Disease

Symptoms and treatment of erysipelas

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The word erysipelas comes from the French word rouge, which means red.

According to the prevalence in the modern structure of the infectious pathology of erysipelas, it takes 4th place - after acute respiratory and intestinal infections, viral hepatitis, it is especially often recorded in older age groups.

From 20 to 30 years of erysipelas, mainly men suffer, whose professional activity is associated with frequent microtraumatization and skin contamination, as well as with sharp changes in temperature. These are drivers, movers, builders, military, etc.

In the older age group, the majority of sick women.

Erysipelas usually appear on the legs and arms, less often on the face, even less often on the body, in the perineum and on the genitals. All these inflammations are clearly visible to others and cause the patient a sense of acute psychological discomfort.

Cause of disease

The cause of the disease is the penetration of streptococcus through damaged by scratches, abrasions, scuffs, diaper rash, etc. skin.

About 15% of people can be carriers of this bacterium, but they do not get sick. Because for the development of an ailment it is necessary that certain risk factors or predisposing diseases are also present in the patient's life.

  • violation of the integrity of the skin (abrasions, scratches, injections, abrasions, scratching, diaper rash, cracks),
  • a sharp change in temperature (both subcooling and overheating),
  • stress
  • insolation (tanning),
  • bruises, injuries.

Erysipelas often occurs against the background of predisposing diseases: foot fungus, diabetes mellitus, alcoholism, obesity, varicose veins, lymphostasis (problems with the lymphatic vessels), foci of chronic streptococcal infection (with facial erysipelas tonsillitis, otitis media, sinusitis, caries, periodontitis, with erysipelas of the extremities thrombophlebitis, trophic ulcers), chronic somatic diseases that reduce general immunity (often in old age).

Streptococci are widespread in nature, relatively resistant to environmental conditions. Sporadic increase in incidence is observed in the summer-autumn period,

The source of infection in this case is both sick and healthy carriers.

Symptoms characteristic of erysipelas

The clinical classification of erysipelas is based on the nature of local changes (erythematous, erythematous-bullous, erythematic-hemorrhagic, bullous-hemorrhagic), on the severity of manifestations (mild, moderate and severe), on the frequency of occurrence of the disease (primary, recurrent and repeated) and on the prevalence of local damage to the body (localized - limited, common).

The disease begins acutely with the appearance of chills, general weakness, headache, muscle pain, in some cases nausea and vomiting, heart palpitations, as well as an increase in body temperature to 39 ° -40 ° C, in severe cases, there may be convulsions, delirium, irritation meninges.

After 12-24 hours from the moment of the disease, local manifestations of the disease join in - pain, redness, swelling, burning and a feeling of tension in the affected area of ​​the skin.

The local process with erysipelas can be located on the skin of the face, trunk, limbs and, in some cases, on the mucous membranes.

At erythematous erysipelas the affected area of ​​the skin is characterized by redness (erythema), swelling and soreness. Erythema has a uniformly bright color, clear boundaries, a tendency to peripheral distribution and rises above the skin. Its edges are irregular in shape (in the form of notches, “flames” or another configuration). Subsequently, peeling of the skin may appear at the site of erythema.

Erythematous bullous form disease begins in the same way as erythematous. However, 1-3 days after the disease at the site of erythema, detachment of the upper layer of the skin occurs and various sizes of bubbles form, filled with transparent contents. Subsequently, the bubbles burst and brown crusts form in their place. After their rejection, young tender skin is visible. In some cases, erosions appear on the site of the blisters, which can transform into trophic ulcers.

Erythematous hemorrhagic form of erysipelas proceeds with the same manifestations as erythematous. However, in these cases, against the background of erythema, hemorrhages appear in the affected areas of the skin.

Bullous hemorrhagic erysipelas has almost the same manifestations as the erythematous-bullous form of the disease. The only difference is that the bubbles formed during the disease at the site of erythema are filled not with transparent, but with hemorrhagic (bloody) contents.

Light form erysipelas is characterized by short-term (within 1-3 days), relatively low (up to 39 ° С) body temperature, moderate intoxication (weakness, lethargy) and erythematous skin lesion of one area.

Moderate form of erysipelas occurs with a relatively long (4-5 days) and high (up to 40 ° C) body temperature, severe intoxication (severe general weakness, severe headache, anorexia, nausea, vomiting, etc.) with extensive erythematous, erythematous-bullous, erythematous hemorrhagic lesions of large areas of the skin.

Severe erysipelas accompanied by a prolonged (more than 5 days), very high (40 ° C and above) body temperature, severe intoxication with impaired mental status of patients (confusion, delirious state - hallucinations), erythematous-bullous, bullous-hemorrhagic lesions of large areas of the skin, often complicated by common infectious lesions (sepsis, pneumonia, toxic toxic shock, etc.).

Recurrent erysipelas, which occurred within 2 years after the primary disease in the same lesion site, is considered. Repeated erysipelas develops more than 2 years after the previous illness.

Recurrent erysipelas is formed after the primary erysipelas suffered due to inferior treatment, the presence of adverse concomitant diseases (varicose veins, mycoses, diabetes mellitus, chronic tonsillitis, sinusitis, etc.), the development of immune deficiency.

Prevention of erysipelas

Prevention of foot injuries and scuffs, treatment of diseases caused by streptococcus.

Frequent relapses (more than 3 per year) in 90% of cases are the result of a concomitant disease. Therefore, the best prevention of the second and subsequent advent of erysipelas is the treatment of the underlying disease.

But there is also drug prevention. For patients who suffer from erysipelas regularly, there are special antibiotics of prolonged (slow) action that prevent streptococcus from multiplying in the body. These medications must be taken for a long time from 1 month to a year. But only a doctor can decide on the need for such treatment.

What can your doctor do?

They treat mug, like any other infectious disease, with antibiotics. Mild outpatient, moderate and heavy in hospital. In addition to drugs, physiotherapy is used: UVR (local ultraviolet radiation), UHF (high frequency current), therapy with lasers operating in the infrared light range, exposure to weak discharges of electric current.

The volume of treatment is determined only by the doctor.

Causes of erysipelas

The cause of erysipelas is infection with group A β-hemolytic streptococcus A. Any person who has diseases caused by streptococcal infection can become a source of bacteria. Sometimes infection occurs from carriers of this microbe. The latter is present in the body of such people, but this is not accompanied by symptoms of any pathology.

The microorganism penetrates the soft tissues through small wounds, abrasions, abrasions on the skin, mucous membranes. Also, streptococcus through the bloodstream can enter the skin from the foci of a chronic infection in the body.

Most often, erysipelas develops if there are the following risk factors:

  • The presence of chronic tonsillitis, sinusitis, otitis media, caries.
  • Permanent damage, skin contamination. The disease is most affected by agricultural workers, metallurgical, chemical enterprises, mechanics, miners, as well as people who wear rubber shoes for a long time.
  • Allergic skin diseases (urticaria, dermatitis, eczema, psoriasis), accompanied by itching, which leads to scratching, damage to the skin.
  • A decrease in the body's immune defense, which occurs, for example, against the background of frequent psycho-emotional stress, diabetes mellitus, alcoholism, drug addiction, treatment with glucocorticosteroids, oncological pathology, HIV infection.

Symptoms

The disease begins with a sharp increase in temperature to 38–40 ° C, severe weakness, severe headache, and pain in the bones and muscles. Also sweating, lack of appetite are noted.

A few hours after the temperature rises, local symptoms of erysipelas occur. Most often, the legs and feet are affected, in more rare cases, the pathological process is localized on the hands, face, body.

