How to treat dry erysipelas. Erysipelatous inflammation of the leg - symptoms, treatment, prevention. The work of the immune system

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

Etiology

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

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

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

How the infection is transmitted

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

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

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

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

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

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

Erysipelatous inflammation of the leg

What contributes to the development of the disease

Predisposing factors are:

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

Pathogenesis

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

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

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

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

Features of local changes in erysipelas

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

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

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

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

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

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

Classification

Erysipelas disease has several clinical forms. It is classified:

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

Symptoms

Erysipelas begins acutely, with common non-specific signs intoxications appear 12-24 hours before local skin changes.

The body temperature rises sharply to febrile figures, which is accompanied by chills, headache, weakness, palpitations. In some patients, against the background of severe intoxication, oneiroid or hallucinatory-delusional syndrome develops. Sometimes already in prodromal period there are signs toxic injury liver, kidneys, heart. There may be excessive drowsiness, nausea with vomiting that does not bring relief. So the initial stage of erysipelas is nonspecific, the patient may take its manifestations for flu symptoms.

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

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

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

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

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

Features of erysipelas of various localization

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

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

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

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

Possible Complications

To the most possible complications faces include:

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

The main consequences of erysipelas are persistent hyperpigmentation and elephantiasis.

Principles of treatment

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

Indications for hospitalization are:

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

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

How to treat erysipelas

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

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

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

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

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

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

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

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

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

Prevention

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

Erysipelatous inflammation in timely handling to the doctor and strict observance his recommendations are successfully treatable and do not lead to permanent disability.

Erysipelas is an infectious skin disease that bacterial nature. The main provocateur of its development is group A hemolytic streptococcus, the action of which leads to severe intoxication and inflamed lesions on the skin.

A pathogen such as hemolytic streptococcus can also cause some other diseases - a sore throat, for example.

However, not all people who have undergone it suffer from erysipelas. In addition to the named pathogen, the following pathologies can be the causes of erysipelas of the leg:

predisposition to the disease;
allergic reactions to staphylococcus aureus;
weakened immunity;
violation of the integrity of the skin;
severe injury;
hypothermia or overheating of the body;
psycho-emotional state;
sunburn, etc.

Erysipelatous inflammation of the leg is contagious - it is transmitted by contact through minor damage to the skin, since the pathogen is constantly on them. With the onset of favorable circumstances, he immediately shows his pathological activity.

It happens that infection occurs from the outside when the skin is treated with non-sterile medical instruments, or by the lymphogenous route.

Localization of erysipelas can be different - the trunk, neck, legs are favorite places of the pathological process. There is also inflammation of the face.

Erysipelatous inflammation of the leg: symptoms and signs

The incubation period of the erysipelatous inflammatory process ranges from several hours to 3-4 days. Physicians classify pathology as follows:

by severity - mild, moderate and severe stage;
according to the nature of the course - erythematous, bullous, erythematous-bullous and erythematous-hemorrhagic form;
by localization - localized (on one part of the body), widespread, metastatic lesion.

The primary symptom of erysipelas of the leg is a sharp causeless increase in body temperature up to 40 degrees, accompanied by headache and muscle pain, general weakness. For a severe degree of the disease, symptoms such as nausea, vomiting, convulsions, delirium are characteristic.

By the end of the first day (less often - the next day), the existing symptoms are accompanied by a burning sensation and bursting of the skin, redness, swelling of the limb, hot to the touch.

Localization of the infection on the skin of the face leads to disfigurement of the appearance. Due to redness and swelling, this pathology got its name "erysipelas".

A characteristic feature inherent in the inflammatory process is the bright red color of the affected areas, similar to flames. Clearly marked edges have elevations along the periphery - the so-called inflammatory shaft.

AT acute form the disease can last from 5 to 15 days. Further, the subsidence of inflammatory phenomena is observed, however, after it, peeling of the skin appears. The lesions remain pigmented.

In a more severe form, erysipelas of the leg leads to exfoliation of the upper layer of the skin with its filling with serous or hemorrhagic contents (erythematous-bullous and bullous-hemorrhagic forms). Blisters form on the affected areas of the skin. It is possible that after the transfer of these serious forms, the patient will also develop long-term non-healing trophic ulcers.

Such a concept as recurrent erysipelas of the leg, gains the right to exist with a relapse that occurred within two years after an acute illness.

