Ointments for erysipelas of the hand. Erysipelas of the hand: causes of the disease

The skin is the outer covering human body with an area of ​​about 1.6 m2, which performs several important tasks: mechanical protection of tissues and organs, tactile sensitivity (touch), thermoregulation, gas exchange and metabolism, protection of the body from the penetration of microbes.

But sometimes the skin itself becomes the object of attack by microorganisms - then dermatological diseases, among which is erysipelas.

Erysipelas (erysipelas) - what is it?

Erysipelas is an acute diffuse inflammation of the skin (less often - mucous membranes) infectious origin, usually affecting the face or lower legs.

Erysipelas is caused by group beta-hemolytic streptococcus BUT when it penetrates into the thickness of the skin through minor abrasions, cuts, insect bites, scratches, abrasions.

Erysipelas is more common in men of working age and in women over 45 years of age. For children under the age of one year, it is a mortal danger (photo 3).

The prevalence of the disease is high - the fourth place after acute respiratory infections, gastrointestinal infections and hepatitis.

Group A beta-hemolytic streptococcus

Group A β-hemolytic streptococcus itself (GABHS) was discovered relatively recently (150 years ago), but mankind has been familiar with the diseases it causes for a long time.

Angina, pharyngitis, laryngitis, scarlet fever, rheumatism, severe damage to kidney tissue - far from complete list pathological conditions caused by GABHS. The Ministry of Health states that the damage to the economy from β-hemolytic streptococcus is 10 times greater than the damage from all viral hepatitis.

It belongs to the conditionally pathogenic microflora, because it is present in almost all people in the oral cavity, respiratory tract on the skin and external genitalia. Good immunity limits its virulence (degree of infectivity).

GABHS very quickly spreads through the air, through the digestive tract and objects, so it is usually detected in rooms where children and labor collectives, 57.6% of angina and 30.3% of acute respiratory infections are caused by it.

Streptococci survive when frozen and heated to 70°C for 2 hours; in dried biomaterial (blood, pus), they remain highly infectious for several months. Toxins cause severe heart and kidney disease.

For children, the carriage of the pathogen in the upper respiratory tract is more characteristic. When examining schoolchildren, BHSA is isolated in the nasopharynx by 20-25% of children.

Causes of erysipelas of the legs

The cause of erysipelas of the legs can be small abscesses, boils and carbuncles, purulent wounds. The spread of dangerous streptococcus in the skin can be facilitated by frequent hypothermia of the legs or excessive sunbathing, causing microtrauma skin.

Erysipelas on the leg is very often the result of other serious diseases:

• diabetes;
• varicose veins;
• thrombophlebitis;
• trophic ulcers;
• fungal infection;
• alcoholism;
• obesity.

Stressful situations that sharply reduce immunity can give impetus to the attack of streptococcus on its carrier.

Chronic foci of infection in the form of destroyed teeth, enlarged tonsils 5-6 times increase the risk of erysipelas in any part of the body.

Symptoms of erysipelas of the leg, photo

A week later (on average) after the introduction of the pathogen into the skin, an acute onset of the disease occurs.

Suddenly there are signs of intoxication:

• severe weakness,
• temperature up to 40°C with chills,
• excruciating headache,
• aches in bones and muscles,
• sometimes - nausea and vomiting.

During the day, symptoms of erysipelas appear on the lower leg: the affected area swells sharply, shines from tension and turns red. The name "erysipelas" comes from the word "red" in some European languages.

The inflamed area is delimited from healthy skin demarcation roller. Its uneven scalloped outlines along the perimeter of the lesion are characteristic. Severe reddening of the skin is caused by hemolysis - the process of destruction of red blood cells (erythrocytes) by streptococcus.

When pressed with a finger, the redness disappears for a few seconds. The lesion is warmer to the touch than the surrounding tissue.

Pain and burning cause great suffering to the patient. The popliteal and inguinal lymph nodes become inflamed. In the direction of them from the affected area under the skin, dense reddish stripes are visible - lymphatic vessels, lymphangitis develops.

Diagnosis of erysipelas

Often the diagnosis is made without tests, according to the totality of general and local symptoms.

In other diseases, they often appear first local signs, and only after them intoxication appears.

Laboratory tests may confirm the presence of β-hemolytic streptococcus.

Forms of erysipelas of the leg

Based on the nature of local changes, there are:

1. Erythematous form- the site has a bright uniform color and clear boundaries.

2. Erythematous-hemorrhagic form- on the affected area, against the background of general redness (erythema), there are multiple petechial hemorrhages- a sign of damage to the blood capillaries.

3. Erythematous bullous(bulla, lat. - bubble) form - with it, on the third day, the upper layers of the skin are stratified with the formation of blisters.

The liquid in them contains a large mass of streptococci with a high degree virulence, therefore, when opening the bubbles, it is necessary to carefully carry out antiseptic treatment. Heal with the formation of a crust, under which smooth skin is formed.

4. Bullous-hemorrhagic form - in the blisters is an opaque bloody fluid.

5. Gangrenous form with areas of skin necrosis.

stands out wandering form when, within a few days, the lesion shifts to a neighboring area, and the primary focus flakes off and heals.

This form is typical for newborn children, with the rapid spread of erysipelas, children may die.