Marked redness of the inflamed area of ​​the skin is noted, this condition is called erythema. The latter rises slightly above unchanged tissues, around it is a dense roller. When feeling this area, a person experiences pain.

Erythema with erysipelas has clear boundaries.

Lymph nodes located near the lesion are enlarged, become painful. With the location of erysipelas on the leg, the popliteal, inguinal accumulations of lymphoid tissue are involved in the pathological process. Axillary lymph nodes increase with erysipelas of the forearms, submandibular, sublingual lymph nodes - with erysipelas of the face.

Photo of symptoms of erysipelas before treatment of the disease.

If the site of erysipelas is uniform in color, this form of the disease is called erythematous. With a bullous form of pathology, blisters appear in the redness area, filled with a clear liquid.

Bullous form of erysipelas.

The bullous-hemorrhagic form of the disease is accompanied by the formation of blisters, inside which there is bloody content. With necrotic erysipelas, necrosis is observed in necrosis of the affected areas with the subsequent development of gangrene.

Bullous-hemorrhagic form of erysipelas.

Complications

If treatment for erysipelas is not started when the first signs of the disease appear, complications such as:

  • An abscess, which is a cavity filled with pus and delimited from healthy tissues by a capsule of connective tissue.
  • Phlegmon is a diffuse purulent inflammation of the subcutaneous fat, which does not have certain boundaries.
  • Phlebitis is an inflammation of the walls of a vein. A condition in which a thrombus forms in the lumen of a vessel is called thrombophlebitis.
  • Lymphostasis - a violation of the outflow of lymph from the affected areas with its subsequent sweating in soft tissues.
  • Trophic ulcers are deep skin defects that do not heal for a long time.
  • Meningitis is an inflammatory lesion of the membranes of the brain and spinal cord.
  • Sepsis is a systemic inflammatory reaction that occurs as a result of generalization of a local infection process.

Phlegmon on the leg, arising against the background of erysipelas.

Lymphostasis often leads to elephantiasis (lymphedema) - a pronounced increase in limb size.

Diagnostics

If erysipelas is suspected, an infectious disease specialist should be consulted. This doctor during the examination finds out how the person’s state of health has changed since the first signs of pathology appeared, examines and probes the affected area.

To confirm the infectious and inflammatory nature of the pathology, the doctor prescribes a general blood test. With erysipelas, the following changes are revealed in this study:

  • The increase in the number of leukocytes over 10.1 * 10 9 / L. With a generalized process or the development of erysipelas against the background of an immunodeficiency state (for example, with cancer, treatment with glucocorticoids, AIDS), the level of white blood cells will be lower than 4 * 10 9 / L.
  • The erythrocyte sedimentation rate (ESR) exceeds 20 mm / hour, sometimes reaches 30–40 mm / hour.
  • With the hemorrhagic form of the disease, a decrease in the level of hemoglobin (less than 120 g / l), red blood cells (less than 4.4 * 10 12 / l in men and less than 3.8 * 4 * 10 12 / l) is possible.

With an atypical course of pathology, a bacteriological study is performed to clarify the diagnosis. To do this, a glass slide is applied to the wound or ulceration in the lesion, then examine it with a microscope.

Other medicines

To eliminate pain, reduce body temperature, non-steroidal anti-inflammatory drugs (NSAIDs) are used. Apply Nimesulide (Nimesil, Nise), Diclofenac (Voltaren), Ibuprofen (Nurofen), Indomethacin.

Treatment of erysipelas on the leg with NSAIDs helps to reduce the severity of inflammation in the lesion, eliminate swelling, and improve overall well-being.

Also, the treatment of symptoms of erysipelas of the foot includes the use of antihistamines, which is necessary to prevent the development of allergic reactions in response to the effects of streptococcus. These drugs include Suprastin, Clemastine, Claritin, Zirtek.

Claritin and Zirtek belong to the second generation of antihistamines, therefore they do not cause drowsiness, they quickly prevent the development of hypersensitivity reactions in erysipelas.

With frequent relapses of the disease with the development of lymphostasis, treatment of erysipelas involves the use of a short course of glucocorticoids to suppress the active inflammatory process. Representatives of this pharmacological group - Hydrocortisone, Prednisolone.

Vitamin-containing preparations and biostimulants (Methyluracil, Pentoxyl) are used to increase general immunity. These funds help accelerate the healing of the lesion.

Folk remedies

Folk remedies can be used only when the first symptoms of the pathology appear after consultation with the doctor. They do not replace the main drug treatment, but serve only as an auxiliary component of therapy.

Often, treatment for erysipelas of the leg at home involves the use of various compresses. Chalk crushed into powder is sometimes used. The last is sprinkled on the affected area of ​​the skin, a sterile gauze dressing is applied on top, the compress is left overnight.

To make a compress from burdock, a freshly washed leaf of the plant is slightly beaten until the juice is released. Burdock is applied to the site of inflammation, fixed with a gauze bandage overnight.

Elderberry broth is used to reduce the manifestations of intoxication. Leaves, young branches of the plant are finely chopped, poured with boiling water, then boiled for 15 minutes over low heat. The tool is insisted for 2 hours, filtered. The broth is taken orally 2-3 times a day, 50 milliliters.

Also used is a pharmacy tincture from a hemophilus - a perennial plant with anti-inflammatory, bactericidal properties. 50 milliliters of water are added to 100 milliliters of the product, the solution is moistened with a sterile gauze dressing.The latter is fixed with a bandage before bedtime, the compress is left overnight.

Compresses with tincture of hemoptysis help reduce itching, pain with erysipelas.

To reduce the severity of inflammation, the affected areas three times a day can be washed with a decoction of coltsfoot, chamomile. The dried plants are mixed in equal proportions, then a tablespoon of the resulting mixture is poured with a glass of boiling water, heated in a water bath for 10 minutes. After cooling to room temperature, the broth can be used.

Surgical methods

Surgical treatment of erysipelas is carried out with bullous, bullous-hemorrhagic, necrotic forms of pathology. If there are multiple blisters, they are opened, the affected surface is treated with an antiseptic, sterile dressings are applied to prevent the secondary infection from joining. In the presence of dead tissue, they are excised, this operation is called necrectomy.

With the necrotic form of erysipelas, surgical treatment is required.

If the disease is complicated by an abscess, the surgeon dissects the skin, subcutaneous fat. Then the doctor opens the capsule of the abscess, removes its contents, and rinses the cavity with an antiseptic. Upon detection of areas of necrosis, they are immediately excised. A drain is placed in the wound to facilitate the outflow of its contents, after some time, the dissected tissue is sutured. With the development of phlegmon, surgical treatment of erysipelas is carried out in a similar way.

Drainage of the wound after opening the abscess.

Physiotherapy

Physiotherapeutic methods can accelerate recovery, prevent the development of complications and relapses. Ultraviolet irradiation is used from the first days of the disease, inhibits the reproduction of microorganisms in the lesion. From 5–7 days after the first signs of pathology appear, UHF therapy is used to reduce the severity of inflammation, pain, and swelling. Also, in the acute period, cryotherapy can be carried out - short-term freezing of the upper layers of the skin with the help of chloroethyl. This allows you to eliminate the symptoms of intoxication, normalize body temperature, reduce pain.

In the recovery period, infrared laser therapy, paraffin therapy, electrophoresis, ozokerite applications are used. These procedures improve blood circulation, lymph flow, accelerate healing processes.

Electrophoresis with lidase, potassium iodide can be used for erysipelas from 5-7 days after the onset of the disease.

