Cutaneous Abscess or Pustule

Presentation

A patient with an abscess presents with localized pain, swelling, and redness of the skin. The patient may or may not have a history of minor trauma (such as an embedded foreign body or a small skin puncture). The area is tender, warm, firm, and usually fluctuant to palpation. Sometimes there is surrounding cellulitis or lymphangitis and, in the more serious case, fever. If the abscess is close to the skin surface, pointing may occur where the skin is thinned, and pus may eventually break through to drain spontaneously. With the advent of community-acquired methicillin-resistant Staphylococcus aureus (MRSA), there may be a central or underlying darkened necrotic area, with the patient often incorrectly reporting a “spider bite.” These abscesses generally are extremely tender and inflamed.

A pustule will appear only as a cloudy tender vesicle surrounded by some redness and induration, and it will occasionally be the source of ascending lymphangitis.