Did you know that applying a topical anesthetic cream on a child’s abscess for about 30 minutes could lead to spontaneous drainage?  In a study done in 2010 in the American Journal of Emergency Medicine, they found that in approximately 1/4 of cases caused the abscess to start spontaneously drain in the ED.  Unfortunately most cases still required an I&D in the end, but the application of 4% topical lidocaine substantially reducing the number needed to receive procedural sedation for the subsequent I&D by about 20%.  In approx 3% of cases the I&D was not even needed after spontaneous drainage… and in my mind 3/100 kids I don’t have to I&D is worth it.

Cassidy-Smith T, Mistry RD, Russo CJ, McCans K, Brown N, Capano-Wehrle LM, Drago LA, Vitale PA, Baumann BM. Topical anesthetic cream is associated with spontaneous cutaneous abscess drainage in children. Amer J Emerg Med. 2010