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Skin bacterial abscess in Adult
See also in: Cellulitis DDx,Anogenital,Hair and Scalp
Other Resources UpToDate PubMed

Skin bacterial abscess in Adult

See also in: Cellulitis DDx,Anogenital,Hair and Scalp
Contributors: Lauren Strazzula MD, Susan Burgin MD, Lowell A. Goldsmith MD, MPH
Other Resources UpToDate PubMed


An abscess is a localized inflammatory process in which the white blood cells accumulate at the site of infection in the dermis and/or subcutaneous tissue, creating a collection of pus. Commonly associated pathogens are Staphylococcus aureus, streptococci, and normal skin flora. Trauma or any break in the skin barrier predisposes to abscess formation.

Lesions evolve over days to 1-2 weeks. They are usually painful / tender, erythematous, warm, and fluctuant masses that are sometimes associated with fever. A tender subcutaneous nodule with overlying erythema but minimal fluctuance may be an early presentation. Incision and drainage is the mainstay of therapy. In an otherwise healthy, ambulatory patient, the addition of antibiotics is not indicated. Indications for the addition of antibiotics may include patients who are systemically ill, have a high burden of disease (indicated by concomitant widespread folliculitis or associated cellulitis), are immunosuppressed, or have failed incision and drainage.

Methicillin-resistant S. aureus (MRSA) first emerged as an important nosocomial pathogen in the 1960s. In more recent years, community-acquired outbreaks of MRSA (CA-MRSA) have increasingly been described among healthy individuals lacking the traditional risk factors for such infections (intravenous [IV] drug use, incarceration, participation in contact sports, etc). These strains have a propensity for causing abscesses, furunculosis, and folliculitis and have a unique antibiotic susceptibility profile from health care-associated strains of MRSA (HA-MRSA).

It has been shown that the majority of purulent skin and soft tissue infections presenting to emergency rooms across the United States are caused by CA-MRSA.


L02.91 – Cutaneous abscess, unspecified

31928004 – Abscess of skin AND/OR subcutaneous tissue

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Differential Diagnosis & Pitfalls

  • Kerion on the scalp are fungal-induced hypersensitivity reactions, commonly associated with adenopathy, and difficult to tell from bacterial-induced abscesses.
  • Atypical mycobacterial infection present as a "cold abscess" (little to no erythema or warmth) in a normal host.
  • Ruptured Epidermoid cyst
  • Inflamed or infected Epidermoid cyst
  • Foreign body reactions or Foreign body granuloma
  • Hidradenitis suppurativa
  • Necrotizing fasciitis – If considered, this is a medical emergency.
  • Pyomyositis
  • Panniculitis – Infectious or noninfectious cause of panniculitis.
  • Pseudolymphoma
Aspergillosis and other opportunistic infections, including Mycobacterium avium-intracellulare infection and Serratia, can present as an abscess in the immunocompromised patient.

The differential diagnosis of a tender, erythematous dermal or subcutaneous nodule in the immunosuppressed host must include bacterial, fungal, and mycobacterial organisms. These cannot be differentiated clinically and must be cultured to determine the causative organism.

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Last Updated:10/08/2017
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Patient Information for Skin bacterial abscess in Adult
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Skin bacterial abscess in Adult
See also in: Cellulitis DDx,Anogenital,Hair and Scalp
A medical illustration showing key findings of Skin bacterial abscess : Abscess, Skin warm to touch, Painful skin lesion
Clinical image of Skin bacterial abscess - imageId=154367. Click to open in gallery.  caption: 'Abscesses on the forearm, one with an ulcer and crust.'
Abscesses on the forearm, one with an ulcer and crust.
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