Question about abcess treatment

[CountrifiedRN]

Tonight my neighbor came over to show me an abcess she has in her armpit. (Yup, you guessed it, she knows I'm a nursing student!:chuckle ) She wanted to know if I would help her with the wet to dry dressing changes the doctor (actually P.A.) said she would need when it's removed in a few weeks. She said she saw a P.A. at the doctors office who put her on antibiotics (Keflex) and prednisone and wants to excise it when the inflammation goes down. When she showed it to me, I was expecting to see a huge abcess, but it looks relatively small, less than the size of a marble. It also had a small white area in the middle as if it is starting to come to a head. I realize that it may be bigger on the inside, I didn't feel it or anything, but I was wondering why it wasn't just lanced. She said her mother told her to see a dermatologist instead, and I also thought that was probably a good idea, since the P.A. told her he had only done an excision once or twice. She's going to make an appointment with a dermatologist on monday.

Anyway, my question is, does anyone know if prednisone is contraindicated for infections like this since it has immunosuppressive effects? This is just a question that went through my mind based on the little bit of knowledge that I have about the drug. Or would it only have those qualities for long term users? (Hers is prescribed for a week) My drug book didn't specify. Can anyone help?

[rachel h, BSN, RN]

Good question. As far as the prednisone goes, I don't think one week of treatment would have any immunosuppressive effects. I think a lot of side effects occur with prednisone when it is prescribed long term for treatment of certain respiratory disorders.

However, since she is on an antibiotic I'm not sure why she would need prednisone... usually an antibiotic will help with the inlammation if it is the correct one...

This sounds like it could have started as a cellulitis? I don't think I have ever seen prednisone prescribed for that, just antibiotics and dressing changes...

[gwenith, BSN, RN]

Prednisone would take down some of the swelling but that is also at the cost of reducing the bodys natural ability to fight the infection. You cannot lance an abcess until it has loculated (come to a head) until then it does not have a firm inner wall. Once lanced it is best to "wick" them for a short while. I KNOW it is old fashioned and pooh!poohed but a warm poultice of epsom salts ( magnesium sulfate) often eased the pain.

Had to edit this after I posted I realised I had a bad case of keyboard dyslexia

[CountrifiedRN]

Thanks for the info, Rachel and Gwenith!

She said she thinks it started as an infected hair follicle. She tried to squeeze it in the beginning, but it was too painful. She is still having a lot of pain, especially due to the location, and he also gave her hydrocodone to help with that. (Although she doesn't want to take it during the day)

[rachel h, BSN, RN]

Yup... sounds like it started as a cellulitus. Those ingrown hairs can be nasty. Once she has it lanced she will probably need wet to dry dressing changes for a little while. Glad she had it taken care of... I recently had a patient who reported having a rectal abscess for upwards of 6 months... he would squeeze the puss out himself everyday because he didn't want to go to a doc. He ended up with an I&D and a very sore rear end!

[gwenith, BSN, RN]

Owwwwchhhh!

[CountrifiedRN]

Originally posted by rachel h

I recently had a patient who reported having a rectal abscess for upwards of 6 months... he would squeeze the puss out himself everyday because he didn't want to go to a doc. He ended up with an I&D and a very sore rear end!

Hurts just to imagine it!

[dabestrn]

Hey, I work in an ER. I see these ALL the time. Once it is lanced, she will feel sooooo much better. They occur a lot in the armpit area. Are due to a ingrown hair follicle, like your friend suggested.

[Mint Julip]

If the boil is small and firm opening it really won't be too helpful. It has to soften first even if a "head" is visible. If the PA prescribed Prednisone, it is probably an abcess involving an apocrine gland. These types of abcesses tend to be more prevalant in women and may have been caused by an ingrown hair (downside to shaving the underarms). Hopefully it will drain quickly. Did he prescribe a topical antibiotic as well?

[CountrifiedRN]

Originally posted by Mint Julip

Did he prescribe a topical antibiotic as well?

No topical that I know of.

I really appreciate everyones input. Thanks again!