The forms of erysipelas include. How to treat erysipelas. Surgical treatment of erysipelas

Millions of people in the world are infected with infectious diseases every day. One of them is erysipelas, which has long been known to medicine.

Erysipelas disease - what is it

Erysipelas is an acute infectious disease caused by beta-hemolytic streptococcus. It is characterized by the appearance of redness on the skin, accompanied by fever and general intoxication of the body (including headache, weakness and nausea).

There are 2 forms of erysipelas:

• Erythematous. In other words, the initial stage. The patient has a burning sensation, pain, swells and the place of inflammation becomes hot. Sometimes there are punctate hemorrhages.
• bullous. It is characterized by the presence of bubbles containing a clear liquid. After a few days, they dry out, forming a crust on the skin.

In both forms, inflammation is accompanied by damage to the lymphatic system.

Important! Primary erysipelas most often appears on the face, while relapses of the disease have "chosen" the lower limbs of a person. The duration of the disease is 5-8 days. Residual manifestations of erysipelas can remain for life if you do not resort to the help of cosmetologists.

Features of the structure of the skin on the legs, arms and face

The skin is the largest human organ and consists of three layers. It weighs approximately 15% of the total body weight. She has various structural features on her legs, arms and face. For example, the skin on the soles of the feet has a high concentration of sweat pores. In this place, its thickest layers.

The skin on the palms lacks hair follicles and sebaceous glands. The inner side of the hands is characterized by great elasticity, thinness and softness. On the face, or rather on the eyelids, there is the thinnest layer of skin on the entire human body. In the region of the eyelids, auricles, forehead and nose, the skin does not have a lower layer. Facial skin is the most susceptible to aging.

Causes of the disease

Erysipelas disease - is it contagious to others? The cause of the disease is a streptococcal infection that has entered the soft tissues. Its source is a streptococcus carrier. Most often, the “entrance door” for microorganisms into the human body is minor injuries, abrasions, cuts in the skin or mucous membranes.

Who is at risk?

According to statistics, people over the age of 18 most often suffer from erysipelas. Moreover, in 65% of cases, doctors diagnose erysipelas in people older than 50 years. Often, men and women are infected with the infection, whose work is associated with microtraumatization and contamination of the skin. Erysipelas can also provoke neglect of personal hygiene.

Symptoms of erysipelas

There are 7 main symptoms of erysipelas:

1. Development of a fever(convulsions, delirium).
2. Manifestation of symptoms of intoxication(including headache, chills).
3. On limited areas of the skin burning sensation, itching. There are painful sensations when interacting with this area. Over time, the skin becomes redder and stronger. After a few days, swelling sets in and the pain intensifies.
4. Insomnia.
5. Elevated temperature.
6. Nausea and vomiting.
7. Weakness in the muscles.

Erysipelas in a child - the first signs

Erysipelas in children occurs almost always in the spring and autumn. The initial phase in babies is faster and more acute than in adults. However, the first signs and symptoms of the disease are the same. A distinctive feature is only heartburn, which is experienced by 99% of infected children.

Important! Girls get sick twice as often as boys.

Diagnostic measures

Diagnosis of erysipelas disease is carried out on the basis of clinical symptoms and the results of laboratory tests that indicate the presence of a bacterial infection. After that, the dermatologist draws up a treatment plan.

Treatment

How to treat erysipelas? There are several treatments for erysipelas. All of them are divided into 3 types:

