There are multiple scenarios when a lesion has formed under the skin that contains either fluid or an accumulation of semi-solid cellular debris. Some examples of these are cysts, abscesses and hematomas. Cysts can form anywhere in the body, and come in all shapes and sizes. Epidermal cysts tend to be harmless and painless, but have the potential to enlarge or become infected without apparent cause. An abscess is an enclosed collection of pus within a confined space of the body which tends to be tender and hot to the touch due to a local infection at the site. Hematomas form when an accumulation of blood coagulates under the skin and forms a firm mass that often appears as a reddish purple lump. The cause is a broken blood vessel under the skin often caused by injury or surgical procedure. All three of these medical concerns can be treated with a procedure called an Incision and Drainage (I&D).
During the procedure, your medical specialist will cleanse the lesion site with isopropyl alcohol and topically numb the area using injectable Lidocaine. She will then use a sterile blade or needle to incise the skin, allowing the fluid or semi-solid to drain through the hole. Careful manual manipulation may be required to fully express the blood, pus or other cellular debris inside. After the cavity is emptied, a sterile cotton gauze strip impregnated with iodine may be inserted in order to keep the entry wound open and allow the lesion to continue to drain naturally. If packing is required, we will need to see you back in the office in a few days to remove it. A round of antibiotics may also be prescribed if your provider thinks it necessary. Wound care will be discussed with you and a written document explaining what to expect will be given to you as well. Oftentimes, if an infection is being treated, a round of oral antibiotics will also be prescribed.

We’ve all gotten splinters embedded in our skin over the years, and usually it is no cause for alarm. We can extract the wooden sliver with a sterilized needle and pair of tweezers, or wait for our bodies to force it out naturally. Occasionally, we are faced with a scenario where the foreign body is either too large, too deep or in too awkward a spot to remove ourselves. In those cases it is savvy to see a specialist at Bryn Mawr Dermatology to have one of our medical specialists extract the offending object. Dermatologists have specialized tools that are designed just for this task. We can also ensure a clean environment that will help reduce the possibility of infection. If you have stepped on a shard of glass, gotten a metal sliver stuck under a fingernail or have a festering lump under your skin and aren’t even sure what it is or how it got there, we can help.

In the case of a non-life threatening laceration or puncture wound that appears to need more attention than a simple Band-Aid, coming to the dermatologist is a great alternative to going to the Emergency Room or Urgent Care. Our medical experts have extensive training in how to clean and repair a wound to get the most aesthetically pleasing result possible. We have the instruments and other tools needed for fine-tuned surgical procedures, and the time and patience to do it right. What’s even better is that you can make an appointment rather than showing up and waiting in a crowded lobby for hours with dozens of sick individuals while your concern is triaged.
In the past we have repaired a dog bite that perforated the cheek and lip of an 8-year-old, a knife wound running across the palm of a home-chef, and treated a puncture wound that ended up being infected and turning into cellulitis. All of these patients avoided the stressful experience of going to an ER, and ended up with personalized attention and results you could never find at an Urgent Care. Our skilled physicians took the time to use the most appropriate tools, technique and suture material to ensure the most subtle scarring possible.