Therapeutic measures in the treatment of erysipelas of the leg usually consist of prescribing drugs such as Penicillin, Oleandomycin, Bicillin-5, Tetracycline and Erythromycin. In large dosages, drugs are used for 7 to 10 days. In the event that these antibiotics did not lead to positive results treatment, they are replaced by anti-inflammatory and anti-allergic drugs.

Less often, but still, funds are prescribed that can strengthen the walls blood vessels. The fight against erysipelas of the leg requires drinking plenty of water. Due to the large amount of fluid, toxins are removed from the body much faster, preventing the further spread of the pathogen.

Local treatment of erysipelas of the leg is carried out in almost every case. It lies in the fact that the bubbles located on the damaged surface are cut, and their contents are squeezed out. The sterile dressing is impregnated special ointment from erysipelas and applied to the treated area of the skin.

If there is a significant weakening of the inflammatory process, then the doctor may prescribe stimulants to restore skin tissues. Local treatment can be carried out with the help of antiseptic solutions(furatsilina solution).

At frequent relapses antibiotic therapy complemented hormonal treatment with the appointment of prednisolone.

The fight against erysipelas of the foot takes a lot of time, and a prerequisite successful treatment in this case is to prevent the occurrence of complications. They appear as:

violation of lymph circulation in the lower extremities, leading to elephantiasis;
the formation of ulcers, abscesses, necrosis of skin areas;
complications in the work of the kidneys;
disruption of the cardiovascular system.

How to treat erysipelas of the leg with traditional medicine

A good folk remedy that facilitates the fight against erysipelas is a compress, which is a thick layer of grated raw potatoes. To the affected areas at night, you can apply and cabbage leaf, repulsed until the appearance of juice.

Dressings for erysipelas of the leg are made according to the following recipes:

juniper in the amount of two tablespoons pour half a liter of boiling water and boil for three minutes, after which we insist. Dip the bandage into the resulting product, wring it out and apply it to the diseased skin 4 times a day.
An infusion of herbs is prepared from chamomile, plantain, sage and St. John's wort. On top of the dressing soaked in this infusion, another is applied soaked in a salt solution (one teaspoon of salt is dissolved in a glass of water). Bandages are applied 3 times a day and 1 time at night.

Good for lubricating the skin of the legs and tinctures of chaga, eucalyptus and valerian, sold in a pharmacy without a prescription.

For internal use(3 times a day, 1 teaspoon) can be prepared remedy, mixing chamomile flowers, well-ground coltsfoot leaves and honey.

To prepare an efficient herbal infusion in equal parts take the following components: eucalyptus and nettle leaves, calamus roots, burnet and licorice, yarrow and cudweed. After measuring 10 g of the resulting collection, it is poured with a glass of boiling water, insisted and at least 4 times a day they drink 50 g each. The bandage is moistened in the same solution and applied to the affected area on the leg.

If it is possible to buy silver water, they simply drink it during the day.

An interesting method of treatment is offered by healers: in the morning, the inflamed area of \u200b\u200bthe skin must be sprinkled with chalk, a red cloth should be applied on top and, having bandaged it to the leg, go through this all day. It is necessary to perform the daily procedure one hour before sunrise for 7 days.

Preventive measures for erysipelas of the leg

Given that erysipelas of the leg is contagious, family members of the sick person should take care of prevention. As far as possible, they should limit direct contact with the patient, and take care of themselves, avoiding skin damage and regularly caring for it. This is especially true for those people who suffer from varicose veins or diabetes.

Prevention of erysipelas of the leg can also be described as a series of the following activities:

timely treatment of diseases provoked by streptococcus;
treatment of all diseases that can cause relapses of erysipelas;
compliance with hygiene rules to prevent damage to the skin of the lower extremities;
taking antibiotics that create obstacles to the reproduction of streptococcus. Long-term use such drugs require mandatory supervision of the attending physician.

Erysipelas infection - contagious disease, in which the skin on the face, scalp, hands is affected. This is dangerous for others, but it also causes painful symptoms and psychological inconvenience to the patient. Worse when the inflammation touches the legs. The patient is not always able to move without assistance. Erysipelatous inflammation of the leg requires an immediate visit to the surgeon. Only in case of early diagnosis is it possible fast healing. Severe cases require hospitalization.

