This patient has a history of autoimmune inflammatory skin condition that causes chronic scarring and abscess formation. There could have been a small cyst there that has gotten inflamed or this could be part of his inflammatory autoimmune condition or this just could be an infectious abscess. This case was a good example of the acid/base shift in infected/inflamed wounds. I put ample lidocaine surrounding and under the area of inflammation. But, as commonly occurs with inflamed wounds the bottom of the pocket that has severe inflammation can not be completely anesthetized. So, I gently probe with blunt tools to break up loculations and search the bottom of the pocket. I then avoid any tender areas. We evacuate as much of the contents as we can to relieve pain, then I allow antibiotics and iodoform gauze do the rest to dry up the pocket and reduce inflammation. Sometimes if there are lots of cyst contents I will flush with saline, but not always. We then monitor closely. Abscess pop. Inflamed cyst pop. Incision and drainage. Dermatology Physician Assistant. Dermatology procedure. MrPopZit.