An abscess of the skin is a common problem. This is treated by incision to relieve the pressure of the abscess and allow blood to flow into the area around it. With the flow of blood into the inflamed tissue around the abscess, the infection is contained. The cavity of the abscess should remain open to keep the pressure down and for blood to continue to flow into this inflamed tissue.
The aphorism “Never let the sun set on pus under pressure” illustrates the importance of an abscess to have an opening for pressure to be relieved.
There is a naive tendency for the pus to be drained. The satisfaction in removing every bit of purulence is foolish. If the abscess is left free to drain, it will.
If this infection is cultured then Staph Aureus is usually isolated. This Staph Aureus has a particular propensity to cause abscess formation around hair follicles even tiny ones that are on skin that has only fine hair. They have a number of virulence factors that tend to cause skin abscesses. The resistance to antibiotics is a virulence factor, however is not the reason these bacteria have a tendency to cause abscess formation in skin structures like hair follicles. It is unfortunate that these organisms are referred to as MRSA (Methacillin Resistant Staph Aureus). Because the infection is named for antibiotic resistance, there is a missguided tendency to use antibiotics. It is common for experts to argue that antibiotics are not needed but getting around the name driven into the situation is difficult. A name for these bacteria without methacillin as a part of it such as Skin Abscess Staph would be more appropriate. Antibiotic treatment with methacillin or similar antibiotics is not needed and will never replace incision and relieving the pressure. It would be useful to dispel the notion that antibiotic resistance is a part of treatment but the implication of this inappropriate name is problematic.
There are cases where these bacteria can penetrate the skin and infect deeper structures. Fever is a significant sign and would reasonably prompt the use of antibiotics effective against this organism. Antibiotic resistance is a complex topic and the nuances of it is beyond the scope of this discussion. There are guidelines, effectively protocols that attempt to specify how much erythema of the skin around an abscess would require the use of antibiotics. These protocols are manufactured by consensus among so called experts. There is no science behind the politics and arrogance of this process.
The important characteristic of this organism is its propensity for infection in skin structures particularly hair follicles. Incision of the abscess allows the abscess to drain and heal. The drainage is teeming with these bacteria. It spreads easily across adjacent skin surfaces in normal skin to other hair follicles, even tiny ones that don’t produce noticeable hair. The skin surface is not supplied with blood and systemically administered antibiotics are not effective in eradicating these staph from the skin surface. Bacteria on the skin can be killed by drying them, even antibiotic resistant bacteria. Drying the skin after bathing or showering is particularly important. Using a hair dryer to thoroughly dry the skin is better than to rely completely on toweling off. If towels are used for multiple days they should be thoroughly dry between use.