According to the severity of the disease are distinguished:

• mild form (the affected area is small, the temperature is not higher than 38.5 ° C),
• moderate (several small lesions, temperature up to 40 ° C for no more than 5 days)
• a severe form, when bullous-hemorrhagic elements cover almost the entire body, the temperature is critical for several days, loss of consciousness, delirium and signs of meningitis.

The inflamed area of ​​the skin remains sensitive to streptococcal infection even after healing, which gives grounds for the diagnosis of “repeated” and “recurrent” erysipelas.

Mild forms of erysipelas can be treated on an outpatient basis. Severe and advanced cases require inpatient treatment.

1) The first and main appointment is antibiotics in the form of intramuscular injections or orally. Penicillin antibiotics retained their effectiveness in the fight against hemolytic streptococcus.

They are combined with taking oleandomycin, furazolidone, erythromycin for one to two weeks.

2) Their action is enhanced sulfa drugs(biseptol).

3) Be sure to prescribe vitamins and biostimulants (levamisole, pentoxyl, methyluracil) to restore immunity and the fastest healing of the focus.

4) As anti-inflammatory and antipyretic drugs are prescribed nonsteroidal drugs: aspirin, diclofenac, ibuprofen, baralgin, reopyrin.

5) In case of severe intoxication, glucose solution or reopyrin is repeatedly injected.

6) To remove intoxication are prescribed plentiful drink and diuretics.

7) Physiotherapeutic procedures:

1. ultraviolet irradiation in acute period has a bacteriostatic effect;
2. lidase electrophoresis,
3. ozokerite,
4. magnetotherapy.

The last three procedures improve lymph flow, preventing the development of elephantiasis.

8) Antihistamines prevent sensitization of the body.

9) Sclerotherapy - the introduction into the affected veins of a substance that causes narrowing and resorption of the vessel - contributes to rapid healing blisters and healing of the inflamed area of ​​the skin.

10) Endovasal laser coagulation - leads to the disappearance of the lumen in diseased veins, preventing the development of lymphostasis.

11) Surgical treatment of the lesion:

1. opening the blisters, treating them with a solution of furacillin, enteroseptol in the form of powder, erythromycin ointment;
2. excision of inflamed veins and necrotic areas.

12) In severe cases, a blood or plasma transfusion is performed.

Treatment of erysipelas of the leg is carried out by a doctor. In order to avoid complications, the patient must strictly comply with all medical prescriptions, even with outpatient treatment.

In the treatment of erysipelas at home It is important to know:

1) You can not tightly bandage the affected area, only light bandages are allowed, which are changed several times a day after antiseptic treatment of the skin.

2) You can not use and - they increase the influx of interstitial fluid and slow down the healing process;
excessive softening of the skin with ointments will lead to additional infection of the wounds.

3) After opening the blisters, you can treat the erosion with hydrogen peroxide and dry the skin under them with powder, which includes:

• boric acid (3 g),
• xeroform (12 g),
• streptocide (8 g).

From above, cover the wound surface with a two-layer gauze.

Complications of erysipelas

Erysipelatous inflammation can go away on its own: after two weeks from the onset of the disease, the redness subsides, but the swelling and pigmentation of the skin remains for a long time. There is a high chance of a repeat process.

With insufficiently active treatment, erysipelas causes general and local complications. It is especially dangerous for patients with diabetes mellitus, allergies, varicose veins and thrombophlebitis, with heart failure and HIV infection.

There is a danger of developing pneumonia, sepsis and meningitis.

Streptococcus toxins cause rheumatism, myocarditis and glomerulonephritis.

Local complications are phlegmons and abscesses, trophic ulcers and lymphostasis (elephantiasis), in which the volume of limb tissues increases sharply due to the accumulation of interstitial fluid and thickening of the skin.

Elephantiasis develops in 15% of all cases of erysipelas. It is accompanied by such phenomena as papillomas, eczema, lymphorrhea (lymph effusion from thickened pigmented skin). All this greatly complicates the life of the patient.

The prognosis after erysipelas on the legs depends on the severity of the disease and the body's immunity.

Recurrent forms often develop when staphylococcal flora is also attached to GABHS.

Due to acquired lymphostasis, working capacity may be reduced.

In general, the prognosis for the patient's life is favorable if complications have been avoided.

Prevention of erysipelas

There is no specific prevention. To prevent erysipelas, some general and local measures must be observed.

• limit contact with patients with erysipelas, after contact, carry out antiseptic treatment of their skin;
• take care of strengthening immunity by establishing a daily routine, physical education, avoiding stressful situations;
• eliminate foci of chronic streptococcal infection in time, monitor the state of health;
• establish the right healthy eating- hemolytic streptococcus multiplies rapidly in stale food, giving particular preference to meat broths;
• in order to avoid relapses after erysipelas, year-round carry out prophylactic injections of bicillin.

Local Measures:

• pay more attention to your feet - wash them regularly, avoid blisters and scuffs, minor cuts, hypothermia and overheating;
• monitor the condition of the venous system and contact a specialist in time.

Erysipelatous inflammation mkb 10

In the international classifier of diseases ICD 10, erysipelas is:

Class I
- A30 - A49 Other bacterial diseases

• A46 Erysipelas

Erysipelas or erysipelatous inflammation of the skin is one of the manifestations of an acute common streptococcal infection. This disease is manifested by a predominant focal lesion of the dermis and underlying subcutaneous fat and proceeds against the background of an intoxication syndrome. Erysipelas is common mainly in countries with a temperate and cold climate, most often an increase in the incidence is observed in the off-season.

