Synopsis
Recognise a drainable collection, distinguish it from cellulitis and chronic follicular disease, perform or arrange safe source control, and investigate recurrent staphylococcal infection without indiscriminate antibiotics or decolonisation.
- A cutaneous abscess is a focal pus collection: look for fluctuance, pointing, focal pain or spontaneous drainage within or beside cellulitis.
- Incision and drainage is the key treatment for an accessible uncomplicated collection; antibiotics cannot reliably sterilise an undrained cavity.
- Use ultrasound when depth or fluctuance is uncertain, particularly with obesity, early infection or important nearby anatomy.
- Send pus for culture in recurrent, severe, unusual, previously treated or MRSA-risk infection and whenever the result will alter ongoing care.
- Add systemic antibiotics for systemic illness, significant surrounding cellulitis, immune compromise, multiple lesions, difficult sites or failed drainage-only care, following local susceptibility guidance.
- Do not squeeze a facial, deep or perineal collection and do not incise near major vessels, nerves or tendon sheaths without appropriate expertise.
- Recurrent abscesses require a site map and diagnostic review for hidradenitis, cyst, pilonidal disease, foreign body, diabetes and injection exposure.
- Decolonisation is a time-limited household-aware protocol agreed with microbiology for recurrent confirmed staphylococcal disease, not a permanent antiseptic routine.
Key red flags
Sepsis, necrotising features, facial or orbital danger triangle, deep hand or perineal disease, injection-related vascular compromise, severe immunosuppression, prosthetic material or inability to achieve safe analgesia and drainage requires urgent referral.
Periorbital, central facial, deep hand, breast, perineal or injection-related disease deserves lower specialist referral thresholds.
Pain out of proportion, rapidly spreading oedema, crepitus, haemorrhagic bullae, skin anaesthesia or shock requires immediate surgery.
Investigation priorities
Confirm fluid, measure depth and identify loculations or important adjacent structures.
Management branches
A superficial collection is confirmed in a stable patient at a site suitable for local drainage.
- Explain alternatives and obtain consent, provide adequate analgesia and asepsis, and collect pus as the cavity is opened.
- Drain loculations and dress according to local practice, avoiding routine antibiotic use when source control is complete and no risk modifier exists.
- Arrange wound review and safety-net fever, spreading inflammation, bleeding, recurrent collection and impaired function.