What is an erysipelas on a leg

Erysipelas is an infectious skin disease that has clear boundaries and a bright red color at the site of the lesion. The causative agent is the bacterium streptococcus. It exists in the environment. If you got a leg injury, just a scratch or you were bitten by an insect, - through damage to the skin, streptococcus enters the body - infection occurs. When you have a weakened immune system, erysipelas will develop very quickly. Often sick people working for outdoors: builders, agricultural workers. According to the international classifier ICD-10, erysipelas has the number A46.

Streptococcus can remain in the body after illnesses, such as chronic streptococcal tonsillitis or caries. If you have a strong immune system, you can live with bacteria for many years and not get sick. Erysipelatous disease can begin after stress, a sharp temperature drop. The provocateur of the inflammatory process is sunburn or hypothermia. provoke erysipelas diseases:

foot fungus;
thrombophlebitis;
diabetes;
varicose veins veins;
obesity;
violations of lymphatic drainage;
allergy.

Symptoms of the disease

Erysipelatous inflammation of the leg begins suddenly. At the initial stage, the temperature rises sharply, weakness appears, muscle pain. Redness, swelling appear on the skin. The lesion rapidly increases in size. In severe forms, confusion, convulsions appear. The patient loses consciousness, may faint. The course of the disease is characterized by:

sensation of heat, fullness;
enlarged lymph nodes;
soreness, itching;
nausea;
bowel problems;
burning sensation.

Causes of the disease

To start erysipelas there are many reasons. A special role is played by violations of the skin as a result of injury to the limbs, insect bites. A small abrasion and microcracks are enough for streptococcus bacteria to enter, causing the disease. One of the reasons is the professional factor. The disease occurs in people who work in chemical plants. Provoking action - long walking in rubber shoes. At the same time, mechanics, miners, people working in metallurgy get sick.

Causes of erysipelas can be:

purulent and viral infections - the infection enters through the opened vesicles;
allergic diseases skin - bacteria penetrate through the places of combing;
metabolic disorders;
decreased immunity;
oncology;
disease internal organs;
taking drugs that reduce immune defense;
ENT diseases;
stress;
advanced age of the patient;
violation of blood flow in the lower extremities;
drinking alcohol, smoking.

Diagnostic methods

Diagnosis of erysipelas of the leg begins with a survey of the patient. It turns out how the disease began, how long it lasts, what are the symptoms. Next, the diseased limb is examined for compliance with the signs of the disease. If they are not pronounced, for clarification, a blood test is done for the presence of infection. If necessary, consult with a dermatologist and an infectious disease specialist. In a controversial situation, histological examination infected tissues.

Is erysipelas contagious

Erysipelatous disease is contagious, it can be transmitted through contact with sick people. If such a diagnosis is in a person close to you and care is required for him, precautions must be taken. For procedures, use gloves. Be sure to wash your hands with soap after contact. Provide the patient with separate dishes, linen.

Treatment of erysipelas of the skin at home

If you seek help in time, it is possible to quickly cure erysipelas. It is produced at home, and only severe cases require hospitalization. The doctor prescribes the method of treatment - he determines necessary drugs and means of recovery. How to treat erysipelas on the leg? Since this is an infectious disease, it all starts with taking antibiotics. Next is assigned:

drugs to eliminate the symptoms of the disease;
physiotherapy;
the use of lotions, compresses;
application of ointments, creams;
baths;
powders;
treatment with folk remedies.

Medically

With erysipelas, it is required to start treatment on time. All doctor's instructions must be followed. In advanced cases, the appearance of non-healing trophic ulcers is possible. To treat the infection, antibiotics are used, which are taken in the form of tablets and injections. Great importance is given to the fight against symptoms, therefore drugs are prescribed:

"Claritin", which relieves itching;
"Nurofen", lowering the temperature, reducing inflammation;
"Hypothiazid", which removes excess liquid that relieves intoxication;
"Prodigiosan", supporting immunity;
vitamin complexes.

Antibiotics

If the disease is mild, a weekly course of antibiotics in tablets is prescribed. These can be drugs: "Azithromycin", "Erythromycin", "Sparamycin". Antibiotics are selected so that they act on the streptococcus that caused erysipelas. If the selected drug does not fit, another one is tried after ten days. For a better effect, intravenous antibiotics are prescribed. In severe cases, in stationary conditions, apply "Benzylpenicillin". Treatment takes place strictly under the supervision of a physician.

