dealing with big abscess in the face

[THAILIBAN]

Hi all,

4 days ago I woke up and suddenly a huge abscess had grown in my face between mouth and eyes, next to the nose. I have had quite some problems with abscesses more than 20 years ago, when I still lived in Europe, but had been able to control it and finally got rid of it with the help of my long-term general practicioner, who was a internal medicines specialist, and an alternative practicioner. an autohaemotherapy, using natural remedies worked wonder.

But that was a thing of the past and I don't think it is related to my new case, only told it here to emphasize that I may have a vulnerability for such things.

but what recently happened was that a few years back, I had a hordeolum, and stupidly did not deal with it properly, means I tried to squeeze it and most properly some pus and germs spread in the area near my eye and in the face probably. since then, every few months or so I could feel that there was some pus developing around this eye, nothing big but it was there only to disappear after a while. but now I got that very huge abscess and I am actually sure that it has to do with that case of the past. the pus somehow tried to find a way out, which I heard is actually how it should be, and I helped it a little. but it is so huge that I am sure that there are a lot of germs around and even though the abscess is not at the same side of my eye that had the hordeolum, I felt that my eyes burnt somehow and I am quite sure it is the pus that is spreading. I am now particularly worried as there is a big danger that the germs wonder thorugh the venes near the nose towards the brain, and last evening I felt such a pain and pressure in my head sometimes, and even now in the morning.

I know I have to go to see a doctor, but I wonder where should I go. I checked for dermatoligists at the big Bangkok hospitals, and got confirmed what was already my impression in the past, that dermatology is Thailand's weakest health sector, as all "dermatology" here is laser-surgery / beauty and skin aesthetics. I could not even find some proper recommendations on google and here in the Forum. Or should I immediately see a neurologist and skip the dermatology department altogether ?

I know that you can use antibiotics to fight those germs in case they somehow have spread and kill them that way, but is this the only way and would it help if some pus has already found its way to the brain via the venes near the nose? A neurologist might ask me to undergo a CT or MRI of my brain to see if there is a higher intracranial pressure or a danger of a cerebral venous thrombosis, but if there is, what can they do to cure that ?

Thanks for everyone who can contribute some clinically sound advice, pls not just "guessing" or "blabla", thank you very much

[Sheryl]

I don't really understand why you think you might need a neurologist.

Either a dermatologist, general surgeon or internist would suit.

Not all dermatologists in Thailand are cosmetically inclined. There are soem excellent ones that are not.

I suggest either Dr. Niyom at Bumrungrad or Dr. Parichart at Saint Louis.

[h90]

Antibiotic creme or if it is worse oral antibiotics and it will be gone fast in most cases....

[Sheryl]

A large abscess, may need to be lanced. Ans systemic abx.

[chubby]

start with dermatology ; hard to believe you can't find a regular dermatologist, maybe your looking for low cost ones?

or if you've seen one already what did they say? don't bother with neuro ; could be many things, like sinuses , et

you have A hordeolum is a common disorder of the eyelid. [1] It is an acute focal infection (usually staphylococcal) involving either the glands of Zeis (external hordeola, or styes) or, less frequently, the meibomian glands (internal hordeola). NOW?

[THAILIBAN]

start with dermatology ; hard to believe you can't find a regular dermatologist, maybe your looking for low cost ones?

or if you've seen one already what did they say? don't bother with neuro ; could be many things, like sinuses , et

you have A hordeolum is a common disorder of the eyelid. [1] It is an acute focal infection (usually staphylococcal) involving either the glands of Zeis (external hordeola, or styes) or, less frequently, the meibomian glands (internal hordeola). NOW?

I don't have a Hordeolum NOW. please read

[THAILIBAN]

I don't really understand why you think you might need a neurologist.

Either a dermatologist, general surgeon or internist would suit.

Not all dermatologists in Thailand are cosmetically inclined. There are soem excellent ones that are not.

I suggest either Dr. Niyom at Bumrungrad or Dr. Parichart at Saint Louis.

Hi Sheryl,

thanks for your as always useful and sound advise and comments.