Etiology

Erysipelas is a skin infection caused by group A β-hemolytic streptococcus. It is also called pyogenic. Moreover, any strain (serovar) of this bacterium is pathogenic for humans and can, under certain conditions, lead to erysipelas.

β-hemolytic streptococcus is an immobile spherical gram-negative bacterium that forms a fairly large amount of substances toxic to humans. They belong to exotoxins, because their isolation does not require the death of the pathogen. It is these substances that form the basis of the aggressiveness and pathogenicity of streptococcus, determine the characteristics of the reaction of the human body to the introduction of this pathogen. They have pyrogenic, cyto- and histotoxic, hemolytic, immunosuppressive effects.

β-hemolytic streptococcus has a fairly high resistance to many external physical factors. It perfectly withstands freezing and drying. But the increase in temperature negatively affects his life. This explains the lower prevalence of all forms of streptococcal infection in countries with a hot climate.

How the infection is transmitted

The penetration of the pathogen occurs by airborne droplets. The contact-household method of transmission of infection is less commonly noted. Entrance gates can be microdamages of the mucous membrane and skin, scratches, abrasions, insect bites, open calluses, wound and postoperative surfaces.

β-hemolytic streptococcus is also the cause of not only erysipelas, but also many other septic conditions. The causative agent of any serovar can lead to the development of various. And this does not depend on the route of entry and the clinical form of streptococcal infection in the patient who became the source of infection. Therefore, erysipelas can develop after contact with a person who suffers from any form of streptococcal infection or even is an asymptomatic carrier.

β-hemolytic streptococcus causes tonsillitis, sinusitis, rheumatism, acute rheumatic fever, scarlet fever, (including in the form and ecthyma). Streptococcus is often detected in patients with sepsis, pneumonia, non-epidemic meningitis, myositis, osteomyelitis, necrotizing fasciitis, food poisoning, acute glomerulonephritis, nonspecific urethritis and cystitis. In women, he is the most common cause postpartum and post-abortion endometritis, and in newborns - omphalitis.

Streptococcus is a fairly common and aggressive pathogen. This leads to a natural question: is erysipelas contagious or not?

A significant number of people in contact with the patient do not get sick. But since the face is one of possible manifestations common streptococcal infection, transmission of the pathogen from a sick person to a healthy one is not excluded. This does not mean the unambiguous development of erysipelas in him. Perhaps the appearance of other forms of streptococcal infection or transient asymptomatic carriage.

In most cases clinically significant pathology and especially erysipelas developed when a person had a number of certain predisposing factors. In general, patients with erysipelas are considered to be slightly contagious.

Erysipelatous inflammation of the leg

What contributes to the development of the disease

Predisposing factors are:

• Immunodeficiency states of any origin. Insufficient reactivity of the immune system may be due to HIV, hypercytokinemia, radiation and chemotherapy, taking immunosuppressive drugs after transplants, certain blood diseases, and glucocorticosteroid therapy. Relative immunodeficiency is also observed after recent or ongoing protracted infectious and inflammatory diseases.
• The presence of chronic venous insufficiency lower limbs with varicose disease. Erysipelatous inflammation of the leg often occurs against the background of stagnation of blood and accompanying trophic disorders of the soft tissues of the legs and feet.
• Tendency to lymphostasis and the so-called elephantiasis. This also includes violations of lymphatic drainage due to the removal of packages of regional lymph nodes at surgical treatment malignant tumors.
• Violation of the integrity of the skin in dermatitis of any etiology, mycoses, diaper rash, chafing, trauma, excessive sunburn. Some microdamages of the epidermis can also lead to occupational hazards(work in an excessively dry, dusty, chemically contaminated room, long-term wearing of tight, poorly ventilated overalls and personal protective equipment). Injections are of particular importance. narcotic substances. They are usually produced under aseptic conditions and contribute to the development of phlebitis.
• The presence of foci of chronic streptococcal infection. Most often, these are carious teeth and concomitant gingivitis, chronic tonsillitis and rhinosinusitis.
• Diabetes.
• Chronic deficiency of essential nutrients and vitamins, which is possible with irrational diets and starvation, diseases digestive tract with predominant bowel disease.

Pathogenesis

Erysipelatous inflammation can occur both in the zone of primary penetration of streptococcus, and at a distance from the entrance gate of infection. In the second case, the key role is played by the hematogenous and lymphogenous pathways of the pathogen from the primary inflammatory focus. It is also possible to activate a pathogen that persists for a long time in the thickness of the dermis, while erysipelas often acquires a recurrent course.

Penetration and subsequent reproduction of β-hemolytic streptococcus leads to a complex of local and general changes. They are caused by direct cell damage, the action of bacterial exotoxins and the inclusion of an immunopathological mechanism. All organs are involved in the process to one degree or another, while the kidneys and the cardiovascular system are among the most likely secondary targets.

Streptococcal infection is characterized by fairly rapid generalization, which is explained by the peculiarities of the local immune response at the site of the pathogen and the high activity of the substances secreted by it. Therefore, with insufficient reactivity of the immune system, sepsis may develop with the appearance of secondary septic foci.