Forecast

If treatment for erysipelas was started immediately after the appearance of erythema and signs of intoxication, complications do not develop, the prognosis is favorable, and the disease ends in complete recovery.

Complicated, often recurring forms of pathology have a less favorable prognosis. The development of lymphostasis with elephantiasis often leads to disability. Against the background of the necrotic form of erysipelas, gangrene often develops, which in many cases requires amputation of the limb. The occurrence of sepsis, meningitis can lead to death of a person.

The development of erysipelas is accompanied by a sharp deterioration in overall well-being and the appearance of painful erythema on the skin. When the first signs of the disease appear, it is urgent to contact an infectious disease specialist, who, when confirming the diagnosis, will prescribe antibacterial drugs and drugs that reduce the severity of general and local symptoms of erysipelas. Treatment with alternative methods is not a substitute for drug therapy; it can be carried out only with uncomplicated forms of the disease.

Erysipelas - etiology of infection

The causative agent of erysipelas is characterized by a high level of resistance to environmental factors. However, they quickly decompose when heated (at a temperature above 56 degrees, streptococci are destroyed within thirty minutes) and treated with antimicrobials and disinfectants.

It should be noted that according to recent studies, in the development of erysipelas of a hemorrhagic-bullous nature, in addition to group A streptococci (B-hemolytic type), Staphylococcus aureus and some gram-negative bacteria (colic Escherichia, protea) can also participate.

Epidemiological features of erysipelas

Erysipelas are common dermatological pathologies. The maximum rise of the disease occurs in summer and autumn.

In patients younger than twenty years old, erysipelas practically does not occur. Erysipelas of the newborn, characterized by an extremely high mortality rate, is practically not encountered at the moment.

From twenty to thirty years old, erysipelas in men are more common than in women. This is due to a higher level of injuries and the impact of professional factors (drivers, masons, mechanics, locksmiths, movers, etc.)

Also, infection is often registered in housewives and elderly patients. In this category of patients, the disease, as a rule, proceeds in a frequently-relapsing form.

How erysipelas is transmitted

Erysipelas are contagious. However, due to the fact that pathogens are widespread everywhere, erysipelas is a low-contagious infection. Even family outbreaks of erysipelas are extremely rare.

Infection with the pathogen can occur:

  • contact and contact-household ways (erysipelas of the skin can be transmitted by touch, using towels contaminated with streptococci, sheets, clothes, dishes, etc.),
  • by airborne droplets, with coughing, sneezing and talking (typical for patients with foci of chronic streptococcal infections in the nasopharynx).

It is also possible lymphogenous or hematogenous introduction of infection from distant infectious foci (streptococcal pyoderma, pharyngeal abscesses of the pharynx, etc.).

Erysipelas - causes

A risk factor contributing to the appearance of erysipelas is the presence of abrasions, scratches, cracks, scratches, etc. in the patient.

Erysipelas of the face often occurs due to streptococci getting on the damaged skin of the nostrils or the external auditory canal, less often inflammation develops due to cracks in the corners of the mouth.

Erysipelas of the leg may be associated with the appearance of cracks in the heels, abrasions and scratches, cracks in the skin covering the interdigital spaces.

Erysipelas of the hand can develop due to damage to the skin between the fingers or abrasions on the skin of the forearms.

Immunity after suffering erysipelatous skin inflammation is fragile. Repeated cases of the disease are recorded quite often. In about a third of patients, erysipelas passes into a frequently recurring form.

Specific prevention of erysipelas is not developed. All prevention is non-specific and is aimed at observing personal hygiene rules, preventing injuries, early treatment of wounds, maintaining and correcting immunity, etc.

Predisposing factors contributing to the occurrence of erysipelas are:

  • hypothermia, overheating of the body, prolonged insolation (being in the open sun), living in regions with a humid climate, etc.,
  • injuries of the skin (burns, frostbite, abrasions, cracks, scratches, etc.),
  • emotional overstrain, stress, depressive states, chronic sleep deficiency, overwork, etc.,
  • the presence of dermatological diseases (psoriasis, eczema, staphyloderma, streptoderma, fungal infections, herpetic infections, etc.),
  • lymphostasis
  • chronic vein diseases,
  • the presence of diabetes mellitus (diabetes mellitus) of the first or second type,
  • the presence of foci of chronic infectious processes (otitis media, tonsillitis, sinusitis, carious tooth damage, etc.),
  • the presence of trophic ulcers affecting the skin of the legs,
  • exposure to occupational hazards, frequent contact with chemicals, etc.,
  • the presence of various immunodeficiencies,
  • vitamin deficiencies, exhaustion,
  • the presence of severe somatic diseases (liver pathology, pathology of the cardiovascular system, etc.).

Pathogenesis of infection

After streptococci of B-hemolytic types get on the damaged areas of the skin, their active accumulation and reproduction in the lymphoid capillaries of the skin begins.

After the end of the incubation period, the stage of toxinemia begins (the release of toxins into the blood, manifested by the appearance of severe intoxication, fever, lethargy, chills, etc.).

The next stage of the disease is the formation of local allergic-infectious foci in the skin. At this stage of the disease, microcirculation in the tissues is disrupted, pinpoint hemorrhages (hemorrhages) are formed, lymph circulation (lymphostasis) is disturbed.

With hemorrhagic-bullous or hemorrhagic-erythematous forms of infection, the activation of the hemostatic system (blood coagulation) plays an important role. Due to the activation of intravascular hemostasis, the inflammatory focus is limited by fibrin barriers that impede the spread of the infectious process.

Types of erysipelas

The severity of intoxication symptoms distinguish mild, moderate and severe forms of the infectious process.

Depending on the general symptomatology and local manifestations of the disease, erythematous, bullous-erythematous, hemorrhagic-erythematic and hemorrhagic-bullous forms of erysipelas are distinguished.

Depending on the degree of generalization of the infection, the disease can occur localized or widespread. Migrating or metastatic types of disease are also distinguished.

Primary infection, repeated and recurrent, is also distinguished.

Depending on the localization of local manifestations of infection, there are:

  • erysipelas affecting the skin of the legs,
  • erysipelas affecting the skin of the hands,
  • erysipelas affecting the skin of the face.

In isolated cases, the disease can affect the skin of the perineum, abdomen, buttocks, and mammary glands.

Erysipelas - symptoms and treatment

Intoxication symptoms appear earlier than local manifestations of the infectious process. With erysipelas, legs, headaches, vomiting, fever, chills, fever, muscle and joint pain can appear 1-2 days before the development of a local inflammatory reaction on the skin.

Erysipelas on the face is often accompanied by the appearance of “precursors” of inflammation - burning, itching, tightness of the skin, a feeling of bursting under the skin, moderate soreness when touching the place where erysipelas will appear in the future.

Also often increase regional (close to the inflammatory focus) lymph nodes.

By the time local inflammatory symptoms appear, the severity of fever and intoxication symptoms reaches its maximum. With the timely treatment of erysipelas, the duration of the febrile period does not exceed five days.

The duration of the febrile period of more than seven days may indicate a generalization of the infectious process or the development of complications.

Normalization of temperature in erysipelas occurs earlier than the disappearance of local symptoms. Local inflammation gradually "fades away" by the fifth or eighth day of the disease, with hemorrhagic forms, by the twelfth or eighteenth day.

After the disappearance of inflammation, temporary swelling of the skin, foci of peeling and hyperpigmentation remain. Also, congestive skin hyperemia, crusts at the site of bullous rashes, sores, etc. can remain.

