Erysipelas is a skin infection.
Patients with erysipelas malozarazny . Women get sick more often than men. In more than 60% of cases, people aged 40 years and older suffer from the face. The disease is characterized by distinct summer-autumn seasonality.
The incubation period of erysipelas is from several hours to 3-5 days. In patients with a relapsing course, the development of the next attack of the disease is often preceded by hypothermia, stress. In most cases, the disease begins acutely.
The initial period of erysipelas is characterized by the rapid development of general toxic phenomena, which in more than half of the patients are ahead of the local manifestations of the disease for a period from several hours to 1-2 days. Are marked
headache, general weakness, chills, muscle aches
nausea and vomiting appear in 25-30% of patients
already in the first hours of the disease, the temperature rises to 38–40 ° C.
in areas of the skin in the area of future manifestations, a number of patients develop a feeling of fullness or burning, weak pain.
The height of the disease occurs in the period from several hours to 1-2 days after the first manifestations of the disease. Achieve a maximum of general toxic manifestations and fever. There are characteristic local manifestations.
Most often, erysipelas is localized on the lower extremities, less often on the face and upper extremities, very rarely only on the body, in the area of the mammary gland, perineum, in the area of the external genital organs.
Manifestations on the skin
First, a small red or pink spot appears on the skin, which in a few hours turns into a characteristic erysipelas. Redness is a clearly delimited area of skin with jagged borders in the form of teeth, “tongues”. The skin in the area of redness is tense, hot to the touch, moderately painful when feeling. In some cases, you can find the “edge roller” in the form of towering edges of redness. Along with redness of the skin, its edema develops, extending beyond the limits of redness.
The development of blisters is associated with an increased effusion in the inflammation. At damage of bubbles or their spontaneous rupture there is an outflow of a liquid, on a place of bubbles superficial wounds appear. While maintaining the integrity of the bubbles, they gradually shrink to form yellow or brown crusts.
Residual erysipelas that persists for several weeks and months include puffiness and pigmentation of the skin, dense dry crusts at the site of blisters.
The diagnosis of erysipelas is done by a general practitioner or infectious diseases specialist.
Increased titers of anti-streptolysin -O and other anti-streptococcal antibodies, detection of streptococcus in the blood of patients (using PCR) have a certain diagnostic value.
Inflammatory changes in the total blood count
Disorders of hemostasis and fibrinolysis (increased blood levels of fibrinogen, FDP, RCMF, increase or decrease in the number of plasminogen , plasmin, antithrombin III, increase in the level of the 4th factor of platelets, reducing their number)
Diagnostic criteria faces in typical cases are:
- acute onset of the disease with severe symptoms of intoxication, fever up to 38-39 ° C and higher;
- preferential localization of the local inflammatory process in the lower extremities and face;
- development of typical local manifestations with characteristic redness;
- swollen lymph nodes in the area of inflammation;
- the absence of marked pain in the focus of inflammation alone
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, the majority of patients with mild erysipelas and many patients with moderate form are treated in polyclinic conditions. Indications for compulsory hospitalization in infectious hospitals (departments) are:
- severe course;
- frequent relapses of erysipelas;
- the presence of severe common comorbidities;
- senile or child age.
Antimicrobial therapy occupies the most important place in the complex treatment of patients with erysipelas. When treating patients in a polyclinic and at home, it is advisable to prescribe antibiotics in pills:
- spiramycin (course of treatment is 7-10 days),
- ciprofloxacin (5-7 days),
- rifampicin (7-10 days).
- In case of intolerance to antibiotics, furazolidone is indicated (10 days); delagil (10 days).
Treatment of erysipelas in a hospital should be carried out with benzylpenicillin , a course of 7-10 days. In severe disease, the development of complications (abscess, phlegmon, etc.), a combination of benzylpenicillin and gentamicin, the appointment of cephalosporins.
In marked inflammation of the skin displays anti-inflammatory drugs: hlotazol or phenylbutazone for 10-15 days.