• Medical treatment. It has been scientifically proven that hemolytic streptococci, which provoke the disease, are highly sensitive to nitrofurans, penicillin antibiotics and sulfonamides. This means that drugs containing penicillins, erythromycin, oleandomycin, clindamycin will be useful in the fight against the disease. They can be taken either orally or by injection. Treatment lasts 5-7 days. After 1-3 days from the moment of its onset, the temperature returns to normal, the inflamed areas gradually turn pale. After 10 days, an antibacterial agent biseptol is prescribed. For topical application, that is, directly for use on the affected areas of the skin, the doctor prescribes erythromycin ointment and powder in the form of crushed tablets, which contain enteroseptol. Drug treatment is often supplemented with biostimulants and vitamins.
• Physiotherapy. In this case, we are talking about ultraviolet irradiation, which has a bacteriostatic effect on active bacteria. It is often given to patients with erythematous erysipelas. In the treatment of relapses of the disease, ultra-high frequency and laser therapy are sometimes used. But short-term freezing of the surface layers of the skin with a stream of chloroethyl until whitening, in combination with antibacterial therapy, is practiced in cases where the disease is particularly acute.
• Surgery. It should be noted that the need for this method of treatment arises when the patient has a bullous form of erysipelas or purulent-necrotic complications. During the operation, the bullae are opened and the pathological fluid is evacuated. Only antiseptic agents are applied locally.

Prevention

First of all, it is necessary to monitor the cleanliness of the skin, treat various wounds and cracks, and treat pustular diseases in a timely manner. And also, during medical manipulations, observe asepsis and use only sterile instruments. Then the risk that a person will undergo erysipelas is minimized.

Consequences of erysipelas

In addition to the typical residual effects of erysipelas, which include peeling of the skin and its pigmentation, lymphedema, that is, the accumulation of protein-rich fluid in the interstitial space, can become a more severe consequence. In this case, surgical intervention is necessary in combination with physical anti-edematous therapy.

Restoration of the skin after the disease

To restore the skin after erysipelas, both cosmetology and an independent fight against the consequences of the disease can help. Before using any medication, it is better to consult a specialist.

Treatment of erysipelas at home - folk recipes

To combat the disease at home, they often use:

• pork fat. They smear the affected skin 2 times a day.
• Kalanchoe juice. It is preserved with alcohol to a strength of no more than 20%, then a napkin is dipped in it and in a five percent solution of novocaine, after which it is applied to the inflamed area.
• Plantain. The plant is crushed and mixed with honey. After that, boil and apply a bandage with a cooled ointment to the skin, changing it every 4 hours.

Important! Some of the remedies that people have been trying to treat erysipelas at home for several centuries not only do not contribute to recovery, but can also cause even more harm to human health. These include, for example, chipping the affected area of ​​the skin with mercury salts.

Video: erysipelas in adults - causes and treatment.

Erysipelas or erysipelatous inflammation of the skin is one of the manifestations of an acute common streptococcal infection. This disease is manifested by a predominant focal lesion of the 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 can, under certain conditions, lead to erysipelas.

β-hemolytic streptococcus is an immobile spherical gram-negative bacterium that forms a fairly 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 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, it is the most common cause of 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 erysipelas is one of the possible manifestations of a common streptococcal infection, the 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 in the presence of a number of certain predisposing factors in a person. 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 of the immune system can be caused by HIV, hypercytokinemia, radiation and chemotherapy, taking immunosuppressive drugs after transplants, certain blood diseases, and 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 the surgical treatment of 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, chemically contaminated room, long-term wearing of tight, poorly ventilated overalls and personal protective equipment). Of particular importance is the injection of 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, these are 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 a predominant lesion of the intestine.

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 key role is played by the hematogenous and lymphogenous pathways 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.

The serous exudate formed during erysipelas impregnates the tissues, accumulates in the 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, there is a paresis of blood capillaries and a sharp increase in 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 contributes to the transition of serous inflammation to purulent. At the same time, secondary immune disorders and a decrease in the barrier function of the skin contribute to the attachment of a 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 forms. 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 eyelid lesions are taken out as a separate clinical form of the disease. Erysipelas of the torso, mammary glands, scrotum, and female external genitalia are quite rare.

