What are the causes of recurrent cutaneous abscesses (skin abscesses)?

From the Guidelines

Recurrent cutaneous abscesses are most commonly caused by local factors, such as foreign material, hidradenitis suppurativa, or pilonidal cyst, as well as by bacterial colonization, particularly with Staphylococcus aureus, including methicillin-resistant S. aureus (MRSA).

Causes of Recurrent Cutaneous Abscesses

• Local factors:
  • Foreign material
  • Hidradenitis suppurativa
  • Pilonidal cyst
• Bacterial colonization:
  • Staphylococcus aureus
  • Methicillin-resistant S. aureus (MRSA)
• Host factors:
  • Neutrophil dysfunction
  • Abnormal systemic host responses
• Environmental factors:
  • Inadequate personal hygiene
  • Exposure to others with furuncles
  • Fomites harboring the organism

Management of Recurrent Cutaneous Abscesses

• Incision and drainage of the abscess
• Eradication of bacterial colonization:
  • Mupirocin ointment applied twice daily in the anterior nares for the first 5 days each month 1
  • Clindamycin 150 mg daily for 3 months 1
• Personal and environmental hygiene measures:
  • Bathing with antibacterial soaps, such as chlorhexidine
  • Thorough laundering of clothing, towels, and bed wear
  • Separate use of towels and washcloths
• Decolonization strategies:
  • Mupirocin and topical antiseptics, such as chlorhexidine and diluted bleach baths 1 Note: The evidence suggests that a multifaceted approach, including incision and drainage, eradication of bacterial colonization, and personal and environmental hygiene measures, is necessary for the management of recurrent cutaneous abscesses 1.

From the Research

Causes of Recurrent Cutaneous Abscesses

The causes of recurrent cutaneous abscesses can be attributed to various factors, including:

• Community-acquired or family transmitted infections 2
• Underlying chronic disorders, such as acquired or innate immunodeficiency, chronic dermatoses, or other systemic diseases 2
• Injectable drug use, particularly when using unsterilized needles or injecting drugs subcutaneously or intramuscularly 3
• Bacterial infections, with Staphylococcus aureus being a common cause of primary skin abscesses 4, 5
• Specific immune deficiencies, which can increase the risk of recurrent superficial abscesses 6

Risk Factors

Certain risk factors can contribute to the development of recurrent cutaneous abscesses, including:

• Skin popping (subcutaneous injection) or muscle popping (intramuscular injection) of drugs 3
• Use of unsterilized needles 3
• Injection of speedball (a mixture of cocaine and heroin) 3
• Underlying conditions, such as diabetes or immunocompromise 5

Associated Conditions

Recurrent cutaneous abscesses can be associated with various conditions, including:

• Hidradenitis suppurativa (HS), a recurrent inflammatory skin disease 4
• Pyoderma gangrenosum, a condition characterized by ulcerative skin lesions 3
• Human immunodeficiency virus (HIV) infection 3
• Vasculitis, endocarditis, and serotonin syndrome 3