Patients with erysipelas need the appointment of a complex of vitamins for 2-4 weeks. In case of severe erysipelas, intravenous detoxification therapy is performed ( hemodez , reopolyglukine , 5% glucose solution, saline) with the addition of 5-10 ml of 5% solution of ascorbic acid, prednisolone. Cardiovascular, diuretic, antipyretic drugs are prescribed.
Treatment of patients with recurrent mug
Treatment of recurrent faces should be carried out in a hospital. Mandatory appointment of reserve antibiotics that have not been used in the treatment of previous relapses. Cephalosporins intramuscularly or lincomycin intramuscularly, rifampicin intramuscularly are prescribed . A course of antibiotic therapy – 8-10 days. For especially persistent relapses, two-year treatment is advisable . Consistently prescribed antibiotics, optimally acting on streptococcus. The first course of antibiotic therapy is carried out by cephalosporins (7-8 days). After a 5-7 day break, a second course of treatment with lincomycin is carried out (6-7 days).When recurrent erysipelas shown immunity correction (methyluracil, sodium nukleinat, prodigiozan, T-activin).
Local face therapy
Treatment of local manifestations of erysipelas is carried out only when its cystic forms with localization of the process on the extremities. The erythematous form of erysipelas does not require the use of local remedies, and many of them (ichthyol ointment, Vishnevsky balsam, ointment with antibiotics) 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 fluid has reached the inflammatory focus, they are bandaged with a 0.1% solution of rivanol or a 0.02% solution of furacilin, changing them several times during the day. Tight bandaging is not allowed.
In the presence of extensive weeping wound surfaces at the site of opened blisters, local treatment begins with manganese baths for the extremities , followed by the imposition of the dressings listed above. For the treatment of bleeding, 5-10% liniment of dibunol is used in the form of applications in the area of the focus of inflammation 2 times a day for 5-7 days.
Traditionally, in the acute period of erysipelas, ultraviolet irradiation is assigned to the area of the center of inflammation, to the area of the lymph nodes. Assign applications of ozokerite or dressings with heated naphthalan ointment (on the lower extremities), application of paraffin (on the face), electrophoresis oflidaz , calcium chloride, radon baths. High efficiency of low-intensity laser therapy of the local inflammatory focus has been shown . The applied dose of laser radiation varies depending on the state of the focus, the presence of associated diseases.
Complications of erysipelas, mostly of a local nature, are observed in a small number of patients. Local complications include abscesses, cellulitis, necrosis of the skin, purulence of the blisters, inflammation of the veins, thrombophlebitis, inflammation of the lymphatic vessels. Common complications that develop in patients with erysipelas are quite rare include sepsis, toxic and infectious shock, acute cardiovascular insufficiency, pulmonary embolism, etc. The effects of erysipelas include persistent lymph stasis. According to modern concepts, the stagnation of lymph in most cases develops in patients with erysipelas against the background of the already existing functional insufficiency of the lymph circulation of the skin (congenital, post-traumatic, etc.).
Preventing recurrence faces
Prevention of relapse of erysipelas is an integral part of the comprehensive dispensary treatment of patients suffering from a recurrent form of the disease. Preventive intramuscular injection of bicillin (5-1.5 million IU) or retarpena (2.4 million IU) prevents recurrences of the disease associated with reinfection with streptococcus.
With frequent relapses (at least 3 in the last year), continuous (year-round) bicillin prophylaxis is advisable over a period of 2–3 years with a bicillin injection interval of 3–4 weeks (in the first months, the interval can be reduced to 2 weeks). With seasonal relapses, the drug begins to be administered one month before the onset of the incidence of the disease in this patient with an interval of 4 weeks for 3-4 months every year. In the presence of significant residual effects after suffering erysipelas, bitsillin is administered at intervals of 4 weeks for 4-6 months.
Forecast and flow
With adequate treatment of mild and moderate forms – full recovery.
Chronic lymphatic edema (elephantiasis) or scars in chronic relapsing course.
Elderly and debilitated – a high frequency of complications and a tendency to frequent recurrence .