Symptoms of a local inflammatory reaction include redness, pain, swelling, warm sensations, and functional limitations (rubor, dolor, tumour, calor, and functio laesa).
Acute inflammation produces an infiltrate that can reabsorb, abscess, or progress into interstitial tissue (phlegmon). The resorption of infiltrate (= local accumulation of fluid, protein, and leucocytes in tissue) can be promoted by taking conservative measures (rest, elevation of the affected body part, and wet compresses). When the inflammatory process cannot be controlled with conservative therapy, it may become an abscess. An abscess is an accumulation of pus in a newly formed cavity, surrounded by an abscess wall. An abscess arises when infiltrate is liquefied, so that in the acute phase the abscess remains surrounded by infiltrate.
When tissue proteolysis due to enzymes and bacterial toxins progresses, the abscess “ripens” and becomes palpable as a fluctuating swelling. The abscess can break through the surface spontaneously. It is better to perform incision and drainage (where there is pus, it must be evacuated). Antibiotics are no longer used for abscess because they inhibit the immune response and may cause the abscess to become encapsulated. General practitioners should not attempt the following: incision of a peri-anal abscess, abscess with mastitis, carbuncle, panaritium ossale or tendineum, and the excision of hidradenitis suppurativa. These disorders should be left to the specialist because local anaesthesia is insufficient. There is therefore insufficient pain control for an adequate procedure to be performed. Peri-anal abscesses usually originate as fistulae, which must also be radically excised. The following disorders may be addressed by a general practitioner.
Superficial Abscess
(An abscessed keratinous cyst).
Therapy: Incision and drainage.
Furuncle
This is an acute inflammation originating in the hair follicle and caused by Staphylococcus aureus.
Therapy:
- In the infiltrative stage, local Betadine/iodine ointment.
- After abscessing, incision and drainage (furuncles usually have central necrosis and no abscess).
- Antibiotics are contra-indicated. Exceptions are the nasal furuncle or furuncles located elsewhere on the face (risk of sinus cavernosus thrombosis and sepsis via the angular vein).