In severe and recurrent courses, against the background of long-lasting lymphostasis, the development of elephantiasis of the limb is possible.

Erysipelas - symptoms (local symptoms)

The manifestations of a local inflammatory reaction depend on the form of the disease. With erythematous types of infection, a pinkish or red spot appears on the skin, which within 1-2 hours transforms into specific erythema with erysipelas.

Local symptoms of erysipelatous inflammation of the legs, arms, face, etc., are:

  • tension, swelling, the appearance of inflammatory skin infiltration in the area of ​​erysipelas,
  • the presence of clearly defined erythema (inflammatory redness of the skin has clear boundaries) similar to tongues of fire, maps, prongs,
  • the appearance of a "peripheral roller" - the edges of erythema can be raised due to edema and skin infiltration (an optional symptom),
  • swollen lymph nodes close to the inflammatory focus and redness of the skin above them (symptom of a “pink cloud”),
  • a decrease in the intensity of the pain syndrome at rest (pain intensifies with movements of the affected limb or during palpation of the inflammatory focus).

With erythematous-bullous forms of erysipelas, against the background of specific erythema, blisters with serous or hemorrhagic-serous contents form. After rupture of the tire of the bubbles, erosive surfaces remain in their place. After healing of erosion, yellowish or brown crusts form.

The hemorrhagic-erythematous form of erysipelas is accompanied by the appearance in the infectious-inflammatory focus of hemorrhages of various sizes (from small petechiae to extensive hemorrhages).

Hemorrhagic-bullous forms of erysipelas are a complication of bullous or hemorrhagic forms. With this type of inflammation, deep damage to the capillaries and blood vessels of the skin is noted, which leads to the appearance of large bullae filled with hemorrhagic or fibrinous-bloody contents.

How to treat erysipelas

Treatment for erysipelas is prescribed by an infectious disease doctor. With mild and uncomplicated forms of the disease, treatment can be carried out at home.

Hospitalization in the infectious ward is indicated for patients over seventy years of age, persons with severe forms of the disease, often recurring course of infection, and also if the patient has severe somatic diseases that complicate the course of the disease.

Erysipelas - treatment

The patient is recommended a plentiful drinking regimen (in the absence of contraindications - heart, blood vessel or kidney disease), exclusion from the diet of fatty, spicy and fried foods, alcohol, strong coffee or tea.

The main treatment for erysipelas is antimicrobial agents effective against the causative agent of the disease.

Recommended for patients:

  • macrolides (azithromycin, spiramycin, roxithromycin, clarithromycin),
  • fluoroquinolones (levofloxacin, ciprofloxacin),
  • cephalosporins (cefazolin, cefaclor, etc.),
  • penicillins (benzylpenicillin),
  • inhibitor-resistant penicillins (amixicillin with clavulanic acid).

To eliminate fever and reduce the severity of edema, hyperemia and pain, non-steroidal anti-inflammatory drugs (nimesulide, ibuprofen diclofenac, indomethacin) are prescribed.

With severe itching and swelling, antihistamines (chloropyramine, cetirizine, loratadine, chifenadine, mebhydroline, etc.) can be prescribed.

In severe cases, parenteral (intravenous drip) detoxification therapy is indicated.

For the prevention of relapse, bicillin prophylaxis courses for two years are indicated.

To prevent the development of relapses of erysipelas, it is recommended to avoid skin injuries, to exclude chemicals, excessive sun exposure, high or low temperatures.

  • sanitation of foci of chronic infections,
  • regular intake of multivitamin preparations,
  • normalization of sleep and rest,
  • elimination of stress, physical or emotional stress.

What is this disease

Erysipelas is a common infectious disease characterized by soft tissue damage.

It is caused by streptococcus group A and often goes into a chronic form. The fact is that streptococcus is very variable, and antibodies produced by the body cannot remember it.

The main provoking factors are the presence of concomitant pathologies and skin damage.


There are other causes of erysipelas:

  • exposure to chemicals
  • viral diseases
  • allergy,
  • decreased immunity,
  • ENT diseases
  • tumors
  • diabetes,
  • cirrhosis of the liver,
  • bad habits.

The very word "erysipelas"Came from french. In this language, rouge means red. The patient’s skin really turns red.

In recent years, the number of cases has increased. Of 10 thousand people, 20-25 people are infected. Usually the disease occurs in autumn and summer. Often the disease occurs in men aged 25 to 40 years who are engaged in physical labor. Among older people, women are more likely to get sick. Pathology can be diagnosed in a newborn if the infection has penetrated the umbilical region.

Erysipelas on the foot: photo

On the foot

Often, a disease of erysipelas on the leg is attributed to an insect bite, an allergic reaction. Erysipelas are most common lower legs . It is easy to identify it by the itching in the calf, severe swelling, pain.

Stages of the disease: from initial to the most extreme

Erysipelas of the lower leg is the cause of elephantiasis and is accompanied by purulent abscesses and abscesses. The development of gangrene can lead to amputation of the limb.

On the hand

Sometimes inflammation on hand is a consequence of the removal of the breast in a woman. It occurs against the background of a decrease in immunity in the presence of microtraumas.

Erysipelas on the arm is accompanied by swelling and burning of the affected area, tension and pain in the area of ​​inflammation are felt. This infection is considered the most severe, because the upper limbs are more often involved in the processes of life than the lower ones. Hands have to be constantly wetted, which provokes the spread of infection to healthy areas.

Nutrition

Plays an important role diet therapy . It will accelerate recovery.

The following products are shown to the patient:

Necessary exclude coffee and chocolate, marinades, smoked meats, hot spices and seasonings.

Statistics and Facts

Erysipelas inflammation takes the 4th place among infectious diseases, second only to respiratory and intestinal diseases, as well as hepatitis. The incidence is 12-20 cases per 10,000 population. The number of patients increases in the summer and autumn.

The number of relapses over the past 20 years has increased by 25%. In 10% of people there is a repeated episode of erysipelas over 6 months, in 30% over 3 years. Repeated erysipelas in 10% of cases ends with lymphostasis and elephantiasis.

Doctors have noted an alarming trend. If in the 70s the number of severe forms of erysipelas did not exceed 30%, today there are more than 80% of such cases. At the same time, the number of mild forms decreased, and the fever period now lasts longer.

30% of cases of erysipelas are associated with impaired blood and lymph flow in the lower extremities, with varicose veins, thrombophlebitis of lymphovenous insufficiency.

Mortality from complications caused by erysipelatous inflammation (sepsis, gangrene, pneumonia) reaches 5%.

Who is more likely to suffer from erysipelas?

  • The disease affects people of all age groups. But the majority of patients (over 60%) are women older than 50 years.
  • There is also erysipelas in infants when streptococcus enters the umbilical wound.
  • There is evidence that people with the third blood group are most susceptible to erysipelas.
  • Erysipelas is a disease of civilized countries. On the African continent and in South Asia, people are extremely ill.
Erysipelas occur only in people with reduced immunity, weakened by stress or chronic diseases. Studies have shown that the development of the disease is associated with an inadequate response of the immune system to the entry of streptococcus into the body. Imbalance of the immune cells is disturbed: the number of T-lymphocytes and immunoglobulins A, M, G decreases, but an excess of immunoglobulin E is produced. Against this background, the patient develops an allergy.

With a favorable course of the disease and proper treatment on the fifth day, the symptoms subside. Full recovery occurs in 10-14 days.