Ointment for skin inflammation

In the treatment of erysipelas of the skin on early stages ointments are not used. They are used in the vesicular form of the disease. Effective in this case, "Ichthyol ointment", which acts as an antiseptic, promotes disinfection. "Vishnevsky's ointment" helps in the treatment of chronic infections. At the stage of recovery, the use of Naftalan ointment gives excellent results.

Folk remedies

When treating erysipelas of the leg with the help of folk remedies, agreement with the attending physician is required - independence leads to complications. As a compress, grated potatoes are used, laid in a thick layer. Recommend applying fresh leaves burdock or cabbage, you should:

wash them;
beat off until juice is released;
tie to a sore spot.

Medicinal properties are attributed to the effect of a red rag - it is recommended to do a dressing after applying a compress. It is advised to try powdered chalk powder - it is left overnight. Treatment with vegetable oil helps, which should be boiled in a water bath for 5 hours. They lubricate the wound and sprinkle with crushed Streptocide. The compress is left overnight.

Which doctor treats erysipelas

If you find signs of erysipelas in your leg, you need to see a surgeon. The disease, which was detected at the initial stage, is treated on an outpatient basis. Complex and severe forms diseases are treated in the hospital. AT doubtful cases when the diagnosis is ambiguous, a consultation with a dermatologist may be necessary. If a child has erysipelas, an infectious disease specialist is involved in the healing.

With erysipelas, both limbs are often affected.

Erysipelatous inflammation of the leg, the symptoms and treatment of which depend on the state of immunity, refers to bacterial infectious diseases. Its causative agent is group A beta-hemolytic streptococcus. More often, the disease affects women over 50 years of age. Factors predisposing to inflammation of the skin on the legs include cracks and burns, low immunity.

The causes of the development of the disease are the penetration of infection into the body through scratches, scratches and other damage to the skin. The main causes of inflammation of the skin are neglected caries, chronic tonsillitis. To additional factors contributing to the development of erysipelas of the leg, infectious disease specialists include:

constant hypothermia of the lower extremities;
strong sunburn;
a sharp change in temperature;
stress.

The causes of erysipelas can be associated with the following pathologies:

obesity.
diabetes.
trophic ulcer.
alcoholism.
thrombophlebitis.
varicose veins.

The disease in question is contagious, since the pathogen is easily transmitted from an infected patient to healthy person. Therefore, doctors recommend avoiding contact with infected patients. If one of the family members is infected, then it is necessary to observe additional measures security.

The incubation period lasts 10 days. After the specified period, the symptoms of erysipelas Make themselves felt. The first signs of the disease appear as general malaise(migraine, chills, weakness, nausea, vomiting). After 24 hours, to the above symptoms are added local signs. Pain, burning, redness and swelling appear on the problem area of \u200b\u200bthe skin. Subsequent symptoms are manifested taking into account the form of the disease.

Infectionists distinguish several forms of erysipelas of the legs:

Erythermatous - the affected area of \u200b\u200bthe skin turns red, erythema is formed, which rises above the cover. Erythema has clear boundaries and irregular shape. Often the above picture is complemented by peeling of the skin.
Erythematous-bullous - 2-3 days after infection, it exfoliates from the problem area upper layer. In this case, bubbles with liquid are formed. They tend to burst. Then a brown crust forms. What is under it depends on the effectiveness of therapy. When providing timely medical care after the crust falls off, pink and smooth skin appears. In other cases, painful erosions occur, which are easily transformed into trophic ulcers.
Erythematous-hemorrhagic - hemorrhage is observed in the affected areas.
Bullous-hemorrhagic - inflammation of the lower leg is accompanied by the appearance of vesicles filled with fluid with blood.

Taking into account the degree of the course of the process, dermatologists distinguish between mild, moderate and severe degree foot inflammation. According to the multiplicity of the development of pathology, primary, recurrent and repeated erysipelas are distinguished. An infectious disease specialist or therapist can diagnose the disease in question. The presence of an inflammatory process is indicated by:

elevated titers of antistreptolysin-O or another antistreptococcal antibody;
impaired hemostasis and fibrinolysis;
inflammatory changes in the general blood test.

Diagnostic criteria for the disease:

acute course of the disease with severe symptoms;
localization local inflammation on the legs and face;
redness of the skin;
enlarged lymph nodes in the area of inflammation;
absence of pain in the focus of the inflammatory process at rest.

