Skin Abscesses: Insights on Treatment and Recovery

Furuncle wound

Hello Doctor, I have a painful swollen bump on my right buttock, so on Monday, October 16, I visited a dermatologist who diagnosed it as an inflamed sebaceous cyst.
They prescribed oral medication and topical ointment.
However, on October 18, the wound started to ooze pus, so I went to see a surgeon.
The doctor incised the wound but mentioned it wasn't fully matured yet, and instructed me to go home and express the pus myself.
The diagnosis on the medical record stated "abscess," not "sebaceous cyst." Could there have been a mistake?
That night, I had to clean the wound myself and noticed that there was a roughly 1.5 cm opening, clearly showing pus and a yellow object inside, which was tightly adhered to the tissue.
I couldn't remove it at home, and it was extremely painful, feeling like it was pulling at my flesh.
I could only clean the visible pus.
The next day, I returned to the dermatologist, explained the situation, and they said that the yellow object was indeed a sebaceous cyst.
They advised me to continue taking the medication and applying ointment to the wound, and to wait for it to heal before scheduling surgery to remove the cyst.
I have the following questions:
1.
So my wound should be a sebaceous cyst and not an abscess, correct?
2.
Given that I have a 1.5 cm diameter wound and about 1 cm deep, with a yellow object that resembles pus but is not pus, and significant secretions inside, it is impossible for me to clean the wound deeply due to the pain.
Following the dermatologist's advice to gently clean the opening daily and change the dressing twice a day, will it heal slowly? How long might that take? I'm worried it won't get better.

3.
Is it necessary to remove the sebaceous cyst first? When I saw the surgeon, they incised my wound without anesthesia, and I'm afraid the same will happen when they remove the cyst, which makes me concerned that I won't be able to tolerate the pain during the surgery.
Thank you for your help in clarifying these issues.

You, 20~29 year old female. Ask Date: 2023/10/21

Dr. Wu Yuxin reply Dermatology

If it is an inflamed sebaceous cyst, treatment must first focus on alleviating the inflammation before proceeding with surgical removal.
It is recommended that you continue to cooperate with your current physician for treatment.

Reply Date: 2023/10/21

More Info

Understanding skin abscesses, particularly in the context of your situation, involves recognizing the nature of the lesion, the appropriate treatment, and the recovery process. Based on your description, it seems that you are dealing with a complex case that may involve both a sebaceous cyst (often referred to as a pilar cyst or epidermoid cyst) and an abscess.

1. Diagnosis Clarification: It appears that there may have been some confusion regarding the diagnosis. A "粉瘤" (fenliu) typically refers to a sebaceous cyst, while "癰" (yong) refers to an abscess. The fact that your lesion was described as inflamed and painful suggests that it may have become infected, leading to the formation of an abscess. The yellow substance you see could be pus or the contents of the cyst itself. It’s essential to follow up with your dermatologist for a definitive diagnosis, as they can provide clarity on whether it is indeed a cyst that has become infected or a separate issue.

2. Wound Care and Healing: For a wound that is 1.5 cm in diameter and has a depth of about 1 cm, proper care is crucial. Your dermatologist's advice to clean the wound daily and change the dressing twice a day is appropriate. Keeping the area clean helps prevent further infection and promotes healing. The presence of a yellow object that is tightly adhered to the wound may indicate that the cyst contents need to be surgically removed for complete healing. However, if it is too painful to manage at home, it is advisable to seek medical assistance rather than attempting to remove it yourself.

Healing time can vary significantly based on several factors, including the extent of the infection, your overall health, and how well you follow wound care instructions. Generally, minor wounds can take a few days to a couple of weeks to heal, while deeper wounds may take longer. If you notice increased redness, swelling, or discharge, or if the pain worsens, you should return to your healthcare provider.

3. Surgical Considerations: Regarding the necessity of removing the cyst, it is often recommended to excise a sebaceous cyst if it becomes symptomatic or infected. This can prevent recurrence and further complications. Your concern about anesthesia during the procedure is valid; typically, local anesthesia is administered to minimize discomfort during such surgeries. Discuss your fears and concerns with your surgeon beforehand, as they can provide reassurance and explain the procedure in detail.

4. Future Prevention: To prevent similar issues in the future, maintaining good skin hygiene is essential. Avoid squeezing or picking at cysts or pimples, as this can lead to infection. If you have a history of cysts, regular check-ups with a dermatologist can help monitor and manage any potential issues before they become problematic.

In summary, while it seems you are dealing with a potentially infected sebaceous cyst, proper wound care and follow-up with your dermatologist are crucial for recovery. Surgical intervention may be necessary, and discussing your concerns about pain management with your healthcare provider will help ensure a more comfortable experience. Always prioritize communication with your medical team to address any uncertainties you may have.

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