Interestingly, erysipelas, although it is an infectious disease, is successfully treated by traditional healers. Qualified doctors recognize this fact, but with the caveat that folk methods can only treat uncomplicated erysipelas. Traditional medicine explains this phenomenon by the fact that conspiracies are a kind of psychotherapy that relieves stress - one of the favorable factors for the development of erysipelas.

The structure of the skin and the immune system

Leather - a complex multilayer organ that protects the body from environmental factors: microorganisms, temperature fluctuations, chemicals, radiation. In addition, the skin performs other functions: gas exchange, respiration, thermoregulation, and the release of toxins.

Skin structure:

  1. Epidermis - surface layer of the skin. The stratum corneum of the epidermis is the keratinized cells of the epidermis, covered with a thin layer of sebum. It is a reliable protection against pathogenic bacteria and chemicals. Under the stratum corneum there are 4 more layers of the epidermis: shiny, granular, prickly and basal. They are responsible for the renewal of the skin and the healing of minor injuries.
  2. Actually skin or dermis - the layer that is under the epidermis. It is he who suffers most from erysipelas. In the dermis are located:
    • blood and lymph capillaries,
    • sweat and sebaceous glands,
    • hair bags with hair follicles,
    • connective and smooth muscle fibers.
  3. Subcutaneous fat. Lies deeper than the dermis. It is a loosely located fiber of connective tissue, and accumulations of fat cells between them.
The surface of the skin is not sterile. It is inhabited by bacteria friendly to humans. These microorganisms do not allow pathogenic bacteria that get on the skin to multiply and they die without causing disease.

Immune system

The immune system - a system of tissues and organs that are designed to protect the body from bacteria, viruses, parasites, toxins and mutated cells of your own body, which can give rise to tumors. The immune system is responsible for protecting against microorganisms, replacing aging body cells and healing wounds.

The immune system includes:

  1. Organs: bone marrow, thymus, tonsils, spleen, Peyer's patches in the intestines, lymph nodes and lymph vessels,
  2. Immune cells: lymphocytes, white blood cells, phagocytes, mast cells, eosinophils, natural killers. It is believed that the total mass of these cells reaches 10% of body weight.
  3. Protein molecules - antibodies must detect to recognize and destroy the enemy. They differ in structure and function: igG, igA, igM, igD, IgE.
  4. Chemical substances: lysozyme, hydrochloric acid, fatty acids, eicosanoids, cytokines. Friendly microorganisms (commercial germs) that inhabit the skin, mucous membranes, intestines. Their function is to inhibit the growth of pathogenic bacteria.
Consider how the immune system works when streptococcus enters the body:
  1. Lymphocytesor rather their receptors, immunoglobulins, recognize bacteria.
  2. They react to the presence of bacteria T-helpers. They actively divide, secrete cytokines.
  3. Cytokines activate the work of white blood cells, namely phagocytes and T-killers, designed to kill the bacteria.
  4. B cells produce antibodies specific for this organism that neutralize foreign particles (areas of destroyed bacteria, their toxins). After that, phagocytes absorb them.
  5. After defeating the disease, special T lymphocytes remember the enemy by his DNA. When it re-enters the body, the immune system activates quickly, before the disease has developed.

Streptococcus

Streptococcus - a genus of spherical bacteria that are very widespread in nature due to their survivability. But at the same time they do not tolerate heating very well. For example, these bacteria do not multiply at a temperature of 45 degrees. Associated with this is the low incidence of erysipelas in tropical countries.

Erysipelas is caused by one of the varieties of bacteria - beta-hemolytic streptococcus group A. This is the most dangerous of the entire family of streptococci.

If streptococcus enters the body of a person with a weakened immune systemthen erysipelas, sore throat, scarlet fever, rheumatism, myocarditis, glomerulonephritis.

If streptococcus enters the human body with a sufficiently strong immunity, then it can become a carrier. Carriage of streptococcus was detected in 15% of the population. Streptococcus is part of the microflora, lives on the skin and mucous membranes of the nasopharynx without causing disease.

The source of infection of erysipelas carriers and patients of any form of streptococcal infection can become. The causative agent of the disease is transmitted through contact, household items, dirty hands and airborne droplets.

Streptococci are dangerous in that they secrete toxins and enzymes: streptolysin O, hyaluronidase, nadase, pyrogenic exotoxins.

How streptococci and their toxins affect the body:

  • Destroy (dissolve) the cells of the human body,
  • T-cells and endothelial cells are stimulated to produce an excess of cytokines - substances that trigger the body's inflammatory response. Its manifestations: severe fever and blood flow to the lesion site, pain,
  • Reduce the level of anti-streptococcal antibodies in the blood serum, which prevents the immune system from overcoming the disease,
  • Destroy hylauric acid, which is the basis of connective tissue. This property helps the pathogen spread in the body,
  • Leukocytes affect immune cells, disrupting their ability to phagocytosis (capture and digestion) of bacteria,
  • Suppress the production of antibodies needed to fight bacteria
  • Immune vascular damage. Toxins cause an inadequate immune response. Immune cells take the walls of blood vessels for bacteria and attack them. Other tissues of the body also suffer from immune aggression: joints, heart valves.
  • Cause vasodilation and increase their permeability. The walls of blood vessels pass a lot of fluid, which leads to swelling of the tissue.
Streptococci are extremely variable, therefore lymphocytes and antibodies cannot "remember" them and provide immunity. This feature of bacteria causes frequent relapses of streptococcal infection.

Skin properties

  1. Skin damage:
    • animal and insect bites,
    • cuts and abrasions,
    • sores and bedsores
    • umbilical wound in newborns,
    • venous catheters and injection sites.

    Any damage to the skin can become the entrance gate for streptococcus. Bacteria penetrate into the deeper layers of the skin and multiply in the lymphatic capillaries. They release toxin into the blood, a poisonous organism. All manifestations of erysipelas are a reaction of the body to the presence of bacteria and their toxins.
  2. Occupational hazards:
    • contact with the skin of chemical compounds,
    • frequent pollution
    • wearing rubber clothes and shoes.
    Such factors are associated with the professions of miners, drivers, mechanics, agricultural workers, workers in the metallurgical and chemical industries.
  3. Viral skin lesions:
    • herpes,
    • shingles,
    • chickenpox.
    These infections reduce immunity and cause skin rashes in the form of fluid-filled blisters. After opening them, bacteria easily penetrate the skin,
  4. Chronic dermatosis and other skin lesions:
    • eczema,
    • atopic dermatitis,
    • psoriasis,
    • neurodermatitis
    • hives,
    • contact dermatitis.
    These diseases are allergic in nature. Immunity cells attack the epidermis, reducing local immunity and causing swelling. If bacteria penetrate into scratches and scratches, then they quickly multiply in allergic skin,
  5. Purulent skin lesions:

  • furuncle,
  • carbuncle,
  • folliculitis.
In the event that inflammation of the sebaceous glands is caused by streptococcus, the bacteria either independently or after extruding the abscess penetrate into the surrounding tissue and lymph vessels. There they begin to multiply and secrete toxins,
  • Circulatory and lymphatic disorders:
    • thrombophlebitis
    • phlebeurysm,
    • lymphovenous insufficiency.
    Disruption of blood supply with damage to blood and lymph vessels leads to oxygen starvation and nutrient deficiency in the surrounding area. This reduces immunity and makes the skin susceptible to infections. In addition, stagnation of lymph in the vessels contributes to the propagation of streptococcus,
  • Scarring:
    • post-traumatic
    • postoperative.
    The tissue of keloid scars consists of undifferentiated epidermal cells, which the body perceives as foreign and attacks them. In addition, scar tissue is disturbed in the circulation, so it becomes a good breeding ground for streptococcus,
  • Fungal diseases feet, scalp. Fungal diseases violate the integrity of the skin, and it is not able to fulfill its protective function. Bacteria easily penetrate cracks in the interdigital folds, causing erysipelas of the lower leg,
  • Complicationsdiseases of the ENT organs and eyes:
    • rhinitis,
    • otitis,
    • conjunctivitis.

