Erysipelas - a skin infection.
Patients mug malozarazny. Women suffer more often than men. More than 60% of the face tolerate people aged 40 years and older. The disease is characterized by a distinct summer-autumn season.
symptoms of erysipelas
The incubation period of faces - from several hours to 3-5 days. In patients with relapsing development of the next attack of the disease is often preceded hypothermia, stress. In most cases, the disease begins acutely.
The initial period of erysipelas is characterized by the rapid development of general toxic effects that are more than half of the patients for a period of from several hours to 1-2 days ahead of the emergence of local manifestations disease. celebrated
- headache, weakness, chills, muscle aches
- in 25-30% of patients have nausea and vomiting
- already during the first hours of the disease the temperature rises to 38-40 ° C.
- on areas of the skin in the area of future manifestations of some patients appear bloating or burning sensation, mild pain.
the height of the disease comes in terms of several hours to 1-2 days after the first symptoms of the disease. Reach their maximum general toxic symptoms and fever. There are specific local manifestations.
Most often face is localized in the lower limbs, at least on the face and upper extremities, only very rarely on the trunk, in the breast, perineum, in the area of the external genitalia.
Manifestations on the skin
First, the skin appears small pink or red spot, which in a few hours turning into a characteristic redness erysipelas. Redness is a clearly delimited area of skin with uneven borders in the form of teeth, "languages". redness in the skin is tense and hot to the touch, moderately painful on palpation. In some cases, you can discover the "marginal ridges" in the form of rising edges of the redness. In addition to the redness of the skin develops its swelling, redness spreads beyond.
The development of blisters associated with increased exudate in inflammation. If the damage bubbles or spontaneous rupture of the liquid outflow occurs in the place of bubbles having surface wounds. While maintaining the integrity of the bubbles are gradually shrivel to form yellow or brown crust.
To the residual effects of faces, persist for several weeks or months, include swelling and skin pigmentation, thick, dry crust on the location of bubbles.
Photo: site of the Department of dermatology Tomsk Military Medical Institute
diagnosis faces
Diagnosis is performed faces therapist or infectious diseases specialist.
- Certain diagnostic value have elevated titers antistreptolisin-O and other protivostreptokokkovyh antibodies, detection of streptococcus in a patient's blood (PCR)
- Inflammatory changes in the general analysis of blood
- Violation of hemostasis and fibrinolysis (increased blood fibrinogen, PDF, RKMF, increase or decrease in the number plasminogen, Plasmin, antithrombin III, Increased platelet 4th factor, the decrease in their number)
Diagnostic criteria of faces in the typical cases are:
- acute onset of the disease with severe symptoms of intoxication, increase in body temperature to 38-39 ° C and above;
- The preferential localization of the local inflammatory process in the lower extremities and the face;
- development of typical local manifestations with the characteristic redness;
- swollen lymph nodes in the area of inflammation;
- the absence of pronounced pain in the inflammation alone
treatment of erysipelas
faces must be treated with regard to the shape of the disease, the nature of lesions, presence of complications and consequences. Currently, the majority of patients with mild faces and many patients with moderate form are treated in outpatient settings. Indications for compulsory hospitalization in infectious diseases hospitals (departments) are:
- heavy flow;
- frequent relapses of erysipelas;
- the common presence of severe concomitant disease;
- senile or child.
The most important place in the complex treatment of patients with erysipelas takes antimicrobial therapy. When treating patients in outpatient and at home it is advisable to use of antibiotics in tablets:
- erythromycin
- oletetrin,
- doxycycline,
- spiramycin (treatment of 7-10 days)
- azithromycin,
- Ciprofloxacin (5-7 days)
- rifampicin (7-10 days).
When antibiotics are shown intolerance furazolidone (10 days); delagil (10 days).
erysipelas treated in a hospital environment it is advisable to carry out benzylpenicillin, the course of 7-10 days. In severe disease, the development of complications (abscess, Phlegmon et al.) May be a combination of penicillin and gentamicin, cephalosporins assignment.
