Pus

WHEN TO SEE YOUR DOCTOR

* A sore does not stop weeping after two to three days or gets worse.

* Pus appears in deep pockets under the skin or in pustules covering a wide area of skin.

* The affected area is also red, painful, swollen, hot or discolored.

* You experience pus coming from your gums, eyes or genitals.

* See your doctor immediately if you also experience fever, chills or sweating.

What Your Symptom Is Telling You

What's white, slimy, oozing and guaranteed to make the strongest stomach queasy? No, it's not your Aunt Martha's homemade mayonnaise. And it's not a Las Vegas lounge singer.

It's pus: that gross-you-out, I-think-I'm-gonna-gag substance that's made us all say "blecchh!" ever since our first skinned knee. What exactly is this awful ooze? Well, if you think it looks like death warmed over, you're exactly right.

"You're looking at a bunch of dead soldiers—casualties of a battle against infection," says Guy F. Webster, M.D., Ph.D., assistant professor of dermatology and director of the Center for Cutaneous Pharmacology at Thomas Jefferson University in Philadelphia. "When skin or other tissue is infected, the body rushes in millions of white blood cells and other products of the immune system to fight off the infection. Pus is the by-product of this confrontation—fallen white cells, rotting tissue and other debris."

This dead material is not only unsavory, it's unwelcome. "The body is trying to expel pus because it interferes with the healing process," says John M. Rabkin, M.D., assistant professor of surgery at Oregon Health Sciences University in Portland. "Not only is it an obstacle for the body's repairing tissues, it's a breeding ground for any surviving bacteria that produced the infection in the first place."

Our skin normally does fine keeping infectious, pus-producing bacteria at bay. But sometimes these stubborn invaders penetrate the skin's defenses. They can sneak in through a wound or come in the form of skin disease, such as a cyst or acne. And in rarer circumstances, bacteria from an internal infection can produce pus just under the skin.

When infection sets in, pus can take two forms. One is a pustule—a self-contained, thin-walled package of visible pus popping through the outer skin. Acne is a good example, but there are a host of other infectious conditions that produce these little white volcanoes, including folliculitis (infected hair follicles) and carbuncles (infected boils).

Other times, pus forms well under the skin. Doctors call this an abscess—a deep pocket or cavity in infected tissue where pus collects and festers. If the abscess isn't too deep, the pus makes it's way to the surface and clears up. But if it's really deep, the abscess can grow.

"If an abscess continues to grow, it will hurt tremendously and can cause the irreversible destruction of skin or other tissue," says Kevin Ferentz, M.D., assistant professor of family medicine at the University of Maryland School of Medicine in Baltimore. For example, the pus-filled pockets formed from periodontitis—an advanced form of gum disease—can lead to the loss of teeth and bone tissue. And in extreme cases, the abscesses in an ulcerating leg wound can produce gangrene and lead to a loss of the limb.

Symptom Relief

Pus is telling us that our white blood cells are trying to clean up the infection," says James Brand, M.D., assistant professor of family medicine at the University of Oklahoma Health Sciences Center in Oklahoma City. "The bad news is that it could mean these cells are having a long, hard fight."

Fortunately, we can give our natural infection fighters a helping hand. Multiple pustular outbreaks and deep abscesses call for a doctor's care, but here's how you can deal with minor cases.

Gently wash with a mild soap and water. The most effective thing one can do for an infection with pus is keep it clean, says Dr. Brand. No need for fancy soaps or hard scrubbings. One or two washings a day with soap and warm water are plenty to clean out bacteria and wash away accumulated pus.

Wrap it up. A bandage will absorb much of the pus from the infected area, protect it from dirt and additional injury and hold in moisture, which is vital in the healing process, according to Dr. Rabkin. There are many specialized bandages available, but a traditional adhesive bandage or gauze pad with tape works just as well. Bandages should also be changed at least three times a day.

Apply a topical antibiotic. Before bandaging, you may want to rub on an antibiotic ointment such as Neosporin or Polysporin or one containing the ingredient bacitracin. According to Dr. Webster, they won't do a lot to fight the germs already inside a wound, but they do help seal in moisture and keep additional germs out. More stubborn infections may call for oral prescription drugs.

Apply warm, moist compresses. Wrapping a pustule or abscess with a warm, moist cloth for 15 minutes several times a day will gently draw pus to the surface and soften the skin so it can naturally rupture and drain without aggravating the infection or causing pain, says Dr. Webster.

Soak away scabs. If a scab is oozing pus, it could mean an abscess is forming. The scab has got to go . . . but don't rip it off. Soak it frequently in warm water and bandage it to keep it moist. Eventually it will come off on its own. When it does, keep the sore clean and bandaged. The pus will drain easier and the wound will heal faster.

Have a doc get the gunk out. Deep abscesses need to be drained, flaps of dead skin cut away and deep debris removed.

Brush, floss and rinse with salt water. If you have gum disease, you will have to see a dentist or periodontist for treatment. In the meantime, brushing with a fluoride toothpaste and flossing between teeth will remove many of the plaque bacteria causing the infection. And rinsing with salt water can draw much of the contents out of the abscess to prevent further damage. (For more tips on dealing with gum disease, see Gum Problems on page 217.)