Abscess L02.9

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Definition
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Localized, encapsulated naxh 4-5 days centrally melting inflammation in the epidermis, hair follicles, in eccrine or apocrine sweat glands, in the dermis and/or subcutis caused by pus-inducing substances or pathogens (bacteria or fungi) and accompanied by tissue melting.

Pus is the constellation of neutrophil granulocytes, cell debridement and liquefied tissue. An abscess is the purulent, fluctuating, cutaneous or subcutaneous cavity formation. Epidermal or infundibular accumulations of pus are called pustule or, in the minus variant, micro-abscess (e.g. Munro-micro-abscess in psoriasis vulgaris).

Notice! The micro-abscess named after Pautrier, which consists of lymphocytes and not of neutrophil granulocytes, is to be understood as a misnomer.

Pathogen
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Mostly staphylococci (especially Staphylococcus aureus), more rarely gram-negative germs (E. coli, Proteus mirabilis) or mixed flora. The typical characteristics are determined by the pathogenic properties of the pathogens. Staphylococci form the enzyme coagulase, which activates the coagulation and slows down the spread of the inflammation in the interstitium.

Dead parasites or their remains are further causes of abscess formation.

Fungi can also lead to abscesses in rare cases.

Clinical features
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Classical signs of inflammation (tumor, rubor, dolor, calor) and fluctuation. Pulse-synchronous throbbing pain; these symptoms are absent in the development of pustules.

Complication(s)
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Specific infections (sedimentation abscess, cold abscess), tumor, phlegmon.

Therapy
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Bacterial follicular and non follicular pustules are treated locally with antiseptic and internally with antibiotics. Dermal abscesses must be sufficiently incised and drained; penicillinase-resistant penicillin, possibly after antibiogram.

Alternative: Clindamycin 3x300mg/day p.o. for 10 days

Alternative: Trimethoprim-Sulfmethoxazole 2x 160TMP/800 SMXmg/day p.o. over 10 days

Literature
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  1. Miller LG et al (2015) Clindamycin versus trimethoprim-sulfamethoxazole for uncomplicated skin infections.N Engl J Med 372:1093-1103

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020