In marked inflammation of the skin displays anti-inflammatory drugs: hlotazol or phenylbutazone for 10-15 days.
Erysipelas should be the appointment of vitamin B complex for 2-4 weeks. In severe erysipelas receive intravenous detoxification therapy (gemodez, reopoligljukin, 5% glucose solution, saline) supplemented with 5.10 ml of a 5% solution of ascorbic acid, prednisolone. Appointed by the cardiovascular, diuretics, anti-pyretic agents.
Treatment of patients with recurrent erysipelas
Treatment of recurrent erysipelas should be carried out in a hospital environment. Be sure to reserve the appointment of antibiotics is not used in the treatment of previous relapses. Cephalosporins are appointed by the intramuscular or intramuscular lincomycin, rifampicin intramuscularly. The course of antibiotic therapy - 8-10 days. When a particularly persistent recurrence advisable dvuhkursovoe treatment. Consistently prescribe antibiotics optimally acting on streptococcus. The first course of antibiotic treatment is carried cephalosporins (7-8 days). After a 5-7-day break for the second course of treatment lincomycin (6-7 days). When recurrent erysipelas shown immunity correction (methyluracil, sodium nukleinat, prodigiozan, T-activin).
Local faces Therapy
Treatment of local manifestations of erysipelas is performed only when it is cystic forms with the localization process in the limbs. Erythematous erysipelas does not require the use of local treatments, and many of them (ihtiolovaya ointment Vishnevsky balm ointment with antibiotics) is generally contraindicated. In the acute phase of their carefully incised in the presence of intact bubbles at one of the edges, and after the liquid entering the hearth inflammation bandage with 0.1% solution of Rivanol or 0.02% solution furatsilina changing several times during the day. Tight bandaging unacceptable.
In the presence of large moist wound surfaces on site revealed the bubbles begin to topical treatment with manganese baths extremities followed by the application of bandages mentioned above. For the treatment of bleeding used 5-10% liniment dibunola in the form of applications in the field of inflammatory focus, 2 times a day for 5-7 days.
Traditionally, in the acute period of ultraviolet irradiation faces is assigned to the area of inflammation focus on the area of the lymph nodes. Assign applications ozokerite or dressings with heated naphthalan ointment (on the lower limbs), paraffin baths (on the face) electrophoresis lidazy, calcium chloride, radon bath. The high efficiency of low-intensity laser therapy local inflammation. The dose of laser radiation varies depending on the focus condition, presence of concomitant diseases.
complications
Complications faces, mostly of a local nature, there are a small number of patients. Local complications include abscesses, cellulitis, skin necrosis, festering blisters, inflammation of the veins, thrombophlebitis, Inflammation of the lymphatic vessels. Common complications developing in patients with erysipelas infrequently include sepsis, Toxic-infectious shock, acute cardiovascular failure, Pulmonary embolism, and others. The consequences are faces persistent stagnation of lymph. According to modern concepts, lymph stagnation in most cases occurs in patients with erysipelas on background already had a functional failure of the skin lymph (congenital, post-traumatic and et al.).
Prevention of recurrence of erysipelas
Prevention of relapse faces is part of an integrated outpatient treatment of patients suffering from recurrent form of the disease. Prophylactic intramuscular bitsillina (5-1,5 million units) or retarpen (2.4 million units) prevents recurrence of diseases associated with streptococcus reinfection.
With frequent relapses (at least 3 for the last year) suitable continuous (year-round) bitsillinoprofilaktika on 2-3 years at intervals of administration bitsillina 3-4 weeks (in the first months of the interval may be reduced to 2 weeks). When seasonal recurrent drug is administered one month before the flu season in this patient with an interval of 4 weeks for 3-4 months a year. In the presence of significant residual effects after undergoing faces, bitsillin administered every 4 weeks for 4-6 months.
Prognosis and course
- With adequate treatment of mild and moderate forms - a full recovery.
- Chronic lymphoedema (elephantiasis) scarring or chronic relapsing course.
- In elderly and debilitated - a high rate of complications and a tendency to frequent recurrence.