Symptoms

Erysipelas begins acutely, with general non-specific signs of intoxication appearing 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 the prodromal period, signs of toxic damage to the liver, kidneys, and heart are noted. 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 the continents on a 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 shade, which is associated with increasing local microcirculation disorders. 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. With adequate treatment, the temperature returns to normal within 3-5 days. Acute manifestations of the 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

In clinical practice, the most common (up to 70% of cases) is erysipelas of the lower leg. It proceeds in an erythematous or hemorrhagic-bullous form and is accompanied by severe lymphatic edema 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 of fungal skin lesions

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. Erysipelas of the face usually proceeds in an erythematous form and has a mild course or, less commonly, moderate severity. Sometimes it is combined with streptococcal lesions of the mucous membranes. The erysipelas of the eyelids is accompanied by severe edema.

Possible Complications

The most likely complications of erysipelas 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 it is possible to treat erysipelas at home (according to modern recommendations of the Ministry of Health of the Russian Federation) 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:

• advanced age of the patient;
• the development of erysipelas in a child;
• severe immunodeficiency in a patient;
• severe course of the disease: pronounced intoxication syndrome, sepsis, widespread bullous-hemorrhagic lesion, necrotic and phlegmonous forms of erysipelas, the addition 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 surgery is required or whether conservative methods can be dispensed with.

In any form of the disease, a full-fledged systemic etiotropic therapy is required. Proper 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 penicillin antibiotics. 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.

NSAIDs (with analgesic, antipyretic and anti-inflammatory purposes), antihistamines (for desensitization) are used as adjuvants. With severe intoxication, infusions based on glucose or saline are indicated. 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. In the 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. Powdering the focus of erysipelas with powdered antibacterial agents and enteroseptol, treatment with antiseptic aerosols is acceptable.

Treatment of erysipelas with folk remedies cannot act as the main method of fighting infection and cannot replace the complex therapy prescribed by the doctor. In addition, when using herbal preparations, there is a risk of increased 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 the timely treatment of any foci of chronic infection, dermatitis, mycoses of the feet and varicose veins, and the achievement of 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 with timely access to a doctor and strict adherence to his recommendations can be successfully treated and does not lead to permanent disability.

Symptoms of erysipelas of the lower extremities occur acutely, their severity increases rapidly. If timely medical care is not provided, complications of the pathology develop, which in severe cases can lead to the death of a person. Treatment of the leg should be aimed at destroying the causative agent of this infectious disease in the body, reducing the severity of the symptoms of the pathology.

Causes of the development of erysipelas

The cause of erysipelas is infection with group A β-hemolytic streptococcus. 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 into 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 chronic infection in the body.

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

• The presence of chronic tonsillitis, sinusitis, otitis, caries.
• Permanent damage, contamination of the skin. The most susceptible to the disease are workers in agriculture, 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, alcoholism, drug addiction, treatment with glucocorticosteroids, oncological pathology, HIV infection.

Symptoms

The disease begins with a sharp rise in temperature up to 38-40 ° C, severe weakness, severe headache, aches in the bones and muscles. There is also increased sweating, lack of appetite.

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

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

Erythema with erysipelas has clear boundaries.

Lymph nodes near the lesion become enlarged and painful. When erysipelas is located 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 skin of the face.

Photo of symptoms of erysipelas before the start of treatment for the disease.

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

Bullous form of erysipelas.

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

Bullous-hemorrhagic form of erysipelas.

Complications

If the treatment of 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 has no definite boundaries.
• Phlebitis - inflammation of the walls of a vein. A condition in which a blood clot forms in the lumen of a vessel is called thrombophlebitis.
• Lymphostasis is a violation of the outflow of lymph from the affected areas, followed by sweating into soft tissues.
• Trophic ulcers are deep skin defects that do not heal for a long time.
• Meningitis is an inflammation of the lining of the brain and spinal cord.
• Sepsis is a systemic inflammatory reaction resulting from the generalization of a local infectious process.

Phlegmon on the leg, which arose against the background of erysipelas.

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

Diagnostics

If you suspect erysipelas, you should contact an infectious disease specialist. During the examination, this doctor finds out how the person’s well-being has changed since the first signs of pathology appeared, examines and probes the affected area.

