Furuncle( chicken) - Causes, symptoms and treatment. MF.

Furuncle - acute purulent-necrotic inflammation of the hair follicle( the root of the hair along with the surrounding root vagina) and the adjacent sebaceous gland, as well as surrounding connective tissue, caused by the introduction of pathogens, especially staphylococci.

A furuncle can form on any part of the skin, except for the skin of the palms and soles. Most often it is located on skin areas exposed to prolonged irritation and contamination, which can occur in production conditions. Such places are face and neck, forearms and hands, lower back.

In men, furuncles are detected about 10 times more often than in women.

Causes of a furuncle

Causes of a single furuncle:

1. Skin contamination, primarily by chemicals( cooling mixtures, lubricating oils and others) and dust particles of coal, lime, cement and other materials is a predisposing factor in the development of a single furuncle. This factor becomes especially topical in combination with prolonged friction applied to the corresponding areas of the skin.

2. Microtraumas of the skin also contribute to the emergence of single furuncles, including calculi that can be observed in skin diseases accompanied by itching, insect bites.
3. Increased sweating and sebum release contributes to the emergence of single furuncles.
4. Sensitization( increased sensitivity of the body) to staphylococcal infection.

The causes of furunculosis - a chronic relapsing skin disease, in which there are multiple furuncles that are at different stages of their development:

1. Immunodeficiency states( impaired immunological reactivity of the body).
2. Genetically determined enzymes( diseases or pathological conditions that develop due to the absence or disruption of the activity of any enzyme).
3. Metabolic diseases, primarily diabetes mellitus and hypovitaminosis( vitamin deficiency, which occurs when the correspondence between consumption of vitamins and their intake into the body is violated).

Symptoms of furuncle

During its course, the boil passes through three consecutive stages:
1) the stage of infiltration( accumulation in the tissues of cellular elements with a mixture of blood and lymph);
2) the stage of formation and rejection of purulent necrotic stem;
3) the stage of scarring.

Therefore, the external manifestations of the furuncle undergo several successive changes corresponding to the stages.

In the first stage( infiltration) in the thickness of the skin appears a minor painful nodule with reddening of the skin above it, in the center of it is hair. After approximately 24-48 hours, a small yellow pustule appears in the mouth of the corresponding hair follicle( pustule).

In the second stage( the formation and rejection of a purulent necrotic stem), the hair follicle and the adjacent sebaceous gland undergo purulent fusion, which is externally manifested by the expansion of the reddening zone of the skin and the increase in the size of the infiltrate. The infiltrate begins to rise above the surface of the skin, taking the shape of a cone with a base diameter of 0.5-1.5 cm, without clear outer boundaries. In the center of the cone infiltrate under the thin skin, the grayish-green masses of the purulent-necrotic stem begin to appear through. In this stage, as a rule, local pain sensations appear and grow, as well as general symptoms: fever to subfebrile figures( about 37.5 ° C), general weakness and headache. However, in a significant number of patients, the furuncle may not cause a general reaction. After melting the skin in the center of the cone infiltrate, purulent-necrotic masses begin to tear away. First comes pus, after which the top of the necrotic stem of greenish color becomes visible. Gradually, along with pus and blood, the stem itself separates, after which a deep enough wound appears in the center of the infiltrate with moderate bleeding from it.

In the third stage( scarring), this formed tissue defect is filled with a connective tissue and epithelialized, leaving after 2-3 days a small retracted scar.

Furuncle

Depending on the location of the boil in his clinical picture, there may be some features. With furuncle, located on the skin of the upper lip, eyelids, superciliary arches and scrotum, as a rule, pronounced edema develops. In the case of a furuncle on the scalp, occiput, in the external auditory canal, a sharp soreness of the furuncle is noted on the back surface of the fingers.

The

"Learn" boil can be identified by one external signs, but in order to avoid possible complications, a laboratory examination may be necessary: ​​

• Complete blood test( ASA): for development of furuncle complications( malignant furuncle, lymphangitis, meningitis) is characterized by leukocytosis( an increase in white blood cells over 9 x 109 / L) with an increase in the content of stab neutrophil forms( above 5%), an increase in ESR( erythrocyte sedimentation rate);
• Biochemical blood test: with furuncle, developed against the background of diabetes characterized by an increase in blood glucose( hyperglycemia);
• Blood test for sterility: is used for a furuncle complicated by sepsis( when the pathogen is spread from a purulent focus to the bloodstream).Allows to establish the nature of the pathogen and determine its sensitivity to antibiotics;
• The investigation of the bacterial separation of the furuncle from the channel( microscopic examination after special coloring of the material) and bacteriological( isolation of pure culture on nutrient media) by methods also makes it possible to determine the nature of the pathogen and determine its sensitivity to antibiotics;
• Study of the immune status of by laboratory tests for the diagnosis of immunodeficiency states in furunculosis.