I actually was not sure if I should see a Dermatologist or Neurologist. I then made an appointment for a dermatoligist at Bumrungrad, but a few minutes later they called me back and suggested to rather see a general surgeon, as a dermatologist would not deal with a bigger abscess, so I agreed. Unfortunately, that Doctor turned out to be no good, a young lady with rather poor English, charging me the highest Doctor fee I ever paid at Bumrungrad for a very superficial 5 minutes of time. She gave me a locally made ointment with a component that is only approved for animals (rabbits mostly) in my home country due to severe side effects.

I told her the abscess is actually now not the main problem anymore, I was rather worried that the bacteria/Pus spread and moved to my brain. I told her that I feel that the liquid Pus had reached both my eyes, my eyes burned and you can smell that (and I have an experience with such thing). I had that before in the eye where I had the Hordeolum some years ago, and some sort of Pus around that eye came back every few months or so, that is why I felt that some bacteria is still around. I too have a history of blood clots so that was the reason why I had considered to see a Neurologist to examine if there was some danger of bacteria and Pus moving into my brain already. I know that such things can happen from abscesses / infections in the face. (cerebral venous / sinus Thrombosis).

Unfortunately that Doctor did more or less ignore what I said and just told me that "I am safe". After I was given the ointment, I read the very small written information with NO mentions of any sort of contraindication, and I googled for it ( Chloramphenicol) and then did not use it. So the abscess wound was already getting smaller and even if it somehow re-filled itself with Pus, it was not the main problem. But the bacteria and Pus that might have spread was and is until today a bigger problem. As I said, I do have a history of blood clots and had a life-threatening thrombosis in my belly in 2006, and still until today I take blood thinner medicine (European-made, similar as Warfarin). I had quite some headache in the past few days and today it's getting even stronger, plus I feel a little dizzy. I do not wanna be paranoid but I almost certainly cheated death back in 2006 and want to make sure nothing bad happened this time now. I am still worried this could be increased intracranial pressure, as the symptoms seem to be similar.

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WIKI: Increased ICP

One of the most damaging aspects of brain trauma and other conditions, directly correlated with poor outcome, is an elevated intracranial pressure.^[6] ICP is very likely to cause severe harm if it rises too high.^[7] Very high intracranial pressures are usually fatal if prolonged, but children can tolerate higher pressures for longer periods.^[8] An increase in pressure, most commonly due to head injury leading to intracranial hematoma or cerebral edema, can crush brain tissue, shift brain structures, contribute to hydrocephalus, cause brain herniation, and restrict blood supply to the brain.^[9] It is a cause of reflex bradycardia.^[10]

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I know there is some Antibiotics that can kill most of those bacteria everywhere in the body, though I did not specifically ask for that when I saw the Doctor, as one should be very careful with such antibiotics, as the bacteria easily can develop resistance against it.

So this is the situation today, I plan to go back to Bumrungrad tomorrow and see a neurologist. And maybe even do a MRI scan ? Do you agree ? or what would you recommend ? Sorry if my words are confusing

[MaeJoMTB]

Cipro 500, 100bht. or less.

[chopin2]

The specialist that deals with an abcess in face, and possible complications: ear nose and throat.

[HooHaa]

I don't really understand why you think you might need a neurologist.

Either a dermatologist, general surgeon or internist would suit.

Not all dermatologists in Thailand are cosmetically inclined. There are soem excellent ones that are not.

I suggest either Dr. Niyom at Bumrungrad or Dr. Parichart at Saint Louis.

Hi Sheryl,

thanks for your as always useful and sound advise and comments.

I actually was not sure if I should see a Dermatologist or Neurologist. I then made an appointment for a dermatoligist at Bumrungrad, but a few minutes later they called me back and suggested to rather see a general surgeon, as a dermatologist would not deal with a bigger abscess, so I agreed. Unfortunately, that Doctor turned out to be no good, a young lady with rather poor English, charging me the highest Doctor fee I ever paid at Bumrungrad for a very superficial 5 minutes of time. She gave me a locally made ointment with a component that is only approved for animals (rabbits mostly) in my home country due to severe side effects.

