Patient handout

Cutaneous abscess / furuncle / carbuncle (I&D-primary purulent SSTI)

PRODUCTION

1. Your condition

This handout is for cutaneous abscess / furuncle / carbuncle (i&d-primary purulent ssti). Your care team identified this based on: fluctuant, tender, erythematous nodule ± pointing/spontaneous drainage — cutaneous abscess (idsa 2014 ssti stevens pmid 24973422 — purulent ssti).

Other reasons your team may use this plan: tender perifollicular pustule/nodule (furuncle) or coalesced multi-loculated mass with multiple draining sinuses (carbuncle) in hair-bearing skin (idsa 2014 ssti stevens pmid 24973422); recurrent painful nodules/abscesses with sinus tracts/scarring in axilla/groin/inframammary — recurrent furunculosis vs hidradenitis suppurativa pivot (alikhan jaad 2019 pmid 30872156); abscess with fever/tachycardia/hypotension or rapidly spreading erythema — sepsis vs necrotizing screen before drainage (ssc 2026; idsa 2014 ssti stevens pmid 24973422).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
incision_and_drainage	—	procedural	single	IDSA 2014 SSTI Stevens PMID 24973422 — I&D is primary curative therapy for any fluctuant cutaneous abscess; loop drainage or simple incision (packing optional, Gaspari Acad Emerg Med 2018 PMID 33037713)

Plan: I&D-primary + severity-tiered adjunctive antibiotics

3. When to call your provider

Contact your care team if any of the following happen:

Necrotizing features → emergent ED + surgery, do NOT incise (IDSA 2014 SSTI Stevens PMID 24973422)
Systemic toxicity / failed outpatient I&D + oral → ED for IV anti-MRSA + admission

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Pain out of proportion, dusky/anaesthetic skin, hemorrhagic bullae, crepitus, "dishwater" drainage, or rapidly spreading erythema around the collection (IDSA 2014 SSTI Stevens PMID 24973422)(life-threatening)
qSOFA ≥2 OR SIRS ≥2 with cutaneous abscess as the source (SSC 2026; IDSA 2014 SSTI Stevens PMID 24973422)
Facial danger triangle, perirectal/perineal, hand/deep palmar space, periorbital, or deep-space abscess (IDSA 2014 SSTI Stevens PMID 24973422)
Neutropenic (ANC <500), transplant, biologic/immunosuppressant, advanced HIV, or poorly controlled diabetes with cutaneous abscess (IDSA 2014 SSTI Stevens PMID 24973422)
No improvement or worsening 48–72 h after adequate-appearing I&D ± oral antibiotics — persistent fluctuance, expanding erythema, new systemic features (IDSA 2014 SSTI Stevens PMID 24973422)

5. Follow-up

≥2 abscesses/year → MRSA decolonization (intranasal mupirocin 5 d + chlorhexidine body wash 5–14 d ± household + hygiene; oral rifampin-based only for refractory) (Fritz CID 2012 PMID 22198793; IDSA 2014 SSTI Stevens PMID 24973422); reconsider hidradenitis suppurativa if intertriginous recurrent with sinus tracts/scarring → route to HS chronic management (Alikhan JAAD 2019 PMID 30872156)

6. Sources

Guideline: IDSA 2014 SSTI Guideline (Stevens et al, CID) purulent-SSTI pathway + Talan NEJM 2016 (TMP-SMX adjunct after I&D) + Daum NEJM 2017 (clindamycin/TMP-SMX adjunct, small abscess) + Schmitz Ann Emerg Med 2010 (no benefit, simple abscess) + Moran NEJM 2006 EMERGEncy ID Net (MRSA prevalence) + Gaspari Acad Emerg Med 2018 (loop drainage RCT) + Subramaniam Acad Emerg Med 2016 (POCUS meta) + Fritz CID 2012 (household MRSA decolonization) + Alikhan JAAD 2019 (HS management guideline)