Of great importance is also the inclusion of an autoimmune mechanism, which is characteristic of infection with β-hemolytic streptococcus. This is accompanied by insufficient efficiency of natural elimination mechanisms. Under certain conditions, a person who has recovered from any form of streptococcal infection remains sensitized. And the re-introduction of the pathogen will trigger an active and not quite adequate immune response in it. Moreover, it may lead to the development secondary diseases with autoimmune mechanism: glomerulonephritis, myocarditis and a number of others.

Features of local changes in erysipelas

The massive intake of exotoxins into the blood contributes to the rapid onset and growth of general intoxication. This is aggravated by the active release of inflammatory mediators due to the triggering of allergic and autoallergic reactions, because erysipelas usually occurs against the background of an already existing sensitization of the body to streptococcal infection.

The introduction of the pathogen, the action of its toxins and the cytotoxic effect of the resulting immune complexes triggers serous inflammation in the reticular layer of the dermis. It proceeds with local damage to the walls of the lymphatic and blood capillaries and the development of lymphangitis, microphlebitis, arteritis. This contributes to the formation of an edematous, painful and sharply hyperemic area, clearly delimited from the surrounding healthy skin.

The serous exudate formed during erysipelas impregnates the tissues, accumulates in the intercellular spaces and is able to exfoliate the skin. This can cause the formation of blisters, the cover of which is the epidermis.

As a result of inflammation and the action of toxins, paresis of blood capillaries occurs and sharp rise their permeability. In this case, erythrocytes go beyond the vascular bed, and serous exudate can become hemorrhagic. And massive toxic hemolysis of erythrocytes exacerbates microcirculation disorders and can cause activation of the blood coagulation system. The formation of blood clots sharply impairs the blood supply to the inflamed area, which can lead to tissue necrosis.

Migrating to the site of inflammation, neutrophils phagocytize bacteria and die with them. The progressive accumulation of such destroyed cells, leukocytes and proteolyzed tissues contributes to the transition of serous inflammation to purulent. At the same time, secondary immune disorders and a decrease in the barrier function of the skin contribute to the attachment of a secondary infection, which aggravates and complicates the course of the disease.

The involvement of the underlying subcutaneous fat in the process exacerbates the violations of lymphatic drainage and contributes to the transition of the disease into a phlegmonous form. In this case, the causative agent gets the opportunity to additionally spread along the fascial cases of the limbs.

Classification

Erysipelas disease has several clinical forms. It is classified:

• By the presence in the body of a focus of streptococcal infection: primary (occurring when the pathogen is introduced from the outside) and secondary (when bacteria spread by the hematogenous or lymphogenous route).
• By the nature of the inflammatory process: erythematous, bullous, phlegmonous and necrotic forms. In fact, they are successive weighting stages of erysipelas.
• By the prevalence of the process: local, migrating, creeping, metastatic.
• According to the type of course: acute primary, repeated and recurrent. They say about repeated erysipelas if the disease of the same localization occurs more than a year after the first episode. And about a relapse - with the development of inflammation in the same focus in less than a year or with a 5-fold lesion of various skin areas.
• By severity: mild, moderate and severe forms of the disease. In this case, it is usually not the severity of local changes that is taken into account, but the general condition of the patient and the manifestations of his intoxication. Only with a progressive widespread lesion they speak of a severe form, even with a relatively good condition of the patient.
• According to the severity of symptoms: the classic form of the disease, abortive, erased and atypical.
• By localization: erysipelas of the lower extremities and hands is most often diagnosed. Erysipelas of the face is also possible, while the eyelid lesion is taken out in a separate clinical form illness. Erysipelas of the torso, mammary glands, scrotum, and female external genitalia are quite rare.

Symptoms

Erysipelas begins acutely, with general non-specific signs of intoxication appearing 12-24 hours before local skin changes.

The body temperature rises sharply to febrile figures, which is accompanied by chills, headache, weakness, palpitations. In some patients, against the background of severe intoxication, oneiroid or hallucinatory-delusional syndrome develops. Sometimes, already in the prodromal period, signs of toxic damage to the liver, kidneys, and heart are noted. Possible excessive sleepiness, nausea with unrelieved vomiting. So the initial stage of erysipelas is nonspecific, the patient may take its manifestations for flu symptoms.

Local changes are the main symptom of the disease. In the classical current they wear local character and are clearly demarcated from adjacent areas of the skin. Erythematous erysipelas is characterized by the appearance of a sharp bright hyperemia (erythema) with clearly defined edges and even with a small roller on the periphery. The lesion has irregular jagged borders. Sometimes it resembles the outlines of the continents on a geographical map. inflamed skin looks dense, swollen, as if stretched and slightly shiny. It is dry and hot to the touch. The patient is worried about burning pain, a feeling of tension and sharp hyperesthesia in the area of ​​erysipelas.

Bright redness can be replaced by a bluish-stagnant shade, which is associated with increasing local microcirculation disorders. Often there are also diapedetic and small hemorrhagic hemorrhages, which is explained by sweating and rupture of blood vessels.

On the 2nd-3rd day of the disease, signs of lymphostasis often join with the development of lymphedema (dense lymphatic edema). At the same time, blisters and pustules may appear within the focus, in which case bullous erysipelas is diagnosed. After opening them, a dense brown crust forms on the surface of the skin.

Resolution of erysipelas occurs gradually. At adequate treatment temperature returns to normal within 3-5 days. Acute manifestations of the erythematous form disappear by 8-9 days, and with hemorrhagic syndrome they can be stored for 12-16 days.