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

• An 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 below 4 * 10 9 / l.
• The erythrocyte sedimentation rate (ESR) exceeds 20 mm/hour, sometimes reaches 30–40 mm/hour.
• In the hemorrhagic form of the disease, a decrease in the level of hemoglobin (less than 120 g / l), erythrocytes (less than 4.4 * 10 12 / l in men and less than 3.8 * 4 * 10 12 / l) is possible.

In case of an atypical course of the pathology, a bacteriological examination is performed to clarify the diagnosis. To do this, a glass slide is applied to the wound or ulceration in the lesion, then it is studied using a microscope.

Treatment of erysipelas

Treatment of erysipelas should be complex - the action of drugs from various pharmacological groups is aimed at destroying pathogens, reducing the severity of intoxication, eliminating pain, and preventing complications.

Antibiotics

Treatment of erysipelas with antibiotics blocks the reproduction of streptococci, causes the death of bacteria in the lesion. The first effect is called bacteriostatic, the second - bactericidal.

The most commonly used drugs are from the penicillin group, which inhibit the synthesis of components of the shell of streptococci, causing their death. Penicillins of natural origin include Benzylpenicillin, Bicillin-5, the protected drugs of this group are Amoxiclav, Augmentin, Panclav, consisting of amoxicillin, clavulanic acid. The latter prevents the destruction of penicillin by enzymes that are produced by bacteria.

In case of intolerance or ineffectiveness of penicillins, macrolides are used. Representatives of this group are Erythromycin, Azithromycin, Azitrus, Sumamed, Rovamycin, Roxitem, Roksimizan.

Macrolides in small dosages have a bacteriostatic effect, in high concentrations they have bactericidal properties.

Another group of antimicrobial agents are tetracyclines. These include Doxycycline, Unidox, Doxilan. These drugs disrupt the synthesis of proteins in the cells of microorganisms, thereby providing a bacteriostatic effect.

The group of fluoroquinolones used for erysipelas includes Levofloxacin, Tavanic, Flexid. These synthetic antibiotics quickly penetrate into the focus of inflammation, causing the death of streptococci.

Other medicines

Non-steroidal anti-inflammatory drugs (NSAIDs) are used to eliminate pain and lower body temperature. Nimesulide (Nimesil, Nise), Diclofenac (Voltaren), Ibuprofen (Nurofen), Indomethacin are used.

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 leg includes the use of antihistamines, which is necessary to prevent the development of allergic reactions in response to exposure to streptococcus. These drugs include Suprastin, Clemastine, Claritin, Zirtek.

Claritin and Zyrtec 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, the treatment of erysipelas includes the use of a short course of glucocorticoids to suppress the active inflammatory process. Representatives of this pharmacological group - Hydrocortisone, Prednisolone.

To increase general immunity, vitamin-containing preparations, biostimulants (Methyluracil, Pentoxyl) are used. These remedies help speed up the healing of the lesion.

Folk remedies

Folk remedies can be used only when the first symptoms of 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 the treatment of erysipelas of the leg at home includes the use of various compresses. Sometimes powdered chalk is used. The affected area of ​​the skin is sprinkled last, a sterile gauze bandage is applied on top, the compress is left overnight.

To make a burdock compress, a fresh washed leaf of the plant is beaten a little until the juice is released. Burdock is applied to the focus of inflammation, fixed with a gauze bandage for the night.

A decoction of elderberry 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 remedy is insisted for 2 hours, filtered. The decoction is taken orally 2-3 times a day for 50 milliliters.

A pharmacy tincture of burnet is also used - a perennial plant with anti-inflammatory, bactericidal properties. To 100 milliliters of the product, add 50 milliliters of water, moisten a sterile gauze bandage with the solution. The latter is fixed with a bandage before going to bed, the compress is left overnight.

Compresses with tincture of burnet help reduce itching, pain during erysipelas.

To reduce the severity of inflammation, the affected areas can be washed three times a day with a decoction of coltsfoot, chamomile. 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 decoction can be used.

