From the Guidelines
Incision and drainage (I&D) is the recommended treatment for an infected or abscessed cyst, as it effectively removes the infected material and allows the inflammation to resolve. The procedure involves making a small incision in the cyst to drain the accumulated pus and fluid, and is typically performed under local anesthesia, such as 1-2% lidocaine with epinephrine injected around the cyst 1. After cleaning the area with antiseptic solution, the healthcare provider will make an incision with a scalpel, drain the contents, and may place a small wick or packing material to keep the wound open temporarily and allow continued drainage.
Some key points to consider when performing an I&D procedure include:
- Gram stain and culture of pus from inflamed epidermoid cysts are not recommended, as they are unlikely to yield useful information 1
- The decision to administer antibiotics should be made based on the presence or absence of systemic inflammatory response syndrome (SIRS) or significant surrounding cellulitis 1
- Patients should keep the area clean and dry, changing dressings as instructed, and apply warm compresses to help with healing
- Pain can be managed with acetaminophen or ibuprofen
It's worth noting that while the 2014 guidelines from the Infectious Diseases Society of America 1 provide the most up-to-date recommendations, earlier studies such as the 2005 practice guidelines for the diagnosis and management of skin and soft-tissue infections 1 also support the use of I&D as the primary treatment for infected or abscessed cysts. However, the 2014 guidelines are considered the highest quality study and should be prioritized when making treatment decisions.
From the Research
Incision and Drainage (I&D) of Cysts and Abscesses
- I&D is a common procedure for managing abscesses, including those that are cutaneous or related to Bartholin glands 2, 3.
- The procedure involves making an incision in the abscess to allow for drainage of the purulent material, and may be followed by packing of the wound to promote healing 2.
- Studies have shown that I&D can be an effective treatment for abscesses, with high success rates and low complication rates 3, 4.
Management of Specific Types of Cysts and Abscesses
- Bartholin gland abscesses and cysts can be managed with I&D, marsupialization, or excision of the gland, with the choice of treatment depending on the size and location of the abscess or cyst 3.
- Cutaneous abscesses can be managed with I&D, with or without antibiotics, depending on the size and severity of the abscess 4, 5.
- Other types of abscesses, such as breast, dental, hidradenitis suppurativa, peritonsillar, and pilonidal abscesses, may require different management strategies, including needle aspiration, loop drainage, or surgical excision 5.
Use of Antibiotics in I&D Procedures
- Antibiotics are not always necessary after I&D procedures, but may be indicated in certain cases, such as when there are signs of infection or complications 2, 4.
- The use of post-operative antibiotics for cutaneous abscesses is variable, with some studies showing that they may be prescribed unnecessarily 4.
- Further research is needed to develop evidence-based guidelines for the use of antibiotics in I&D procedures 4, 5.