Treatment of Painful Abscess on the Forearm
The cornerstone of treatment for a painful forearm abscess is incision and drainage, followed by appropriate antibiotic therapy if indicated. 1
Initial Management
Incision and Drainage Procedure
- Make an adequate incision along skin tension lines to allow complete drainage
- Explore the cavity with a blunt instrument to break up loculations
- Irrigate the cavity thoroughly with normal saline
- For abscesses larger than 5 cm, packing may reduce recurrence and complications 2
- For smaller abscesses (<5 cm), packing may be safely omitted 3
Antibiotic Therapy
Antibiotics should be prescribed in the following situations:
- Facial abscesses (due to risk of spread to critical structures)
- Systemic symptoms (fever, tachycardia, hypotension)
- Immunocompromised patients
- Extensive surrounding cellulitis
- Inadequate drainage
Recommended Antibiotic Options:
- First-line: Amoxicillin-clavulanic acid 875/125 mg PO every 12 hours 1
- For MRSA coverage: Trimethoprim-sulfamethoxazole 160-320/800-1600 mg PO q12h 1
- Alternative MRSA coverage: Doxycycline 100 mg PO q12h 1
- For penicillin-allergic patients (non-anaphylactic): Cephalexin 500 mg four times daily 1
- For penicillin-allergic patients (anaphylactic): Clindamycin 300-450 mg four times daily 1
Post-Procedure Care
- Cover the surgical site with a dry dressing 1
- Recommend warm soaks to promote drainage 1
- Prescribe appropriate analgesics (acetaminophen or NSAIDs) 1
- Schedule follow-up in 48-72 hours to assess healing progress 1
Special Considerations
Wound Culture
- Obtain a wound culture during the procedure to identify causative organisms and guide antibiotic therapy if needed 1
- Staphylococcus aureus accounts for less than half of all cutaneous abscesses, with MRSA being increasingly common 4
Antibiotic Duration
- Standard course is 7-10 days when antibiotics are indicated 1
- May need longer treatment for immunocompromised patients or extensive infection 1
Prevention of Recurrence
- Emphasize good hygiene practices 1
- Consider decolonization strategies for recurrent staphylococcal infections:
- Intranasal mupirocin
- Daily chlorhexidine washes
- Daily decontamination of personal items 1
- Search for underlying causes (foreign material, hidradenitis suppurativa) 1
Potential Complications to Monitor
- Spread of infection to adjacent structures
- Systemic infection
- Recurrence (which may require repeat drainage)
- Fistula formation 1
Remember that while antibiotics are important in certain cases, they do not improve healing for most simple abscesses that have been adequately drained 2. The primary treatment remains proper incision and drainage with appropriate follow-up care.