Treatment of erysipelas at home includes taking antibiotics. More often, patients are prescribed drugs of the penicillin and cephalosporin series. The causative agent of the disease is most sensitive to these medicines. Antibiotics are taken within 7-10 days. Tablets are recommended to drink strictly on time. Clinical assessment the effectiveness of therapy is carried out simultaneously with the microbiological assessment of the condition of the skin. Such A complex approach to the fight against erysipelas contributes to the rapid and complete recovery of the patient.

It is possible to cure erysipelas with medication, following the recommendations of a doctor. At the same time, the patient is prescribed desensitizing and immunomodulatory therapy. During life, microbes release toxins that provoke allergies. To prevent the aggravation of the pathology, Dimedrol or new generation medicines are taken. Effective immunomodulatory drugs include Timalin, Dekaris, Timalin. If necessary, use specific immune preparations - antistreptococcal serum, staphylococcal toxoid.

Local treatment is prescribed to have a direct effect on the pathological site. This therapy includes the application of cooling procedures. With the help of ethyl chloride cooling, pain can be relieved within 3-4 days. Also used during treatment antiseptic dressings. They are used to kill the pathogen and prevent the activation of secondary flora, which can provoke serious consequences of the underlying disease.

Additionally, with erysipelas, the following medications are taken:

Sulfonamides (Streptocid, Biseptol) - prevent the formation of bacteria in cells.
Nitrofurans (Furadonin) - their action is aimed at slowing down the growth and reproduction of bacteria.
Glucocorticoids (Prednisolone) - have a strong anti-allergic effect, but at the same time depress the immune system. Such medicines are taken as prescribed by the attending physician.
Biostimulants (Pentoxyl) - their action is aimed at stimulating the formation of cells of the immune system, accelerating the restoration of the skin in the problem area.
Multivitamins ( Vitamin C, Askorutin) - strengthen the walls of the CS, increasing the activity of the immune system.
Thymus medications (Taktivin) - the medication is administered intramuscularly. It improves the functioning of the immune system by increasing the number of T-lymphocytes.
Proteolytic enzymes (Trypsin) - presented as subcutaneous injection, the action of which is aimed at improving tissue nutrition and resorption of the infiltrate.

For the treatment of affected skin, you can not use synthomycin, cherry and ichthyol ointment. Such drugs increase the inflammatory process, provoking an abscess. Problem areas of the leg can be treated with the following means:

Application with a 50% solution of Dimexide - a gauze napkin is wetted in a solution, applied to problem skin. The procedure is repeated 2 times a day. With the help of Dimexide, pain and inflammation are relieved, blood circulation improves. The drug has an antimicrobial effect, increasing the effect of antibiotic therapy.
Powder Enteroseptol - clean dry skin 2 times a day is sprinkled with powder. The drug prevents the attachment of other microbes.
Bandage with Microcide solution - compress paper is applied to the bandage. Microcide has an antimicrobial effect, destroying microbes in the thickness of the skin.
Oxycyclosol aerosol - problematic skin is treated with a similar agent. The agent is sprayed at a distance of 20 cm from the surface of the site. The procedure is repeated 2 times a day.

Physiotherapy for erysipelas of the leg is aimed at normalizing the disturbed metabolism in the tissues. With the help of this method of treatment, the frequency of recurrence is reduced, since they completely cure the patient. More often, doctors use ultraviolet irradiation of the affected areas of the skin. Such therapy causes the death of the pathogen, enhancing the therapeutic effect of the first stage of treatment. A similar technique is used in the presence of pathologically altered tissues. With a migratory form of erysipelas, diseased and healthy skin are exposed to radiation.

If a relapse occurs, other physiotherapeutic methods of treatment (ozokeritotherapy, paraffin therapy) are used. They are also prescribed for chronic skin process. They are aimed at improving microcirculation, which helps to attract immune cells to the focus of the process. With an exacerbation of the disease, electro- or phonophoresis of Hydrocortisone is used.

If the erysipelas is accompanied by a purulent lesion of the legs, surgical treatment is performed. The operation consists in the prompt opening and creation of an outflow of pus from the focus of inflammation. Such therapy prevents the development of purulent intoxication.

Folk remedies against erysipelas are taken after consultation with the attending physician. Healers advise treating erysipelas with conspiracies and a red cloth moistened with cobwebs and mold. Effective folk remedies for strengthening immunity are black radish, currants, cabbage, buckwheat, oats, peas, beets.

