a chicken breast is injected with mock purulent material to create the simulator. Twenty physicians familiar with abscess identification and management assessed the model. The educational value of the model and its sonographic fidelity were evaluated via closed-ended questions and open-ended feedback.
 +
 +RESULTS:
 +All 20 physician evaluators agreed that an abscess simulator model would be a useful teaching tool and that this particular abscess model would be a useful teaching tool. The evaluators'​ found the model to realistically simulate a realabscess,​ but cited the lack of purulent loculations as a potential limitation. When responding to the statement "the ultrasound image of the simulated abscess appears realistic,"​ all physicians either "​strongly agreed"​ or "​agreed"​ with the statement (n = 20).
 +
 +DISCUSSION:
 +This new simulation model may be an effective tool to teach skin abscess management. Physicians who evaluated the simulated abscess found that it replicates the classic palpable fluctuance and ultrasound findings of an actualabscess,​ and it can be surgically incised and drained in a similar fashion. Although physicians agreed that this model would be useful, future studies may validate this task trainer as an effective teaching tool.
 +
 +[[http://​journals.lww.com/​simulationinhealthcare/​pages/​articleviewer.aspx?​year=2010&​issue=08000&​article=00009&​type=abstract |Society for Simulation in Healthcare]]
 +
 +** Use of ultrasound elastography for skin and subcutaneous abscesses.**
 +
 +July 2009
 +
 +Gaspari R, Blehar D, Mendoza M, Montoya A, Moon C, Polan D.
 +Source
 +Department of Emergency Medicine, University of Massachusetts School of Medicine, Worcester, Massachusetts 01655, USA. [[romolo.gaspari@umassmemorial.org]]
 +
 +**Abstract**
 +
 +OBJECTIVE:
 +Elastography is a new adjunct to real-time ultrasound imaging that overlays traditional B-mode imaging with a color graphic representation of tissue elasticity. Soft tissue infections are common presenting conditions in the emergency department, and elastography has the potential to help in diagnosis and treatment of evolving soft tissue infections as they progress from induration to fluctuant abscesses, but to our knowledge, no studies of elastography in superficial soft tissue have been published. We hypothesized that elastography would provide increased information regarding skin abscesses.
 +
 +METHODS:
 +This was a prospective study of patients with suspected skin abscesses requiring surgical drainage in the emergency department of an urban tertiary care center. Abscesses were imaged with B-mode imaging and elastography in orthogonal planes. Ultrasound images were analyzed for characteristics of the elastographic images.
 +
 +RESULTS:
 +A total of 50 patients with suspected skin abscesses underwent B-mode imaging and elastography. Elastography accurately differentiated the induration surrounding the abscess from the surrounding healthy tissue, a differentiation that was not visible on B-mode imaging. The elastographic properties of the abscess cavity were variable and not always seen, even with purulence identified during incision and drainage. In some cases, elastography identifiedabscess cavities not seen on B-mode imaging. When seen, the abscess cavity could be characterized by elastographic color and speckle patterns.
 +
 +CONCLUSIONS:​
 +Elastography identified the tissue induration and some abscess cavities not seen on B-mode imaging. It offers a way to characterize abscesses that may be useful clinically, but more research is needed.
 +
 +[[http://​www.ncbi.nlm.nih.gov/​pubmed/​19546327|PubMed]]
 +
 +** A skin abscess model for teaching incision and drainage procedures.**
 +
 +Jul 2008
 +
 +Fitch MT, Manthey DE, McGinnis HD, Nicks BA, Pariyadath M.
 +Source
 +Emergency Medicine Educational Research and Development Group, Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem,​ North Carolina, USA. [[mfitch@wfubmc.edu]]
 +
 +**Abstract**
 +
 +BACKGROUND:
 +Skin and soft tissue infections are increasingly prevalent clinical problems, and it is important for health care practitioners to be well trained in how to treat skin abscesses. A realistic model of abscess incision and drainage will allow trainees to learn and practice this basic physician procedure.
 +
 +METHODS:
 +We developed a realistic model of skin abscess formation to demonstrate the technique of incision and drainage for educational purposes. The creation of this model is described in detail in this report.
 +
 +RESULTS:
 +This model has been successfully used to develop and disseminate a multimedia video production for teaching this medical procedure. Clinical faculty and resident physicians find this model to be a realistic method for demonstratingabscess incision and drainage.
 +
 +CONCLUSION:
 +This manuscript provides a detailed description of our model of abscess incision and drainage for medical education. Clinical educators can incorporate this model into skills labs or demonstrations for teaching this basic procedure.