    There is a danger of the spread of streptococcus with blood flow to the lymphatic capillaries of the skin. In this case, erysipelas most often occurs on the face and scalp, but can also appear on other parts of the body, especially where blood circulation is impaired,
  • Clothing that injures the skin and impairs blood circulation.

    Tight underwear, tight jeans disrupt the movement of blood through the vessels. Small abrasions that occur when the seam is rubbed against the skin contribute to the penetration of bacteria into it. If the clothes are made of synthetic materials, then it does not absorb moisture and creates a greenhouse effect. Such conditions are favorable for the propagation of streptococci.

    General information

    Erysipelas (erysipelas) is an infectious disease caused by group A streptococcus, mainly affecting the skin and mucous membranes, characterized by the occurrence of limited serous or serous-hemorrhagic inflammation, accompanied by fever and general intoxication. Erysipelas is one of the most common bacterial infections.

    Pathogen Characterization

    I give birth to beta-hemolytic group A streptococcus, most often the species Streptococcus pyogenes, which has a diverse set of antigens, enzymes, endo- and exotoxins. This microorganism can be an integral part of the normal flora of the oropharynx, be present on the skin of healthy people. The reservoir and source of erysipelas infection is a person who suffers from one of the forms of streptococcal infection, and a healthy carrier.

    Erysipelas is transmitted by an aerosol mechanism mainly by airborne droplets, sometimes by contact. Damage and microtrauma of the skin and mucous membranes of the oral cavity, nose, and genitals serve as the entrance gate to this infection. Since streptococci often live on the surface of the skin and mucous membranes of healthy people, the risk of infection if the rules of basic hygiene are not followed are extremely high. The development of infection is facilitated by factors of individual predisposition.

    Women get sick more often than men, susceptibility increases with prolonged use of steroid hormone drugs. The risk of erysipelas in persons suffering from chronic tonsillitis and other streptococcal infections is 5-6 times higher. Erysipelas of the face more often develops in people with chronic diseases of the oral cavity, ENT organs, caries. Damage to the chest and extremities often occurs in patients with lymphovenous insufficiency, lymphedema, edema of various origins, with fungal infections of the feet, and trophic disorders. Infection can develop in the area of ​​post-traumatic and postoperative scars. Some seasonality is noted: the peak incidence occurs in the second half of summer - early fall.

    The causative agent can enter the body through damaged integumentary tissues, or, if there is a chronic infection, enter the skin capillaries with a blood stream. Streptococcus multiplies in the lymphatic capillaries of the dermis and forms a focus of infection, causing active inflammation, or latent carriage. Active reproduction of bacteria contributes to a massive release into the bloodstream of their vital products (exotoxins, enzymes, antigens). The result of this is intoxication, fever, probably the development of toxic infectious shock.

    Erysipelas classification

    Erysipelas are classified according to several criteria: by the nature of local manifestations (erythematous, erythematous-bullous, erythematous-hemorrhagic and bullous-hemorrhagic forms), by the severity of the course (mild, moderate and severe, depending on the severity of intoxication), by the prevalence of the process (localized widespread, migratory (wandering, creeping) and metastatic). In addition, primary, repeated and recurrent erysipelas are isolated.

    Relapsing erysipelas is a recurring case from two days to two years after the previous episode, or relapse occurs later, but inflammation repeatedly develops in the same area. Repeated erysipelas occurs no earlier than two years later, or is localized in a place different from the previous episode.

    A localized erysipelas is characterized by a restriction of infection by a local focus of inflammation in one anatomical region. When the outbreak beyond the boundaries of the anatomical region, the disease is considered common. Joining phlegmon or necrotic changes in the affected tissues are considered complications of the underlying disease.

    Treatment for erysipelas

    Erysipelas is usually treated on an outpatient basis. In severe cases, with the development of purulent-necrotic complications, frequent relapses, in old and early childhood, the patient is shown in a hospital. Etiotropic therapy consists in prescribing a course of antibiotics of the first and second generation cephalosporin series, penicillins, some macrolides, fluoroquinolones lasting 7-10 days in medium therapeutic dosages. Erythromycin, oleandomycin, nitrofurans and sulfonamides are less effective.

    With frequent relapses, the sequential administration of two types of antibiotics of different groups is recommended: after beta-lactams, lincomycin is used. Pathogenetic treatment includes detoxification and vitamin therapy, antihistamines. With bullous forms of erysipelas, the bubbles are opened and often replaced gauze napkins with antiseptic agents are applied. Ointments are not prescribed so as not to irritate the skin once again and not to slow healing. Topical preparations may be recommended: dexpanthenol, silver sulfadiazine. As a means of accelerating the regression of skin manifestations, physiotherapy is recommended (UHF, UFO, paraffin, ozokerite, etc.).

    In some cases of relapsing forms, patients are prescribed courses of anti-relapse treatment with benzylpenicillin intramuscularly every three weeks. Persistently recurring erysipelas is often treated with injection courses for two years. If there are residual effects after discharge, patients may be prescribed a course of antibiotic therapy for up to six months.

    Immunity status

    Streptococcus is very common in the environment, and every person encounters it daily. In 15-20% of the population, he constantly lives in tonsils, sinuses, cavities of carious teeth. But if the immune system is able to restrain the growth of bacteria, then the disease does not develop. When something undermines the body's defenses, the bacteria multiply, and streptococcal infection begins.

    Factors that inhibit the body's immune defense:

    1. Taking medications that suppress immunity:
      • steroid hormones
      • cytostatics
      • chemotherapy drugs.
    2. Metabolic diseases:
      • diabetes,
      • renal failure
      • cirrhosis of the liver,
      • hypothyroidism.
    3. Diseases associated with a change in blood composition:
      • atherosclerosis,
      • anemia,
      • high cholesterol.
    4. Immune system diseases
      • AIDS,
      • hypercytokinemia,
      • severe combined immunodeficiency.
    5. Malignant neoplasms
    6. Chronic diseases of ENT organs:
      • sinusitis
      • sinusitis,
      • tonsillitis,
      • otitis.
    7. Exhaustion as a result
      • lack of sleep
      • malnutrition
      • stress
      • vitamin deficiency.
    8. Bad habits
      • alcoholism,
      • addiction,
      • smoking.
    9. Hypothermia.
    To summarize: in order for erysipelatous inflammation to develop, the following factors are necessary:
    • entrance gate for infection - skin damage,
    • violation of blood circulation and lymph,
    • decrease in general immunity,
    • hypersensitivity to streptococcus antigens (toxins and cell wall particles).
    In what areas does erysipelas develop more often?
    1. Leg. Erysipelas on the legs can result from fungal infections of the feet, corns, and injuries. Streptococci penetrate through skin lesions and multiply in the lymph vessels of the leg. The development of erysipelas is promoted by diseases that cause circulatory disorders: atherosclerosis obliterans, thrombophlebitis, varicose veins.
    2. Arm. Erysipelas occurs in men 20-35 years old due to intravenous drug administration. Streptococci penetrate the skin lesions at the injection site. In women, the disease is associated with removal of the mammary gland and stagnation of lymph in the hand.
    3. Face. With streptococcal conjunctivitis, erysipelas develops around the orbit. With otitis media, the skin of the auricle, scalp and neck becomes inflamed. Damage to the nose and cheeks (like a butterfly) is associated with streptococcal infection in the sinuses or boils. Erysipelas on the face is always accompanied by severe pain and swelling.
    4. Torso. Erysipelas occur around surgical sutures if patients do not observe aseptic or due to the fault of medical personnel. In newborns, streptococcus can penetrate the umbilical wound. In this case, erysipelas is very difficult.
    5. Crotch. The area around the anus, scrotum (in men) and the labia majora (in women). Erysipelas occurs at the site of scuffs, diaper rash, scratching. Particularly severe forms with damage to the internal genital organs occur in women in childbirth.