Puffiness and hyperemia of the skin decreases, its surface begins to itch and peel off. In some patients, after the disappearance of the main symptoms, uneven hyperpigmentation and dark congestive hyperemia are noted, which disappear on their own. But after a severe bullous-hemorrhagic erysipelas, it can persist for years and even decades.

Features of erysipelas of various localization

AT clinical practice most often (up to 70% of cases) there is erysipelas of the lower leg. It proceeds in an erythematous or hemorrhagic-bullous form and is accompanied by severe lymphatic edema and secondary thrombophlebitis of the superficial veins of the lower limb. In most cases, erysipelas on the leg develops against the background of varicose veins, less often -.

1. Bullous-hemorrhagic form of erysipelas
2. Erysipelas, lymphostasis and ingrown nail on the background of fungal skin lesions

Erysipelatous inflammation of the hand has a predominantly erythematous form. Almost 80% of cases in this case occur in patients with postoperative lymphostasis that occurred after radical mastectomy about breast cancer. Relapses of erysipelas on the arm at the same time aggravate the condition and lead to an increase in elephantiasis. This further disrupts the woman's ability to work.

The manifestation of the disease on the face can be primary and secondary. Often, its development is preceded by angina, otitis, sinusitis, caries. Facial erysipelas are usually erythematous and mild or less common middle degree gravity. Sometimes it is combined with streptococcal lesions of the mucous membranes. The erysipelas of the eyelids is accompanied by severe edema.

Possible Complications

The most likely complications of erysipelas include:

• extensive phlegmon or abscess;
• thrombophlebitis of nearby veins;
• infectious-toxic shock;
• sepsis;
• TELA;
• arthritis;
• tendovaginitis;
• myocarditis;
• nephritis, glomerulonephritis;
• acute infectious psychosis.

The main consequences of erysipelas are persistent hyperpigmentation and elephantiasis.

Principles of treatment

Since it is possible to treat erysipelas at home (according to modern recommendations of the Ministry of Health of the Russian Federation) with mild and moderate severe course disease, in most cases it is possible to do without hospitalization of the patient. He is under the supervision of a local therapist and receives the treatment prescribed by him at home. In the presence of blisters, a surgeon's consultation is required to open and empty large bullae, and select local therapy.

Indications for hospitalization are:

• advanced age of the patient;
• the development of erysipelas in a child;
• severe immunodeficiency in a patient;
• severe course of the disease: pronounced intoxication syndrome, sepsis, widespread bullous-hemorrhagic lesion, necrotic and phlegmonous forms of erysipelas, the addition of purulent complications;
• the presence of decompensated and subcompensated clinically significant somatic pathology- especially diseases of the heart, kidneys, liver;
• relapsing course.

In the absence of indications for surgical intervention The patient is admitted to the infectious diseases department. And when placed in surgical hospital he should be in the department of purulent surgery.

How to treat erysipelas

In the treatment of erysipelas, the form, localization and severity of the disease are taken into account. Important points are also the age of the patient and the presence of concomitant somatic diseases. It also depends on which doctor will treat erysipelas, whether it will be necessary surgical intervention Or you can do it conservatively.

In any form of the disease, a full-fledged systemic etiotropic therapy is required. Competent treatment erysipelas with antibiotics is aimed not only at stopping current symptoms but also for the prevention of relapses and complications. After all, the task of antibiotic therapy is the complete elimination of the pathogen in the body, including its protective L-forms.

β-hemolytic streptococcus retained high sensitivity to antibiotics penicillin series. Therefore, they are used as a first-line drug in the treatment of erysipelas. If there are contraindications to penicillins or if it is necessary to use tablet forms, antibiotics of other groups, sulfonamides, furazolidones, biseptol can be prescribed. Properly selected antibiotic allows you to improve the patient's condition within the first day.

In severe cases, antistreptococcal serum and gamma globulin may be used in addition to antibiotic therapy.

As aids NSAIDs are used (with analgesic, antipyretic and anti-inflammatory purposes), antihistamines(for desensitization). With severe intoxication, infusions based on glucose or saline are indicated. For the treatment of severe bullous forms and the emerging pronounced lymphostasis, systemic short-term glucocorticosteroid therapy is additionally performed.

In some cases, measures are taken to activate the immune system. This may be the use of thymus preparations, biostimulants and multivitamins, autohemotherapy, plasma infusions.

Local therapy is also shown, which can significantly improve the patient's well-being and reduce the severity of inflammation. AT acute stage are used wet dressings with dimexide, furacillin, chlorhexidine, microcide. A dense ointment for erysipelas is not used at this stage, as it can provoke the development of an abscess and phlegmon. It is permissible to dust the focus of erysipelas with powdered antibacterial agents and enteroseptol, treatment with antiseptic aerosols.

Erysipelas treatment folk remedies cannot act as the main method of fighting the infection and is not able to replace the one prescribed by the doctor complex therapy. In addition, when using herbal preparations there is a risk of strengthening allergic reaction and blood flow in the affected area, which will negatively affect the course of the disease. Sometimes, in agreement with the doctor, irrigation with infusion of chamomile and other agents with a mild antiseptic effect is used.

Physiotherapy is widely used: ultraviolet radiation in erythemal doses, electrophoresis with proteolytic enzymes and potassium iodide, infrared laser therapy, magnetotherapy, lymphopressotherapy.

