Treatment for Facial Abscess
The primary treatment for a facial abscess is incision and drainage, followed by appropriate antibiotic therapy, with Amoxicillin-clavulanate 875/125 mg PO twice daily being the first-line antibiotic option. 1
Diagnosis and Initial Assessment
- Facial abscesses present as painful, tender, fluctuant red nodules, often surrounded by erythematous swelling
- Typically polymicrobial, containing normal skin flora and organisms from adjacent mucous membranes
- Staphylococcus aureus is present as a single pathogen in approximately 25% of cutaneous abscesses 2
Treatment Algorithm
1. Surgical Management
Incision and drainage (I&D) is the cornerstone of treatment for facial abscesses 2, 1
- Thorough evacuation of pus
- Probing the cavity to break up loculations
- Simply covering the surgical site with a dry dressing is usually the most effective post-drainage wound management
Deroofing technique is preferred over simple I&D when possible 2
- Involves removing the skin overlying the abscess or sinus
- Associated with lower recurrence rates compared to simple I&D
Avoid simple incision and drainage alone for recurrent lesions as it has been associated with recurrence rates approaching 100% 2
2. Antibiotic Therapy
First-line antibiotic therapy:
- Amoxicillin-clavulanate 875/125 mg PO twice daily for 7-14 days 1
Alternative options (especially if MRSA suspected):
- Clindamycin: 300-450 mg PO every 6 hours for severe infections 3
- Trimethoprim-sulfamethoxazole: 160-320/800-1600 mg PO every 12 hours 1
- Doxycycline: 100 mg PO every 12 hours 1
Important considerations for antibiotic use:
- Systemic antibiotics are generally unnecessary for simple abscesses after adequate I&D 2
- Antibiotics should be considered in cases with:
- Multiple lesions
- Extensive surrounding cellulitis
- Severe systemic manifestations (e.g., high fever)
- Immunocompromised patients
- Facial location (due to risk of complications)
3. Post-Procedure Care
- Warm soaks to promote drainage 2, 4
- Re-evaluation in 48-72 hours to assess healing progress 1
- Pain management with acetaminophen or NSAIDs 1
Special Considerations
Complications to Monitor
- Spread of infection to adjacent structures
- Systemic infection
- Recurrence if drainage is inadequate
- Fistula formation 1
Prevention of Recurrence
- Good hygiene practices
- Consider decolonization strategies for recurrent staphylococcal infections 1
Important Caveats
- Gram stain and culture of pus are not routinely recommended for typical cases but may be considered if unusual infection is suspected 1
- Avoid packing of drained abscesses as studies show equal efficacy without packing, and less patient discomfort 5
- For facial abscesses specifically, careful consideration of cosmetic outcomes is important when planning incisions
- Recognize that facial abscesses may require more aggressive treatment due to proximity to critical structures and risk of spread to intracranial spaces