    At the doctor’s appointment

    Poll

    In order to correctly diagnose and prescribe effective treatment, a specialist must distinguish erysipelas from other diseases with similar symptoms: abscess, phlegmon, thrombophlebitis.

    The doctor will ask the following Doctor will ask the following questions:

    • How long have the first symptoms appeared?
    • Was the onset of the disease acute, or did the symptoms develop gradually? When did skin appear before or after fever?
    • How fast does inflammation spread?
    • What sensations arise at the site of the lesion?
    • How pronounced is intoxication, is there general weakness, headache, chills, nausea?
    • Is the temperature elevated?
    Inspection of lesions in erysipelas.

    On examination, the doctor identifies characteristic signs of erysipelas:

    • the skin is hot, firm, smooth,
    • redness is uniform, hemorrhages and blisters are possible against its background,
    • uneven edges are clearly defined, have an edge roller,
    • the surface of the skin is clean, not covered with nodules, crusts and scales of the skin,
    • soreness when palpating, lack of severe pain at rest,
    • the pain is mainly along the edge of the focus of inflammation, in the center the skin is less painful,
    • nearby lymph nodes are enlarged, soldered to the skin and painful. From the lymph nodes to the inflamed area, a pale pink path stretches along the lymph - an inflamed lymphatic vessel,
    General blood test for erysipelas:
    • the total and relative number of T-lymphocytes is reduced, which indicates the inhibition of the immune system by streptococci,
    • increased SOE (erythrocyte sedimentation rate) - evidence of an inflammatory process,
    • the number of neutrophils is increased, which indicates an allergic reaction.
    When is a bacteriological examination prescribed for erysipelas?

    With erysipelas, a bacteriological examination is prescribed to determine which pathogen caused the disease and which antibiotics it is most sensitive to. This information should help the doctor choose the most effective treatment.

    However, in practice, such a study is uninformative. Only in 25% of cases it is possible to establish the pathogen. Doctors attribute this to the fact that antibiotic treatment quickly stops the growth of streptococcus. A number of scientists believe that bacteriological examination for erysipelas is not advisable.

    Material for bacteriological examination of the tissue is taken in case there are difficulties with the diagnosis. Examine the contents of wounds and ulcers. To do this, a clean glass slide is applied to the focus and an imprint containing bacteria is obtained, which is examined under a microscope. To study the properties of bacteria and their sensitivity to antibiotics, the resulting material is grown on special nutrient media.

    How to increase immunity?

    In the treatment of erysipelas, it is very important to increase immunity. If this is not done, then the disease will return again and again. And each subsequent case of erysipelas is more difficult, treated more difficult and more often causes complications, which can lead to disability.

    1. Identify foci of chronic infectionthat weaken the body. To fight infection, you must undergo a course of antibiotic therapy.
    2. Restore normal microflora - use fermented milk products daily. Moreover, the shorter their shelf life, the more they contain live lactobacilli, which will not allow streptococci to multiply.
    3. Alkaline Mineral Water help to remove poisons from the body and eliminate the symptoms of intoxication. You need to drink them in small portions of 2-3 sips throughout the day. During a fever, at least 3 liters of fluid should be consumed.
    4. Easily digestible proteins: lean meat, cheese, fish and seafood. They are recommended to be boiled or stewed. Proteins are needed by the body to create antibodies to fight streptococci.
    5. Fats help the skin recover faster. Healthy fats are found in vegetable oils, fish, nuts and seeds.
    6. Vegetables, fruits and berries: especially carrots, pears, apples, raspberries, cranberries, currants. These products contain potassium, magnesium, phosphorus, iron and a complex of vitamins necessary to strengthen immunity.
    7. The fight against anemia. A decrease in hemoglobin in the blood has a bad effect on the immune system. In this situation, iron preparations, hematogen, apples, persimmons will help.
    8. Strengthening the immune system. For one month, 2 times a year, it is recommended to take natural preparations to stimulate the immune system: echinacea, ginseng, Rhodiola rosea, eleutherococcus, pantocrine. Other mild immunomodulators are also effective: immunofan, lycopid.
    9. Fresh honey and perga - These bee products are rich in enzymes and chemical elements necessary to promote health.
    10. UV exposure problem areas 2 times a year. It is necessary to take sunbaths dosed, starting from 15 minutes a day. Daily increase the time spent in the sun by 5-10 minutes. A sunburn can trigger a relapse of erysipelas. You can go through the Ural Federal District and in the physical room of any clinic. In this case, the dose is determined by the doctor.
    11. Dosed physical activity. Be in the fresh air daily. Walking for 40-60 minutes a day 6 times a week provides normal physical activity. 2-3 times a week, it is advisable to do gymnastics. Yoga helps well. It helps to increase immunity, stress resistance and improve blood circulation.
    12. Healthy sleep helps restore strength. Allocate at least 8 hours of rest per day.
    13. Don't let overwork, hypothermia, overheating, prolonged nervous tension. Such situations reduce the protective properties of the body.
    14. Not recommended:
      • alcohol and cigarettes,
      • products containing caffeine: coffee, cola, chocolate,
      • spicy and salty foods.

    Causes of erysipelas

    In order for erysipelas to occur, three conditions must be met:

    1. The presence of a wound - for bacteria to penetrate the skin, it is not necessary to have extensive damage to the soft tissues. Enough scratching, “cracking” of the skin of the legs or a small cut,
    2. If a certain microbe gets into the wound, it is believed that only hemolytic streptococcus A can cause erysipelas. In addition to local skin damage, it produces strong toxins and disrupts the immune system. This is manifested by intoxication of the body and the possibility of erysipelas to recur (appear again, after a certain time),
    3. Weakened immunity - this factor is of great importance for the development of skin infections. Erysipelas practically does not occur in healthy people whose immunity is not weakened by another disease or harmful living conditions (stress, physical / mental overload, smoking, drug addiction, alcohol, etc.).

    Despite the fact that the disease can occur in every person, under the above conditions, mostly people of senile age suffer. Also at risk are infants with diabetes mellitus, HIV, any oncological pathology, or those taking glucocorticosteroids / cytostatics.

    What is erysipelas

    There are several forms of erysipelas, which differ in the severity of symptoms, severity and treatment tactics. It should be noted that they can sequentially move one into another, so it is important to start treatment in a timely manner.

    In principle, the following forms of the disease should be divided:

    1. Erythematic erysipelas - manifested by classic symptoms, without any additional changes in the skin,
    2. Bullous form - characterized by the formation of blisters on the skin with serous contents,
    3. Hemorrhagic (bullous-hemorrhagic) - a feature of this type of erysipelas is damage to the small blood vessels by infection. Because of this, blood flows through their wall and forms bubbles with hemorrhagic contents,
    4. Necrotic is the most severe form in which necrosis of the affected skin occurs.