Prevention

Prevention of erysipelas includes timely treatment any foci of chronic infection, dermatitis, mycosis of the feet and varicose veins, the achievement of compensation when diabetes. It is recommended to follow the rules of personal hygiene, choose comfortable clothes made from natural fabrics, wear comfortable shoes. When diaper rash, abrasions appear, they must be treated in a timely manner, additionally treating the skin with antiseptic agents.

Erysipelatous inflammation with timely access to a doctor and strict adherence to his recommendations can be successfully treated and does not lead to permanent disability.

About such pathological condition as erysipelas was known to Hippocrates, however, that it is also contagious, they began to talk only in the 19th century. This disease is often referred to as erysipelas. The term " erysipelas"derived from the word" the Rose". The thing is that with this disease, the face acquires a crimson hue similar to the color of this flower. In addition, the shape of the resulting edema is similar to the shape of rose petals.

What is this pathology?

General information about streptococci

Causes and predisposing factors for the development of the disease

Provoking factors:

• Injuries and bruises;
• Sudden overheating or hypothermia of the body;
• Insolation ( Tan);
• Violations of the integrity of the skin ( diaper rash, abrasions, injections, cracks, etc.);
• stressful conditions;
• foot fungus;
• Chronic somatic pathologies;
• Chronic streptococcal infections;
• Problems with the lymphatic vessels;
• Drinking large amounts of alcohol;

Existing classifications

According to the severity of the course, this disease can be:

• light form;
• moderate form;
• heavy form.

• erythematous form ( accompanied by swelling of the skin and hyperemia, i.e. overflow of blood vessels in a certain part of the body);
• erythematous-bullous form ( proceeds with the formation of edema, hyperemia, as well as blisters filled with serous fluid);
• erythematous-hemorrhagic form ( characterized by the development of hemorrhages that occur against the background of severe redness and inflammation of the skin);
• bullous-hemorrhagic form ( accompanied by the formation of blisters with serous-hemorrhagic contents, due to deep damage to the capillaries).

• common ( inflammation extends beyond the boundaries of one anatomical region);
• localized ( inflammation occurs in one anatomical region);
• migratory ( inflammation moves from one anatomical region to another);
• metastatic ( foci of inflammation are at a distance from each other).

• primary: infection occurs due to the penetration of streptococcus through damaged skin. In most cases, the face is affected;
• secondary or recurrent: occurs as a complication of the existing local purulent process. Most often it affects the legs, forming foci of inflammation, which are very distant from each other.

Relapses of erysipelas

Age features

• Children rarely get sick. Even if this happens, the infectious process is easily tolerated by them;
• Elderly people tolerate the disease very difficult. They have a febrile period that can last up to 4 weeks. In addition, there is an exacerbation of existing chronic ailments.

General symptoms

• Nausea and vomiting;
• A sharp increase in body temperature to 39 - 41 degrees;
• Disorders of consciousness;
• Burning, pain, redness and swelling in the affected area;
• Pain in the area of ​​enlarged lymph nodes;
• peeling of the skin;
• The appearance of bubbles filled with a cloudy liquid.

Possible complications of the disease

• Phlegmon ( ulcers unrestricted from surrounding tissues);
• Thrombophlebitis ( inflammation of the venous walls);
• Abscesses ( ulcers limited from surrounding tissues by a capsule);
• Necrosis ( death of skin tissue);
• Ulcers ( deep inflamed defect of the epithelium of the skin);
• Elephantiasis ( persistent increase in the size of any part of the body due to painful growth of the skin and subcutaneous tissue).

Diagnostics

Treatment

Treatment of erysipelas with folk remedies

Recipe #2: we take in equal quantities honey, rye flour, as well as black elderberry leaves, after grinding them into powder. We mix all the ingredients and apply the resulting mixture to the affected areas 3-4 times a day.

Recipe #3: steam a teaspoon of white birch buds in 1 glass boiled water. After 10 minutes, the infusion is filtered and taken orally 1/3 cup 3 times a day. The same infusion can be used for compresses, lotions and baths.

Recipe #4: Boil 50 g of the aerial part of the prickly tartar for 10 minutes in 500 ml of water. The resulting infusion is used for compresses.

Recipe number 5: boil a teaspoon of crushed blackthorn bark for 10 - 15 minutes in 1 cup of boiled water. We filter the broth, let it brew, and use it for lotions.

Forecast

Prevention measures

• We follow all the rules of skin hygiene;
• We lead a healthy lifestyle;
• We treat all background pathologies in a timely manner;
• Refuse to wear someone else's shoes;
• We try not to rub our feet;
• We raise defensive forces organism;
• Avoid hypothermia and sudden changes in temperature;
• We take vitamins;
• We use special antibioticsthat interfere with the reproduction of streptococcus in the body;
• We monitor the total body weight;
• We regularly visit the necessary specialists;
• We eat rationally.

Patients with erysipelas are not contagious. Women get sick more often than men. More than 60% of cases of erysipelas are carried by people aged 40 and older. The disease is characterized by a distinct summer-autumn seasonality.

Erysipelas symptoms

The incubation period of erysipelas is from several hours to 3-5 days. In patients with a recurrent course, the development of the next attack of the disease is often preceded by hypothermia, stress. In the vast majority of cases, the onset is acute.