 +
 +[[http://​www.ncbi.nlm.nih.gov/​pmc/​articles/​PMC2453116/?​tool=pubmed|BioMedCentral]]
 +
 +======External Links======
 +
 +[[http://​www.nlm.nih.gov/​medlineplus/​ency/​article/​000863.htm|Skin Abscess]] Medline Plus
 +
 +[[http://​www.ingentaconnect.com/​content/​iuatld/​ijtld/​2011/​00000015/​00000007/​art00026?​token=00531938bc5713764275c277b425720674c483f345f703a2b59592f653b2a2d3a7c4e7247702209e6fe |Mycobacterium kansasii cutaneous abscesses occurring as immune reconstitution inflammatory syndrome.]] July 2011
 +
 +[[http://​journals.lww.com/​pec-online/​pages/​articleviewer.aspx?​year=2009&​issue=01000&​article=00013&​type=abstract |Ultrasound soft-tissue applications in the pediatric emergency department: to drain or not to drain?]] Jan 2009
 +
 +
 +
 +======Classifications======
 +
 +ICD-10 ​  ​[[http://​www.icd10data.com/​ICD10CM/​Codes/​L00-L99/​L00-L08/​L02- |L02]]
 +
 +ICD-9  [[http://​www.icd9data.com/​2012/​Volume1/​680-709/​680-686/​682/​default.htm|682]] see also: [[http://​www.icd9data.com/​2012/​Volume1/​680-709/​680-686/​686/​686.9.htm |686.9]] ​
 +
 +MeSH   ​[[http://​www.nlm.nih.gov/​cgi/​mesh/​2011/​MB_cgi?​field=uid&​term=D000038|D000038]]
 +
 +======Diagnostic Images======
 +
 +[[http://​www.google.com/​search?​hl=en&​psj=1&​q=cutaneous%20abscess&​bav=on.2,​or.r_gc.r_pw.,​cf.osb&​biw=853&​bih=544&​um=1&​ie=UTF-8&​tbm=isch&​source=og&​sa=N&​tab=wi&​ei=J-srT_WFCOqa2gWnhLWKDw|Google]]
 +
 +[[http://​images.search.yahoo.com/​search/​images;​_ylt=AlePR9XTMA2Xj3RhoJf0iGCbvZx4?​p=cutanenous+abscess&​toggle=1&​cop=mss&​ei=UTF-8&​fr=yfp-t-701|Yahoo]]
 +
 +======Lymphedema People Infection Information Links======
 +
 +[[Infections Associated with Lymphedema]]
 +
 +[[Impetigo]]
 +
 +[[Lymphangitis]]
 +
 +[[Preventing Hospital Infections]]
 +
 +[[Fungal Infections Associated with Lymphedema]]
 +
 +[[Infectious Disease Doctor]]
 +
 +[[Scalded Skin Syndrome]]
 +
 +[[Impetigo]]
 +
 +[[http://​www.lymphedemapeople.com/​thesite/​lymphedema_and_necrotizing_fasciitis.htm |Necrotizing Fascitis]]
 +
 +[[http://​www.lymphedemapeople.com/​thesite/​MRSA_Methicillin_Resistant_Staphylococcus_Aureus.htm |MRSA Methicillin Resistant Staphylococcus Aureus]]
 +
 +[[http://​www.lymphedemapeople.com/​thesite/​lymphedema_cellulitis.htm |cellulitis]]
 +
 +[[http://​www.lymphedemapeople.com/​thesite/​lymphedema_erysipelas.htm |erysipelas]]
 +
 +[[http://​www.lymphedemapeople.com/​thesite/​lymphedema_antibiotics.htm|Lymphedema Antibiotics]]
 +
 +[[http://​www.lymphedemapeople.com/​thesite/​lymphedema_carbuncles.html|Carbuncles,​ Furncles and Boils]]
 +
 +[[http://​www.lymphedemapeople.com/​thesite/​lymphedema_folliculitis.htm|Folliculitis]]
 +
 +[[http://​www.lymphedemapeople.com/​thesite/​lymphedema_lymphadenitis.htm|Lymphadenitis]]
 +
 +[[How to Treat a Lymphedema Wound]]
 +
 +[[How to Prevent Mistakes with your Medicines]]
 +
 +======Lymphedema People Resources======
 +
 +[[[Lymphedema People Blogs]]
 +
 +[[Lymphedema People Forums]]
 +
 +[[Lymphedema People Glossaries]]
 +
 +[[Lymphedema People Online Support Groups]]
 +
 +[[Privacy Statement]]
 +
 +[[Terms of Use]]
 +
 +[[Rules of Conduct]]
 +
 +Contact:
 +
 +[[lymphedemapeople@aol.com]]
 +
 +[[lymphedemapeople@yahoo.com]]
  
cutaneous_abscess.txt · Last modified: 2012/10/16 14:40 (external edit)