Incision and Drainage

Question 1

Folliculitis:

• what is this?
• tx
• MC cause of hot tub folliculitis?

Answer 1

What: superficial infection of hair follicles in the epidermis

Tx: resolve spontaneously, warm compress may help

MC cause hot tub = pseudomonas aeruginosa

Question 2

What is the difference between:

• skin abscess
• furunlce
• carbuncle

Answer 2

Skin abscess: collection of pus within the dermis and deeper skin tissues

Furuncle: infection of hair follicle, pus extends through dermis into sub Q tissue.

Carbuncle: multiple furuncles

Question 3

Indications for I&D

CI/Concerns for I&D

Answer 3

Most skin abscesses should undergo I&D.
–if draining spontaneoulsy may elect to follow.

CI/Concerns:

• abscess location:
• -perirectal area
• -anterior and lateral neck
• -breast near areola
• -near vital nerves or blood vessels
• -hand abscess (excluding paronchyia)
• -central triangle of face
• abscess types:
• -recurrent or interconnected abscesses
• -larger than 5cm
• pt factors:
• -airway issues
• -bleeding disorder or anticoagulation

**in these circumstances you may need to refer to someone above your pay grade.

Question 4

Risk factors for Abscess

What are some preprocedure medical issues you should address?

Answer 4

DM, immunological abnormalities, breaches of skin barrier.

Medical issues:

• lidocaine allergy (may use injectable benadryl)
• heart valve or total joint, need abx prophylaxis

Question 5

When to consider abx therapy after abscess drainage?

Which abx would you prescribe?

Answer 5

if abscess greater than 5cm, extensive cellulitis, signs and sx of systemic infection, comorbidities, immunosuppression, prosthetic joints and valves.

Abx:

• clindamycin, doxycycline, smx/tmp
• -if SICK with suspected MRSA parenteral vancomycin.
• dicloxacillin, keflex