The initial period of erysipelas is characterized rapid development general toxic phenomena, which in more than half of the patients for a period of several hours to 1-2 days ahead of the occurrence of local manifestations of the disease. Are celebrated

• headache, general weakness, chills, muscle pain
• 25-30% of patients develop nausea and vomiting
• already in the first hours of the disease, the temperature rises to 38-40 ° C.
• on areas of the skin in the area of ​​future manifestations, a number of patients develop a feeling of fullness or burning, mild pain.

The height of the disease occurs within a period of several hours to 1-2 days after the first manifestations of the disease. General toxic manifestations and fever reach their maximum. There are characteristic local manifestations.

Most often, erysipelas is localized on the lower extremities, less often on the face and upper limbs, very rarely only on the trunk, in the area of ​​​​the mammary gland, perineum, in the area of ​​​​the external genital organs.

Skin manifestations

First, a small red or pink spot appears on the skin, which turns into a characteristic erysipelatous redness within a few hours. Redness is a clearly delimited area of ​​the skin with uneven boundaries in the form of teeth, "tongues". The skin in the area of ​​redness is tense, hot to the touch, moderately painful to the touch. In some cases, you can find a "marginal roller" in the form of raised edges of redness. Along with reddening of the skin, its edema develops, spreading beyond the redness.

The development of blisters is associated with increased effusion at the site of inflammation. If the blisters are damaged or spontaneously rupture, fluid flows out, superficial wounds appear in place of the blisters. While maintaining the integrity of the blisters, they gradually shrink with the formation of yellow or brown crusts.

The residual effects of erysipelas, which persist for several weeks and months, include swelling and pigmentation of the skin, dense dry crusts in place of the blisters.

Photo: website of the Department of Dermatovenereology of the Tomsk Military Medical Institute

Diagnosis of erysipelas

Diagnosis of erysipelas is carried out by a general practitioner or infectious disease specialist.

• certain diagnostic value have elevated titers of antistreptolysin-O and other antistreptococcal antibodies, detection of streptococcus in the blood of patients (using PCR)
• inflammatory changes in general analysis blood
• Violations of hemostasis and fibrinolysis (increased blood levels of fibrinogen, PDF, RKMF, increase or decrease in the amount of plasminogen, plasmin, antithrombin III, increase in the level of platelet factor 4, decrease in their number)

Diagnostic criteria for erysipelas in typical cases are:

• acute onset of the disease with severe symptoms of intoxication, fever up to 38-39°C and above;
• predominant localization of the local inflammatory process on the lower extremities and face;
• development of typical local manifestations with characteristic redness;
• swollen lymph nodes in the area of ​​inflammation;
• absence of severe pain in the focus of inflammation at rest

Erysipelas treatment

Treatment of erysipelas should be carried out taking into account the form of the disease, the nature of the lesions, the presence of complications and consequences. Currently, most patients with mild erysipelas and many patients with moderate forms are treated in a polyclinic. Indications for mandatory hospitalization in infectious diseases hospitals (departments) are:

• severe course;
• frequent relapses of erysipelas;
• the presence of severe common comorbidities;
• old age or childhood.

The most important place in complex treatment patients with erysipelas takes antimicrobial therapy. When treating patients in a polyclinic and at home, it is advisable to prescribe antibiotics in tablets:

• erythromycin,
• oletethrin,
• doxycycline,
• spiramycin (course of treatment 7-10 days),
• azithromycin,
• ciprofloxacin (5-7 days),
• rifampicin (7-10 days).

In case of intolerance to antibiotics, furazolidone (10 days) is indicated; delagil (10 days).

It is advisable to treat erysipelas in a hospital with benzylpenicillin, a course of 7-10 days. In severe cases of the disease, the development of complications (abscess, phlegmon, etc.), a combination of benzylpenicillin and gentamicin, the appointment of cephalosporins are possible.

With severe inflammation of the skin, anti-inflammatory drugs are indicated: chlotazol or butadione for 10-15 days.

Patients with erysipelas need to prescribe a complex of vitamins for 2-4 weeks. In severe erysipelas, intravenous detoxification therapy is performed (hemodez, reopoliglyukin, 5% glucose solution, saline) with the addition of 5-10 ml of a 5% solution of ascorbic acid, prednisolone. Cardiovascular, diuretic, antipyretic drugs are prescribed.

Treatment of patients with recurrent erysipelas

Treatment of recurrent erysipelas should be carried out in a hospital setting. It is mandatory to prescribe reserve antibiotics that were not used in the treatment of previous relapses. Cephalosporins are prescribed intramuscularly or lincomycin intramuscularly, rifampicin intramuscularly. Well antibiotic therapy- 8-10 days. With especially persistent relapses, a two-course treatment is advisable. Consistently prescribe antibiotics that optimally act on streptococcus. The first course of antibiotic therapy is carried out with cephalosporins (7-8 days). After a 5-7-day break, a second course of treatment with lincomycin is performed (6-7 days). With recurrent erysipelas, immunity correction is indicated (methyluracil, sodium nucleinate, prodigiosan, T-activin).

Local therapy for erysipelas

Treatment of local manifestations of erysipelas is carried out only with its cystic forms with localization of the process on the limbs. The erythematous form of erysipelas does not require application local funds treatment, and many of them ( ichthyol ointment, Vishnevsky balm, antibiotic ointments) are generally contraindicated. In the acute period, in the presence of intact blisters, they are carefully incised at one of the edges, and after the release of fluid, bandages are applied to the inflammation site with a 0.1% solution of rivanol or a 0.02% solution of furatsilin, changing them several times during the day. Tight bandaging is unacceptable.

