1) Localized suppurative inflammation

A) Abscess B) Special type of abscess

Boil (furuncle)
Stye
Carbuncle
A) Abscess
Definition:
Localized area of suppuration characterized by cavity formation
full of pus.

Fig. 1: Photograph showing simple abscess in the face

Causes:
The causative organism is commonly staphylococcus aureus
which releases coagulase enzyme leading to localization of
infection.
Pathogenesis (mechanism of abscess formation)
The same as pus formation
Morphology of the abscess
An abscess has a central largely necrotic area composed of pus,
rimmed by a layer of preserved (living) neutrophils, with a
surrounding zone of dilated vessels and parenchymal and
fibroblastic proliferation (pyogenic membrane), indicating early
repair. In time the abscess may become walled off and ultimately
replaced by connective tissue (ulcer)
There is also fibrin network leading to localization of infection in
this area

Fig. 2: Morphology of an abscess

Sites of abscess: anywhere in the body e.g. subcutaneous

tissues, perianal region, lung, liver, spleen, brain, kidney, breast.
… etc

Diagnose of the abscess:

On the skin
Feeling it
Deep structure
Ultra sound
CT
MRI
Fig. 3: CT showing brain abscess. Fig. 4: Diagrammatic illustration
showing lung abscess

B) Special type of abscess

1) Boil (furuncle):
It is a small abscess related to hair follicles or sebaceous glands. It
is commonly found is the face, back, neck and in the axilla.

Fig. 5: Photograph showing Boil (furuncle)

2) Stye
It is an abscess in the eyelid related to the eye lashes

Fig. 6,7: Photograph showing Stye in the upper and lower eye lashes.

Carbuncle: is a multilocular abscess in the skin and

subcutaneous tissue discharging pus through numerous
openings.
- Group at risk
It is usually found in the back of the neck especially in
diabetic persons because of their low resistance to infection.
- Commonest sites
The commonest site is the back of the neck, scalp, and
buttocks because the subcutaneous tissue in this area is
tough and is divided into compartments by fibrous septa. The
suppurative lesion is made of multiple cavities which
communicate with each other and open through multiple
points in the skin.
 Fig. 8: Photograph showing carbuncle in the neck diabetic patient

Treatment of an abscess
Unlike other infections, antibiotics alone will not usually cure an
abscess. In general, an abscess must open and drain in order
for it to improve. Sometimes draining occurs on its own, but
generally it must be opened with the help of a warm compress
or by a doctor in a procedure called incision and drainage
(I&D).

Abscess Treatment: Self-Care at Home

• If the abscess is small (less than 1 cm or less than a half-inch

across), applying warm compresses to the area for about 30
minutes 4 times daily may help.
• Do not attempt to drain the abscess by squeezing or pressing
on it. This can push the infected material into the deeper
tissues.
• Do not stick a needle or other sharp instrument into the
abscess center, because you may injure an
underlying blood vessel or cause the infection to spread.
Medical Treatment
The doctor may open and drain the abscess.
• The area around the abscess will be numbed with medication.
It is often difficult to completely numb the area, but local
anesthesia can make the procedure almost painless.
• The area will be covered with an antiseptic solution and sterile
towels placed around it.
• The doctor will cut open the abscess and totally drain it of pus
and debris.
• Once the sore has drained, the doctor may insert some
packing into the remaining cavity to allow the infection to
continue to drain. It may be kept open for a day or two.
o A bandage will then be placed over the packing, and you
will be given instructions about home care.
o Most people feel better immediately after the abscess is
drained.
o If you are still experiencing pain, the doctor may
prescribe pain pills for home use over the next 1-2 days.
o You are usually sent home with oral antibiotics.
Fig. 8: Diagrammatic illustration showing incision and drainage of an
abscess
Fate of an abscess
1. If evacuated
Healing process occurs or complicated by failure in healing
process results in (ulcer, sinus or fistula.)
2. if not evacuated:
a. Becomes chronic
b. Undergoes pathological calcification.
Why an abscess should be evacuated?
1. To relief the pain and pressure.
2. To help elimination of bacteria.
3. To reduce abscess cavity and to allow process of healing by
fibrosis.
4. Prevent complications.
Reference
1) ROBBINS AND COTRAN PATHOLOGIC BASIS OF DISEASE,
Ninth Edition
[Edited by] Vinay Kumar, Abul K. Abbas, Jon C. Aster; with
.illustrations by James A. Perkins
Chapter3: Healing and repair page:
2) https://www.webmd.com/a-to-z-guides/abscess