Reasons for low defensive forces body are associated with nervous and mental overstrain. To combat such factors, ordinary hops, prickly hawthorn, lungwort, lemon balm, oregano are used.

Raspberry and blackberry leaves have useful properties. They contain amino acids, in the absence of which there are violations in the vital activity of the patient's body. When treating erysipelas on the legs at home, it is recommended:

Weakly bandage the affected area, allowing only a light bandage, which must be changed 2-3 times a day. Previously shown antiseptic treatment of the skin.
Avoid excessive softening of the skin with ointment. Otherwise, additional infection of the wound will begin to develop.
After opening the bubbles, erosion is treated with hydrogen peroxide. The skin is dried with a powder consisting of boric acid, xeroform, streptocide. From above, the wound is covered with a two-layer gauze.

2 weeks after the onset of the disease, the redness subsides, but the swelling and pigments remain. In the absence of treatment, there high risk relapse. If carried out passive treatment, inflammation provokes general and local complications. This pathology is dangerous for patients with diabetes, allergies, heart failure and HIV infection. Exists high probability development of sepsis, pneumonia and meningitis.

Pathogen toxins provoke myocarditis, rheumatism and glomerolonephritis. Local complications of erysipelas of the lower extremities include abscesses and phlegmons, trophic ulcers. At the same time, the volume of leg tissues sharply increases (due to the accumulation of fluid and thickening of the skin). Elephantiasis against the background of erysipelas is accompanied by the appearance of papillomas and lymphorrhea.

Forecast and prevention

Specific prevention of erysipelas on the lower extremities has not yet been developed. To prevent the disease in question, it is recommended to observe local and general measures. The first group includes the following recommendations:

foot care - regular washing, avoiding scuffs and calluses, cuts, overheating and hypothermia;
prevention of varicose veins and timely consultation with a doctor.

To general measures precautions for the development of erysipelas, infectious disease specialists include:

limited contact with infected people;
after contact, antiseptic treatment of the skin is carried out;
regular strengthening of the immune system due to the observance of the daily regimen;
avoidance of stress;
timely elimination of foci of chronic streptococcal infection;
proper nutrition - the menu includes meat broths and excludes the use of stale food;
year-round preventive injections of Bicillin.

The prognosis of pathology depends on the severity of its course and the state of immunity. The recurrent form develops against the background of staphylococcus adherence to GABHS. Acquired lymphostasis reduces the patient's ability to work.

In general, for the life of the patient, the prognosis of erysipelas is favorable (in the absence of complications).

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

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

Erysipelas (erysipelas) - what is it?

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

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

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

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

Group A beta-hemolytic streptococcus

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

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

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

BGSA very quickly spreads through the air, through digestive tract and objects, so it is usually detected in rooms where children and labor collectives stay for a long time, 57.6% of sore throats and 30.3% of acute respiratory infections are caused by it.

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

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

Causes of erysipelas of the legs

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

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

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

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

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

Symptoms of erysipelas of the leg, photo

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

Suddenly there are signs of intoxication:

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

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

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

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

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

Diagnosis of erysipelas

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

In other diseases, local symptoms often appear first, and only after them does intoxication appear.

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

Forms of erysipelas of the leg

Based on the nature of local changes, there are:

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

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

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

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

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

5. Gangrenous form with areas of skin necrosis.

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

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

According to the severity of the disease are distinguished:

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

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

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

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

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

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

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

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

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

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

7) Physiotherapeutic procedures:

ultraviolet exposure to acute period has a bacteriostatic effect;
lidase electrophoresis,
ozokerite,
magnetotherapy.

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

8) Antihistamines prevent sensitization of the body.

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

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

11) Surgical treatment of the lesion:

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

12) B severe cases transfusion of blood or plasma.

Treatment of erysipelas of the leg is carried out by a doctor. To avoid complications, the patient must strictly comply with all medical appointments even in outpatient settings.

In the treatment of erysipelas at home it's important to know:

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

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

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

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

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

Complications of erysipelas

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

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

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

Streptococcus toxins cause rheumatism, myocarditis and glomerulonephritis.

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

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

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

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

Due to acquired lymphostasis, working capacity may be reduced.

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

Prevention of erysipelas

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

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

Local Measures:

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

Erysipelatous inflammation mkb 10

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

Class I
- A30 - A49 Other bacterial diseases

A46 Erysipelas