Dr. Blackhead Extractions EP:259 – REMOVAL PIMPLE

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Should you squeeze out a sebaceous cyst?

You should not attempt to squeeze out a sebaceous cyst on your own as this can cause trauma to the cyst, and increase the chance of infection and scarring. If there is any pain or discharge, you need to consult a dermatologist.

How can I get rid of a cyst at home?

You can use warm sterile water and apply it on a compress to the sebaceous cyst.  It is important not to  use boiling hot water to avoid burning the skin. Leave the warm compress on the affected area and apply an over the counter antibiotic ointment and benzoyl peroxide ointment twice a day.  Repeat the warm compresses several times during the day as needed.

Can I stick a needle in a sebaceous cyst?

Some patients attempt to sterilize a needle and puncture the cyst. However, it is likely that you will be unable to remove all of the cyst contents and the cyst wall and will have irritated the area and make it more prone to infection.

How do you remove a sebaceous cyst at home?

It is not advised to remove a sebaceous cyst at home since this can lead to scarring and infection.  It would be almost impossible to remove the cyst wall without special medical tools, so the cyst would be irritated and prone to infection, recurrence, and scarring.

What can happen if a cyst is left untreated?

If the cyst is left untreated and is small and not uncomfortable then it does not need to be treated. However, if the cyst is large, or in a location which is uncomfortable, painful, or cosmetically unsightly, you should consult your dermatologist for removal of the cyst.

A large hand and finger abscess typically forms when there’s an infection beneath the skin that causes a pocket of pus to develop. This can be very painful and may be caused by bacteria entering the skin through a cut, puncture, or other injury, or by an existing skin infection spreading deeper.

Here’s a basic overview of how it’s treated:

1. Medical Attention: It’s important to see a doctor or healthcare professional right away. They may need to drain the abscess to release the pus and reduce the pressure and pain.
2. Drainage: If the abscess is large or severe, the doctor may need to make a small incision to drain it. This is typically done in a sterile environment to reduce the risk of further infection.
3. Antibiotics: If the infection has spread or is causing significant symptoms, antibiotics may be prescribed to fight the bacteria. In some cases, a healthcare provider may take a sample of the pus to determine the exact type of bacteria causing the infection, which can help choose the right antibiotic.
4. Pain Management: Pain relievers like ibuprofen or acetaminophen may be recommended to reduce pain and inflammation.
5. Follow-up Care: In some cases, follow-up visits are necessary to ensure the infection is healing properly and there are no complications.

Sure! A hand and finger abscess is a localized collection of pus that forms in response to infection, and it typically involves bacterial organisms such as Staphylococcus aureus, though other bacteria can also cause the condition. These abscesses are common in the hand and fingers because of their frequent exposure to cuts, punctures, and infections, such as paronychia (infection of the nail fold) or felon (infection of the fingertip pulp). When an infection becomes severe, it can progress to an abscess.

Pathophysiology and Causes

An abscess forms when bacteria invade the body and trigger the immune system to send white blood cells to the infection site. These white blood cells form pus as they try to neutralize the bacteria. Over time, the pus accumulates in a cavity or space in the tissues, leading to the formation of an abscess.

Infections in the hand and fingers may develop from:

• Trauma: Puncture wounds or cuts can allow bacteria to enter the body.
• Infections: Paronychia (infection around the nail) or felon (deep infection in the fingertip) are common causes.
• Spread from other infections: Infections from other areas, like the skin or joints, can spread to the hand.

Symptoms

The symptoms of a hand or finger abscess can vary depending on the severity, but typically include:

• Pain: Intense, throbbing pain that worsens with movement or pressure.
• Redness and Swelling: The affected area becomes red and swollen.
• Warmth: The area around the abscess feels warm to the touch.
• Fever: A high fever may indicate a more severe infection.
• Pus: Drainage of yellow, green, or bloody pus may occur if the abscess ruptures.

Diagnosis

A healthcare provider will typically:

1. Examine the Area: Physical examination of the swollen and painful area.
2. Imaging: In some cases, an X-ray or ultrasound may be used to assess the size and depth of the abscess.
3. Microbiological Culture: Pus or fluid may be cultured to identify the bacteria causing the infection, which helps guide antibiotic therapy.

Treatment

Treatment usually involves:

1. Drainage: This is the mainstay of treatment. The abscess is typically drained by making a small incision over the most fluctuant (softest) area. This allows the pus to be removed and helps alleviate the pressure and pain. In many cases, a healthcare provider will place a drainage catheter or packing to keep the wound open and allow continued drainage.
   • Incision and Drainage (I&D) is usually done in an outpatient setting under local anesthesia unless the infection is severe.
2. Antibiotics: If the infection is widespread or if the abscess is located near bones or joints (increasing the risk of complications), antibiotics are given. Antibiotics such as cephalexin, dicloxacillin, or clindamycin may be prescribed. If a resistant strain like MRSA (methicillin-resistant Staphylococcus aureus) is suspected, stronger antibiotics like trimethoprim-sulfamethoxazole or clindamycin might be used.
   • Culture Results: A culture of the pus may help guide antibiotic selection, ensuring the correct medication is prescribed.
3. Pain Management: Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or acetaminophen may be recommended to reduce pain and inflammation.
4. Follow-Up Care: After the abscess is drained, follow-up visits may be necessary to monitor healing. Sometimes, additional drainage or antibiotic therapy is needed if the infection recurs or worsens.
5. Tetanus Prophylaxis: If the abscess is caused by a puncture wound, a tetanus shot may be recommended, depending on the nature of the injury and the patient’s immunization history.

Complications

• Spread of Infection: If untreated, the infection can spread to nearby tissues, joints, or bones, which may lead to more serious conditions like osteomyelitis (bone infection) or septic arthritis.
• Chronic Abscess Formation: Sometimes, abscesses may not drain completely, leading to chronic infection or recurrent abscess formation.
• Scarring or Deformity: In severe cases, especially when abscesses affect areas like the fingertip (felon), permanent tissue damage or deformity can occur if the infection is not adequately treated.

Prevention

• Good Hygiene: Regular handwashing and cleaning of wounds can help prevent infections.
• Proper Wound Care: Promptly cleaning and covering cuts or puncture wounds can minimize the risk of bacteria entering the body.
• Prompt Treatment of Infections: Early treatment of skin infections (like paronychia) can prevent them from developing into abscesses.

References:

1. “Hand infections and abscesses” – Medscape: This article reviews hand infections, types of abscesses, and treatment strategies: Link (accessed 2025)
2. Surgical Management of Hand Infections – Journal of Hand Surgery: This article delves into the surgical treatments for hand infections, including drainage and management of complications.
3. “Felon and Paronychia” – American Family Physician: Provides a detailed explanation of felon and paronychia infections, common causes, and management strategies. Link (accessed 2025)