Cysts and Abscesses

Question 1

acute or chronic, localized inflammation associated with collection of pus

Answer 1

skin abscess

Question 2

a patient presents with a fluctuant mass with surrounding induration that is painful and tender to palpitation. what is the diagnosis and treatment?

Answer 2

skin abscess

incision and drainage + antibiotics

Question 3

what diagnostic can be used to differentiate between an abscess and cellulitis?
what will an abscess show?

Answer 3

ultrasound

pocket of fluid

Question 4

chronic, suppurative, scarring disease of apocrine and eccrine gland-bearing skin

Answer 4

hidradenitis suppurativa

Question 5

what does hidradenitis suppurativa look like when ruptured and infected?

Answer 5

like an abscess

Question 6

what are 3 risk factors for hidradenitis suppurativa?

Answer 6

obesity
smoking
genetic acne

Question 7

a patient presents with this acute skin lesion. what is the diagnosis and treatment?

Answer 7

hidradenitis suppurativa

intralesional steroid injection + I&D

Question 8

what is the treatment for an acute hidradenitis suppurativa?

Answer 8

intralesional steroids +
Incision and drainage

Question 9

what improves healing and reduces reoccurrences of hidradenitis suppurativa?

Answer 9

topical clindamycin

Question 10

what are some systemic meds for hidradenitis suppurativa outbreaks? (5)

Answer 10

tetracycline
clindamycin + rifampin
acitretin (retinoid)
dapsone
adalimumab/infliximab

Question 11

a patient presents with this skin lesion. what is the diagnosis and treatment?

Answer 11

hidradenitis suppurativa (severe)

surgical removal of all skin down to fascia + skin grafting

Question 12

a patient presents with this single, mobile, benign subcutaneous tumor. what is the diagnosis and treatment?

Answer 12

lipoma

excision

Question 13

a patient presents with multiple, mobile, benign subcutaneous tumor. what is the diagnosis and treatment? what can be done if it becomes secondarily infected?

Answer 13

lipoma

excision
antibiotics before removal

Question 14

cyst in hair follicle that is filled with epidermal cells and epithelial debris that connects with the surface by keratin-filled pore

Answer 14

epidermal inclusion cyst

Question 15

a patient presents with inflamed erythema + pain and tenderness. there is a cream-colored drainage that smells like rancid cheese. what is the diagnosis and 2 possible treatments?

Answer 15

epidermal inclusion cyst

removal of capsule
OR
complete excision of epidermal cyst wall

Question 16

what is the treatment regimen for an epidermal inclusion cyst if it is infected? (3)

Answer 16

I&D
start antibiotics
decapsulate after infection is gone

Question 17

chronic gland infection in the depths of the gluteal cleft

Answer 17

pilonidal disease

Question 18

what are 3 patient presentations of pilonidal disease?

Answer 18

acute abscess
chronic draining pits
complex, recurrent disease post surgery

Question 19

a patient presents with this lesion in the gluteal region. what is the diagnosis?

Answer 19

pilonidal disease

Question 20

what is the treatment for an acute abscess in a patient with pilonidal disease? (2)

Answer 20

I&D (incise 1cm off midline)
+/- antibiotics

Question 21

what is the treatment for chronic draining pits in a patient with pilonidal disease? (2)

Answer 21

shave gluteal skin + remove hair from pits
repeat q 1-2 weeks

Question 22

what should we do it chronic draining pits persist with drainage and inflammation for 2-3 months?

Answer 22

refer to surgery

Question 23

what is the treatment for complex, recurrent pilonidal disease?

Answer 23

flap surgery removing all tissue from midline