Treatment of a furuncle

Treatment of boils may be general and local. General treatment of is used only for the location of boils on the face, the presence of complications of boils, as well as the occurrence of boils against the background of severe concomitant diseases( immunodeficiency diseases, diabetes mellitus).Such patients are prescribed antibacterial and anti-inflammatory drugs, ultraviolet irradiation of blood is used.

Local treatment. In uncomplicated furuncle only conservative treatment is shown, which depends on the stage of the course of the boil. In the infiltration stage, treatment of the skin with alcohol and cauterization of the fistula with a 5% solution of iodine is shown. Possible application of dry heat, the appointment of laser therapy and UHF therapy. The use of warming compresses is unacceptable because they contribute to loosening the skin and creating optimal conditions for the development of wound infection.

In the stage of formation of a purulent-necrotic stem, medical manipulations should be aimed at accelerating its retreat. To do this, on the skin in the area of ​​necrosis are placed crystals of salicylic acid, which within a few hours dissolve the thin skin and promote the removal of the core, and around the skin is treated with ointment( to protect it from the effects of salicylic acid), top dry bandage. As an alternative, it is possible to physically remove the purulent necrotic stem by a doctor with tweezers or a thin clamp after treatment with a disinfectant solution. This manipulation does not require anesthesia. After the outflow of purulent-necrotic masses begins to ensure their continuous outflow into the formed channel, the doctor introduces a thin strip of rubber( glove graduate).Conduct daily dressings, and the glove graduate is removed if the infiltration disappears and the purulent discharge is stopped, which usually occurs on the third day. After this, it is possible to apply dry bandages or to keep the wound open, in which it is daily treated with an alcohol solution of brilliant green( green).

With furunculosis antibacterial therapy is prescribed, a comprehensive examination is conducted to identify and eliminate associated diseases that contribute to its development: the treatment of diabetes mellitus, correction of the immune status, vitamin therapy and the like.

Complications of the boil

In some cases, with a certain localization and some contributing factors, the furuncle can be complicated by the development of the so-called malignant furuncle, lymphangitis, lymphadenitis, facial vein thrombophlebitis, purulent meningitis and even sepsis.

When trying to squeeze out the boil, damage its initial elements during shaving, and also inadequate local treatment, the formation of the so-called malignant furuncle is possible. It is characterized by a significant increase in inflammatory infiltration, swelling, tension and thickening of the skin above it. Sometimes outside the edema, the affected veins in the form of dense strands( thrombophlebitis) are probed. At the same time there are intense pains. As a general reaction of the body is characterized by an increase in body temperature, and in the general analysis of blood - leukocytosis and increased ESR.

With the location of the furuncle on the limbs( usually on the skin of the rear of the hand and fingers), it can be complicated by lymphangitis( inflammation of the lymphatic vessels) and lymphadenitis( enlarged lymph nodes).

When the furuncle is located on the skin of the face, especially on the upper lip or in the nasolabial triangle, the most serious complication of the furuncle may occur-purulent thrombophlebitis( thrombosis with inflammation of the vein wall and the formation of a clot closing its lumen) of the facial veins, which often subsequently leads to the development of purulentmeningitis( inflammation of the membranes of the brain) and even sepsis( contamination of the blood).When sepsis can form numerous abscesses( purulent inflammation of the tissues with their melting and the formation of a purulent cavity) in various organs and tissues, most often in bones, muscles, perennial cellular tissue, kidneys.

Nasolabial triangle - a dangerous zone for the location of boils

Forecast

The prognosis for an uncomplicated single furuncle is generally favorable and depends on its location. With the development of complications, the prognosis is determined by the adequacy and timeliness of the treatment.

Prevention of boils

Prevention of boils reduces to adhering to the rules of individual hygiene and protecting the skin from traumatic effects, as well as from its maceration( softening and loosening of the skin as a result of prolonged exposure to liquids).In addition, sufficient attention should be paid to the timely detection and treatment of diseases that contribute to the emergence of a furuncle.
In order to prevent complications of the boil, it is unacceptable to squeeze out the boil, cut off the pustule with a razor and apply warming compresses.

Doctor surgeon Kletkin ME