In the presence of extensive weeping wound surfaces at the site of the opened blisters, local treatment begins with manganese baths for the extremities, followed by the application of the bandages listed above. For the treatment of bleeding, 5-10% dibunol liniment is used in the form of applications in the area of ​​​​the inflammation focus 2 times a day for 5-7 days.

Traditionally, in the acute period of erysipelas, ultraviolet irradiation is prescribed to the area of ​​​​the focus of inflammation, to the area of ​​\u200b\u200blymph nodes. Appoint applications of ozokerite or dressings with heated naftalan ointment (on the lower limbs), paraffin applications (on the face), electrophoresis of lidase, calcium chloride, radon baths. Shown high efficiency low-intensity laser therapy of a local focus of inflammation. The applied dose of laser radiation varies depending on the state of the focus, the presence of concomitant diseases.

Complications

Complications of erysipelas, mainly of a local nature, are observed in a small number of patients. To local complications include abscesses, phlegmon, skin necrosis, suppuration of blisters, inflammation of the veins, thrombophlebitis, inflammation lymphatic vessels. To common complications, developing in patients with erysipelas quite rarely, include sepsis, toxic-infectious shock, acute cardiovascular insufficiency, thromboembolism pulmonary artery etc. The consequences of erysipelas include persistent stagnation of lymph. By modern ideas, lymph stagnation in most cases develops in patients with erysipelas against the background of already existing functional insufficiency lymphatic circulation of the skin (congenital, post-traumatic, etc.).

Prevention of recurrence of erysipelas

Prevention of recurrence of erysipelas is an integral part of the complex dispensary treatment of patients suffering from a recurrent form of the disease. Preventive intramuscular injection bicillin (5-1.5 million units) or retarpen (2.4 million units) prevents relapse of the disease associated with reinfection with streptococcus.

With frequent relapses (at least 3 per Last year) continuous (year-round) bicillin prophylaxis is advisable for 2-3 years with an interval of 3-4 weeks for the administration of bicillin (in the first months, the interval can be reduced to 2 weeks). With seasonal relapses, the drug is started to be administered a month before the start of the morbidity season in this patient with an interval of 4 weeks for 3-4 months annually. In the presence of significant residual effects after suffering erysipelas, bicillin is administered at intervals of 4 weeks for 4-6 months.

Forecast and course

• With adequate treatment of mild and moderate forms - a complete recovery.
• Chronic lymphedema(elephantiasis) or scarring in chronic relapsing course.
• In the elderly and debilitated high frequency complications and a tendency to frequent recurrence.

Erysipelas is one of the most common infectious diseases skin and at the same time is on the list of the most dangerous diseases caused by infection. Complicating the situation is that erysipelas in some cases has various symptoms and intensity, which makes treatment difficult. Also, the disease can be caused by surgery, such as a mastectomy, and act as a complication.

Erysipelas can be contracted directly from the carrier of the infection, therefore, even with minor skin lesions, it is recommended to limit contact with the patient.

Symptoms of erysipelas of the hand

Symptoms of erysipelas of the hand depend on the intensity of the course of the disease. In most cases, the disease first manifests itself through chills, which quickly increase. It is also accompanied by lethargy, weakness and drowsiness. Despite the ambiguity of the signs of the disease, it is still worth worrying when they appear and go to the doctor for an appointment so that you have a disease detected in time.

Sometimes the patient, in the first hours after infection, may feel more obvious symptoms:

• severe throbbing headache;
• nausea;
• gagging;
• muscle spasms;
• heat.

This condition of the patient cannot be ignored, so you should not wait until the condition worsens, you must immediately call ambulance Or go see a doctor, if possible.

In some cases, the symptoms of erysipelas of the hand can be even more unpleasant - convulsions, impaired speech and delirium. In this case, the count goes on for minutes, if you do not immediately seek help from medical professionals, then there will be a threat to the lining of the brain, which may suffer from irritation.

If erysipelas of the arm occurs after a mastectomy (removal of the breast), then the affected arm begins to hurt very badly. In this case, erysipelas acts as a complication, and since the woman is under the supervision of a doctor, the disease is usually detected in the first stages.

by the most dangerous complication with hands is erysipelas. The disease develops due to ulcers, trophic disorders in venous and lymphatic insufficiency. The trigger for erysipelas is a decrease in immunity, during which an exacerbation occurs. In this case, when erysipelas is detected, the severity of the disease is determined and the question of the need for hospitalization is decided, since erysipelas can also have complications in the form of:

• abscess;
• septicemia;
• deep veins.

How to treat erysipelas of the hand?

First of all, when erysipelas is detected, the patient is hospitalized. Next, the course of therapy begins. which can last from seven to ten days. The course of treatment for erysipelas of the hand is based on antibiotics and detoxification drugs. If the drugs are prescribed correctly and taken in accordance with the instructions, then the chills and fever disappear after a day, and the patient's condition improves significantly. Immediately after this, inflammation decreases and the level of pain decreases.

Erysipelatous inflammation of the hand and fingers is unpleasant because these parts of the body are always in motion - it is difficult for a person to do ordinary actions without their participation. It is recommended for the period of treatment and until complete recovery to move your hands less.

Three days after the start of taking antibiotics for erysipelas of the hand, the diagnosis is reviewed and the severity of the disease is determined, after which the course of treatment may change.