I told her the abscess is actually now not the main problem anymore, I was rather worried that the bacteria/Pus spread and moved to my brain. I told her that I feel that the liquid Pus had reached both my eyes, my eyes burned and you can smell that (and I have an experience with such thing). I had that before in the eye where I had the Hordeolum some years ago, and some sort of Pus around that eye came back every few months or so, that is why I felt that some bacteria is still around. I too have a history of blood clots so that was the reason why I had considered to see a Neurologist to examine if there was some danger of bacteria and Pus moving into my brain already. I know that such things can happen from abscesses / infections in the face. (cerebral venous / sinus Thrombosis).

Unfortunately that Doctor did more or less ignore what I said and just told me that "I am safe". After I was given the ointment, I read the very small written information with NO mentions of any sort of contraindication, and I googled for it ( Chloramphenicol) and then did not use it. So the abscess wound was already getting smaller and even if it somehow re-filled itself with Pus, it was not the main problem. But the bacteria and Pus that might have spread was and is until today a bigger problem. As I said, I do have a history of blood clots and had a life-threatening thrombosis in my belly in 2006, and still until today I take blood thinner medicine (European-made, similar as Warfarin). I had quite some headache in the past few days and today it's getting even stronger, plus I feel a little dizzy. I do not wanna be paranoid but I almost certainly cheated death back in 2006 and want to make sure nothing bad happened this time now. I am still worried this could be increased intracranial pressure, as the symptoms seem to be similar.

------------------------------------------------------------------------------------------------------------------------------

WIKI: Increased ICP

One of the most damaging aspects of brain trauma and other conditions, directly correlated with poor outcome, is an elevated intracranial pressure.^[6] ICP is very likely to cause severe harm if it rises too high.^[7] Very high intracranial pressures are usually fatal if prolonged, but children can tolerate higher pressures for longer periods.^[8] An increase in pressure, most commonly due to head injury leading to intracranial hematoma or cerebral edema, can crush brain tissue, shift brain structures, contribute to hydrocephalus, cause brain herniation, and restrict blood supply to the brain.^[9] It is a cause of reflex bradycardia.^[10]

----------------------------------------------------------------------------------------------------------------------------------

I know there is some Antibiotics that can kill most of those bacteria everywhere in the body, though I did not specifically ask for that when I saw the Doctor, as one should be very careful with such antibiotics, as the bacteria easily can develop resistance against it.

So this is the situation today, I plan to go back to Bumrungrad tomorrow and see a neurologist. And maybe even do a MRI scan ? Do you agree ? or what would you recommend ? Sorry if my words are confusing

i suspect you are something of a hypochondriac. you have an abscess.

Get a second opinion with another GP. you wont get anywhere near a neurologist without a recommendation form a GP anyways and even if you do be prepared for a significant doctors fee

ICP has nothing to do with it.

if anything you have a sinus infection.

but i suppose if you want to pay for an mri, go for it.

[Sheryl]

If the infection had spread to the brain you would be having very severe and obvious symptoms, and would be in no condition to be posting here.

A neurologist is likely to be baffled as to why you came in and unlikely to recommend an MRI, which is nto indicated and would be a waste of money.

[NancyL]

I did a google search on "Chloramphenicol" and found no mention of especially nasty side effects or the fact that it was only approved for use on rabbits. Maybe that's because I was only reading reputable websites like Wikipedia, Mayoclinic and NHS.uk

[Sheryl]

Taken systemically, chloramphenicol does have some potential side effects that are serious (though it is still approved for use in most countries). However this does not pertain to topical chloramphenicol -- skin creams, eye drops, ear drops etc. Widely used and very good safety margin.

The referral to a surgeon rather than a dermatologist was becuse OP described this as a "large abscess" but from the treatment given and fact that it has subsided, this is almost surely not what it was. More likely a pimple. It may have seemed large to him but to medical people the term "large abscess" conjures up something altogether different.

However re-reading post #7, OP is on anticoagulents and has headache and dizizness. This has absolutely nothing to do with the "abscess" on the face, nor with the prior stye (hordeolum). It should be checked out if it persists...any persistant headache with dizziness warrants evaluation and especially when in someone on blood thinners.

OP if you wish to see a neurologist for the HA and dizziness, do so (or alternately see any doctor for initial screening). But I suggest when you do, you not talk about the "abscess", the stye (hordeolum) of many years ago, or this concern about pus spreading as none of that is plausible and will likely cause the doctor to dismiss you out of hand. What you need to be concerned about is possible bleeding in the brain or simple hypertension, neither of them related to the skin problems.