    Depending on the location, erysipelas may be on the face, leg, arm. Much less often, the infection forms in the perineum or in other parts of the body.

    Onset of erysipelas

    From the moment of infection of the wound to the onset of the first symptoms, on average, 3-5 days pass. Symptoms of erysipelas of the skin of the face, arm, legs and any other localization begin with a rise in temperature and soreness of the affected area.As a rule, on the first day of the disease, a fever of not more than 38 ° C is observed. In the future, body temperature can rise to 40 ° C. Due to the action of streptococcus, the patient has all the characteristic signs of intoxication of the body:

    • Severe weakness
    • Decreased / loss of appetite,
    • Increased sweating,
    • Hypersensitivity to bright light and annoying noise.

    A few hours after the temperature rises (up to 12 hours), symptoms of skin and lymphatic lesions appear. They differ slightly, depending on the location, but they are united by one sign - this is the pronounced redness of the skin. Erysipelas can spread outside the affected area, or remain in only one area. It depends on the aggressiveness of the microbe, the body's resistance to infection and the time of initiation of therapy.

    Local symptoms of erysipelas

    Common signs of erysipelas on the skin are:

    • Severe redness of the affected area (erythema), which rises somewhat above the surface of the skin. From healthy tissues, erythema is delimited by a dense roller, however, with a widespread erysipelas, it may not be,
    • Pain when palpating the redness
    • Swelling of the affected area (feet, lower leg, face, forearm, etc.),
    • Sore lymph nodes, next to the focus of infection (lymphadenitis),
    • With a bullous form, transparent bubbles may appear on the skin, filled with blood or serous fluid (plasma).

    In addition to common signs, erysipelas have their own characteristics when localized in different parts of the body. They must be taken into account in order to suspect an infection in time and start treatment in a timely manner.

    Features of erysipelas

    The face is the most unfavorable location of the infection. This part of the body is very well supplied with blood, which contributes to the development of severe edema. Lymphatic and blood vessels connect the surface and deep structures, which is why there is a likelihood of purulent meningitis. The skin of the face is quite tender, therefore, it is damaged by the infection a little more than with other localizations.

    Given these factors, you can determine the characteristics of the symptoms of erysipelas on the face:

    • Soreness of the infected area increases with chewing (if the erysipelas is located in the lower jaw or on the surface of the cheeks),
    • Severe edema not only of the reddened area, but also of the surrounding facial tissues,
    • Soreness when palpating the lateral surfaces of the neck and under the chin is a sign of inflammation of the lymph nodes,

    Symptoms of intoxication with infection of the skin of the face are more pronounced than with other localizations. On the first day, body temperature can increase to 39-40 ° C, severe weakness, nausea, severe headache and sweating appear. Erysipelas on the face is an occasion to immediately contact a doctor or in the emergency room of a surgical hospital.

    Features of erysipelas on the leg

    There is a belief among doctors that erysipelas of the lower extremity is closely associated with a violation of personal hygiene. The lack of regular washing of the legs creates excellent conditions for the propagation of streptococci. In this case, for their penetration into the skin, one microtrauma is enough (cracks in the feet, a small scratch or puncture).

    The clinical features of erysipelas in the leg area are as follows:

    • The infection is located on the foot or lower leg. The thigh is rarely affected
    • As a rule, in the area of ​​inguinal folds (on the front surface of the body, where the thigh passes into the trunk), you can find painful formations of a round shape - these are inflamed inguinal lymph nodes that inhibit the spread of streptococcal infection,
    • With severe lymphostasis, leg edema can be quite strong and spread to the foot, ankle region and lower leg. It is easy enough to find it - for this you need to finger press the skin to the bones of the lower leg. If there is swelling, then after removing the finger, a fossa will remain for 5-10 seconds.

    In most cases, erysipelas of the lower extremities is much easier than with a different location of the infection. The exception is necrotic and complicated forms.

    Features of erysipelas on the arm

    Streptococcal infection affects the skin of the hands quite rarely, since it is difficult to create a large concentration of microbes around the wound. Erysipelas on the upper limb may be the result of a puncture or cut of a contaminated object. The risk group consists of children of preschool and school age, intravenous drug addicts.

    Erysipelas on the arm are most often common - it captures several segments (hand and forearm, shoulder and forearm, etc.). Since the upper limbs, especially in the area of ​​the axillary fossa, have well-developed lymphatic tracts, edema can spread from the fingers to the pectoral muscles.

    If you feel the inner surface of the shoulder or armpits, you can find regional lymphadenitis. Lymph nodes will be enlarged, smooth, painful.

    Surgery

    As already mentioned, the indications for surgery are the formation of ulcers (phlegmon, abscesses), necrosis of the skin or a bullous form of erysipelas. Surgical treatment should not be feared, in most cases it takes no more than 30-40 minutes and is performed under general anesthesia (anesthesia).

    During the operation, the surgeon opens the cavity of the abscess and removes its contents. The wound, as a rule, is not sutured - it is left open and a rubber graduate is installed to drain the fluid. If dead tissues are detected, they are completely removed, after which conservative therapy is continued.

    Surgical treatment of a bullous form of an erysipelatous infection occurs as follows: the doctor opens the existing blisters, treats their surfaces with an antiseptic and applies dressings with a 0.005% chlorhexidine solution. Thus, the attachment of an extraneous infection is prevented.

    Skin after erysipelas

    On average, treatment for erysipelas infection takes 2-3 weeks. As the local inflammatory response decreases and the amount of streptococcus decreases, the skin begins to renew. Redness decreases and a peculiar film appears in place of the damaged area - this "old" skin separates. As soon as it is finally rejected, it should be removed on its own. Under it should be an unchanged epithelium.

    Over the next week, peeling of the skin may persist, which is a normal reaction of the body.

    In some patients, erysipelas may take a recurring course, that is, appear again in the same place after a certain time (several years or months). In this case, the skin will be prone to trophic disturbances, chronic edema of the limb or replacement of the epithelium with connective tissue (fibrosis) may form.

    Frequently Asked Questions from Patients

    Erysipelas is a serious illness that is dangerous due to severe intoxication and the development of complications. As a rule, with timely initiation of treatment, the prognosis is favorable. If the patient turned after a week or more from the onset of infection, his body is weakened by concomitant diseases (diabetes, heart failure, HIV, etc.), erysipelas can lead to fatal consequences.

    In almost all forms of erysipelas, this process occurs independently, without the intervention of doctors. The main thing is to eliminate the source of infection and local inflammatory phenomena. The exception is necrotic erysipelas. In this case, the skin can only be restored by surgery (skin grafting).

    In this case, we are talking about a recurring form of erysipelas. Group A streptococcus has the ability to disrupt the immune system, which leads to repeated inflammatory reactions in the affected skin. Unfortunately, adequate methods for the prevention of relapse have not been developed.

    Currently, tetracycline antibiotics do not use for the treatment of erysipelas infection. Studies have shown that most hemolytic streptococci are resistant to this drug, therefore it is recommended to use the following antibiotics for erysipelas - a combination of synthetic penicillin + sulfanilamide or 3rd generation cephalosporin (Ceftriaxone).

    Not. Physiotherapy during the acute period will lead to increased inflammation and the spread of infection. It should be postponed until the recovery period. After suppressing the infection, the use of magnetotherapy or ultraviolet radiation is possible.

    Treatment of erysipelatous inflammation of the hands, feet and any other part of the body is carried out according to the same principles.

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    Watch the video: Bacterial Skin Infection - Cellulitis and Erysipelas Clinical Presentation, Pathology, Treatment (April 2020).