• Jason Chouake, Aimee Krausz, Brandon L Adler, Hillel W Cohen, Joshua D Nosanchuk, and Adam Friedman.
• J Drugs Dermatol. 2014 Feb 1; 13 (2): 119-24.

ImportanceThere is currently no data detailing the degree to which dermatologists follow CDC/Infectious Diseases Society of America (IDSA) guidelines in the treatment of abscesses, which recommend that incision and drainage (I+D) as primary therapy for skin and soft tissue infections (SSTI).ObjectiveTo evaluate the management of skin abscesses by dermatologists.Design, Setting, ParticipantsA national email survey of 780 dermatologists was conducted from May-June 2012. Awareness, experience, and preparedness of respondents for abscess treatment, as well as the treatment practices in different clinical scenarios were evaluated. Response rate = 65% (n=510).Eligibility Criteriaboard certified/eligible dermatologists practicing in US. Main practice affiliation: solo (20%), group (33%), university health system/academic (32%), multi-specialty (13%), and other (2%). Main practice setting: urban (49%), suburban (42%), and rural (9%).Main Outcome And MeasuresPractitioner report of: awareness of national guidelines, use of I+D in initial management of uncomplicated abscess found on face, trunk, and extremity on patients age 6 months, 3, 15, 50, and 80 years, and use of antibiotics in the initial management.Results99% of respondents were capable of performing I+D in their practice. The IDSA recommends cultures in all patients treated with antibiotic therapy, and does not recommend antibiotics for the treatment of simple abscess. 18% of respondents reported culturing abscesses less than 50% of the time, while 91% incorporated antibiotics into initial treatment. Nearly a quarter (24%) of respondents would choose an initial antibiotic that would not cover Methicillin-resistant Staphylococcus aureus (MRSA). For facial abscesses, as the age of the patient increased from infant, respondents were more likely to incorporate I+D into their initial treatment. For abscesses on the trunk and extremities, respondents were less likely to I+D infants and toddlers, compared to adolescents, adults and the elderly.ConclusionAlthough most dermatologists were prepared to manage uncomplicated abscesses (98%), this survey identifies gaps in clinical standards of care established by the CDC/IDSA. Identification of these practice gaps may impact physician practice and dermatology residency curricula, and may serve to improve abscess management and antibacterial stewardship in the outpatient setting.

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