[THAILIBAN]

Taken systemically, chloramphenicol does have some potential side effects that are serious (though it is still approved for use in most countries). However this does not pertain to topical chloramphenicol -- skin creams, eye drops, ear drops etc. Widely used and very good safety margin.

The referral to a surgeon rather than a dermatologist was becuse OP described this as a "large abscess" but from the treatment given and fact that it has subsided, this is almost surely not what it was. More likely a pimple. It may have seemed large to him but to medical people the term "large abscess" conjures up something altogether different.

However re-reading post #7, OP is on anticoagulents and has headache and dizizness. This has absolutely nothing to do with the "abscess" on the face, nor with the prior stye (hordeolum). It should be checked out if it persists...any persistant headache with dizziness warrants evaluation and especially when in someone on blood thinners.

OP if you wish to see a neurologist for the HA and dizziness, do so (or alternately see any doctor for initial screening). But I suggest when you do, you not talk about the "abscess", the stye (hordeolum) of many years ago, or this concern about pus spreading as none of that is plausible and will likely cause the doctor to dismiss you out of hand. What you need to be concerned about is possible bleeding in the brain or simple hypertension, neither of them related to the skin problems.

Hi Sheryl,

thanks for your comments and thoughts.

It was and is really an abscess. As I have mentioned earlier, I unfortunately had experience with really huge abscesses, albeit not in the face but at my bottom. Abscesses so huge the nurses and practitioners were outright shocked. But that was a thing of the past. since moving to Asia more than ten years ago, I never had such problems. I am just suspecting that due to my Hordeolum a few years back and my stupid and improper way to handle it, there is still some bacteria in my body and somehow moving around. As I said, every few weeks/months, I feel there is some sort of pus around my eye and who knows where else. But I had never a real abscess in that area until now. The size of more than half a sugar cube, but that for sure is considered big when it is in the face and my face actually looked scary. I did not actually use that ointment I was given, for the reason I explained in my last post. The actual "wound" was not the problem, the pus moving around was and is. the area where the abscess was/is is still filling itself with Pus again and again. Plus, as I mentioned, I can feel that it is around both my eyes too. That is why I am worried it may have moved further to my head, plus I have a vertain headache and pressure in my head since a few days and slight - though not really severe - sort of postural sway/dizzyness. The pus is around my eyes virtually at all times, every couple of minutes a little drop somehow drips out of it and makes my eyes burn. It has that smell too. It is definitely nothing else, as I said, I really have more than enough experience with that. I did not go to any hospital today because I was really unsure what to do and what kind of practicioner to see, and I hoped it would somehow get better and my body would finally successfully fight it, but no. For sure I am not eager to undergo a MRI if not necessary (I would have to pay it by myself), and I am at the same time not eager to use antibiotics as the next time I have this, the bacteria may have developed a resistance. I am very sure it will come back in the future because it did so in the past, albeit not in such an extreme way in form of a huge abscess. But I need to take action in any way, that is way I posted this here. Maybe go to a general practicioner again. I know a very good internal specialist at Bumrungrad since years that I trust but I thought this is rather not his field? But maybe I am wrong. Now in the evening the postural sway is getting a little worse, during daytime it was better. and yes, the pus is still around my eyes too. it will for sure not go away by itself. anyway, thank you for your time and advise, it is appreciated

[Sheryl]

A good internist can certainly manage the wound you describe, and can evaluate the headache and dizziness and determine whether or not a referral to a neurologist is indicated.

Half the size of a sugar cube is not a huge abscess. When you say huge abscess on the face, it suggests something at least the size of a fist. The size you describe is just a large pimple or (if it is actually on the eyelid or conjuctiva) stye (which is, of course, a type of abscess, but not serious).

Pus in superficial skin lesions does not move around in the way you fear, and the hordeleum of the past could not result in pus hiding in your body, moving to your brain etc etc. Some people are simply prone to repeat styes. Sometimes this is related to an underlying skin problem and sometimes there is no apparent reason (though stress, lack of sleep or anything else that impairs the immune system can play a role). Whatever is causing your headache and dizziness, it is not that.