ALL ABOUT ABSCESSES
What is an abscess?
An abscess is a pocket of pus. Pus means you have an infection. Pus is made of dead tissue, germs (bacteria), and white blood cells. The white blood cells rally around to kill the germs. Sometimes, abscesses will burst and drain, a way the body has of getting rid of the infection.
What causes an abscess?
An abscess can start anywhere in the body where bacteria infect tissue. Drug shooters often get abscesses on their arms or legs - mostly (but not always) at injection sites. You are more likely to damage tissue and develop an abscess when you "skin pop," "muscle it," or miss your vein. Both the cut and the drug itself can cause infection and damage tissue. You can even get an abscess AFTER you stop injecting.
Where do the germs come from?
Germs are invisible without a microscope. They are on most surfaces, including skin, and on any used item such as a rig, cooker, cotton, or tourniquet. Germs are on your skin - even if you think you're clean. All of these germs can get into your body.
What signs should I look for?
A hard, reddish, tender lump. It will usually appear at the injection site, but it can also pop up in other places. The lump might feel warmer than the skin around it. It might even feel hot. It usually hurts. It might look pink and puffy. If it gets bigger, the infection is getting worse. As the infection spreads, you might see red streaks spreading out and away from the abscess. The infection might make you feel tired or cause fever or chills. You might have chest pains if the infection goes to your heart or lungs.
What should I do if I get an abscess?
It depends on how bad it is. Here are some guidelines:
Treat at HOME with a HOT SOAK if:
- You don't have any red streaks or hot puffy skin around it.
Go to a CLINIC if:
- It has not improved after 5 to 7 days.
- The lump gets bigger or more painful.
- You see red streaks spreading out from the lump.
- The lump is hot, puffy, and pink, or if you get a fever.
Go to the EMERGENCY ROOM if:
- You have chest pains.
- You have chills or a high fever.
- The infection looks like it is spreading really fast.
About hot soaking...
Soaking helps draw out the infection. It helps the abscess come to a head and drain.
How do I hot soak?
- Soak the abscess in a tub of plain hot water. This works well if the abscess is on your hand or lower arm.
- Better yet, soak it in hot water and Epsom Salts.
- Make sure the water is hot, but not so hot that it burns your skin.
- Hold a hot, wet wash cloth over the abscess if the abscess is in a spot you can't easily put under water.
- Soak at least 3 or 4 times a day, 10 to 15 minutes each time.
If you have a bad infection, you may need to take antibiotics. If your doctor prescribes antibiotics, be sure to finish them ALL - even if you feel better before they're used up. If you don't take the whole course of antibiotics, or if you don't take them correctly, the germs they are supposed to treat can develop resistance. Resistant bacteria make antibiotics less useful against future infections. If pus is trapped under the skin, a health provider may need to open the wound to drain the pus. Antibiotics alone may not treat trapped pus.
How can I reduce my risk for abscesses?
- Before you shoot, WASH your skin and hands with HOT SOAPY WATER. Hot water and vigorous rubbing make the veins bigger, too.
- Use a BRAND NEW, STERILE RIG every time you inject or divide drugs. If you can't get a new rig, use one that is well-rinsed, bleached for at least 30 seconds, then rinsed again with fresh, clean water.
- Use clean cottons, clean cookers and fresh, clean water every time.
- Clean the injection site properly with alcohol wipes.
- Don't lick the needle before you inject. You carry a lot of bacteria in your mouth that can cause infections under your skin.
- Choose good veins. Keep your veins big and fat by drinking lots of water. It is harder to miss when you have big veins. Sometimes a miss will get infected and turn into an abscess.
- Use a tourniquet. This increases blood pressure in the veins and makes skinnier veins bigger around, easier to see, and easier to hit.
- Slow down. Relax. Take a deep breath to help keep your hand steady so you don't miss. Shaky hands from a 5-day speed run or from being dope sick can cause you to miss.
- Avoid shooting into your hands and especially avoid feet, and legs.
Where do I shoot? Vein? Muscle? Skin? What's safer?
All three have risks. All three put you at risk for infections like HIV and Hepatitis B and C. Muscling and skin popping are more likely to cause abscesses and skin infections. If treated early, these infections usually clear up in a short period of time. Shooting into a vein is more likely to cause longer-term problems like endocarditis. Shooting into a vein is also more likely to cause an overdose. Abscesses hurt, and they can cause ugly disfigurement, but they're rarely fatal. Endocarditis and overdose, on the other hand, are more likely to result in death.
- DO NOT shoot into or near an abscess.
- DO NOT squeeze or cut into an abscess - you could push germs into your bloodstream. This could "seed" your heart lining with bacteria that can cause an infection to grow in your heart. This is called endocarditis, and it's a life-threatening condition.
- People with weak immune systems are more likely to develop abscesses. If you have a weak immune system, you need to be even more careful.
I've got no money. Where do I go for help?
Get free or low-cost treatment at the Needle Exchange Medical Clinic or a community health clinic. For an emergency, go to a medical center. See the resource list on this site for Seattle area numbers.
The Medical Clinic at the downtown Needle Exchange is open 1:30 to 4:30 Monday though Friday. Walk-ins are always welcome!
Use alcohol wipes before every injection!
- Alcohol wipes help to remove dirt and germs from your skin.
- This makes an "antiseptic field" on your arm.
- Alcohol wipes reduce your changes for "tracks" (scar tissue), abscesses (pus pockets), and other infections.
- They stimulate the skin surface and make it shine.
- Hard-to-find veins are easier to see and hit, especially if you use side lighting!
Wash your hands and skin!
Use plenty of hot, soapy water!
Follow up with alcohol pads!
How do I use alcohol pads?
Take an alcohol pad and wipe back and forth where you plan to inject. This will probably be your arm. Press kind of hard this first time. Use as many pads as you need to get the dirt off of your skin. But don't stop here!
Now grab a new pad and press down over the spot where you're going to inject. This time, wipe in a circle. Start with small circles and make bigger circles as you go around. This pushes any leftover dirt and bacteria on your skin outward from the spot where you're going to shoot.
Note: If you bleed after you shoot, press down with dry cotton or a band-aid to stop the flow. Don't use an alcohol pad; alcohol slows down clotting.