Surgical methods

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

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

If the disease is complicated by an abscess, the surgeon cuts the skin, subcutaneous fat. Then the doctor opens the abscess capsule, removes its contents, and rinses the resulting cavity with an antiseptic. If areas of necrosis are found, they are immediately excised. Drainage is placed in the wound, facilitating the outflow of its contents, after a while the dissected tissues are sutured. With the development of phlegmon, surgical treatment of erysipelas is carried out in a similar way.

Drainage of the wound after the opening of the abscess.

Physiotherapy

Physiotherapeutic methods can speed up recovery, prevent the development of complications and relapses. Ultraviolet irradiation is used from the first days of the disease, it suppresses 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 performed - a 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, and ozocerite 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.

Prevention

To prevent the development of erysipelas, it is necessary to timely treat foci of chronic inflammation (tonsillitis, sinusitis, caries). Casual and work clothes should be loose, quickly absorb moisture, let air through, and not rub the skin.

It is recommended to take a contrast shower at least once a day, while alternating cool, warm water 3-5 times during the hygiene procedure. Preference should be given to soap, shower gel with a pH slightly less than 7.0, as well as products containing lactic acid. Many bacteria and fungi die in an acidic environment.

It is important to monitor the condition of the skin, especially on the feet, if signs of a fungal infection appear, immediately treat it. Also, local immune protection of the skin is reduced by burns, frostbite, diaper rash, when they appear, it is necessary to treat the affected areas with healing agents, for example, Bepanthen or Panthenol.

In case of circulatory disorders, lymph outflow in the lower extremities, in agreement with the doctor, massage courses can be taken twice a year.

Forecast

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

Complicated, often recurrent 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 the death of a person.

The development of erysipelas is accompanied by a sharp deterioration in general 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, upon confirmation of the diagnosis, will prescribe antibacterial drugs and agents that reduce the severity of general and local symptoms of erysipelas. Treatment with folk methods does not replace drug therapy, it can be carried out only with uncomplicated forms of the disease.

Infectious pathology, which is characterized by damage to the skin and subcutaneous tissue as a result of the penetration of streptococcal infection, is called erysipelas. According to statistics, older men and women are more likely to suffer from it.

General information

The causative agent of the disease enters the damaged skin, as a result, an inflammatory process develops. Immunity after the illness is not formed, so relapses are frequent. Which doctor treats erysipelas? This question worries those who are faced with this problem.

If the first signs of the disease are found, you should contact your local doctor, who, if necessary, will refer you to a surgeon or an infectious disease specialist. There are quite a few complications of the disease (abscess, thrombophlebitis, elephantiasis, necrotic erysipelas, phlegmonous, erythematous) and some of them pose a danger to the life of the individual.

Historical information

The disease of erysipelas has been known since ancient times. Many works of Abu Ali Ibn Sina, Hippocrates and other scientists were devoted to the diagnosis and treatment of this disease. In the second half of the nineteenth century, cases of outbreaks of erysipelas in maternity hospitals and surgical hospitals were described. At that time it was believed that this pathology is highly contact. For the first time, a pure culture of streptococcus was obtained by the scientist Feleizen I. in 1882 from a patient with erysipelas. Further study of the pathogenetic mechanisms and epidemiological features, as well as the effect of the ongoing therapy with sulfonamides and antibiotics, changed the idea of ​​this disease. In Soviet times, erysipelas was also actively studied.

The main factors in the development of erysipelas

Causes of erysipelas:

• constant contact with pollution or chemicals;
• allergic reactions;
• dermatological diseases (contact dermatitis, neurodermatitis);
• viral diseases of the dermis (herpes);
• skin damage: cracks, various wounds, including from the installation of a catheter or other medical devices, insect bites, navel wounds in newborns;
• lymphostasis;
• the presence of chronic pathologies: otitis media, diabetes mellitus, tonsillitis in the chronic stage;
• reduced immunity.

Clinical picture of erysipelas

The incubation period of erysipelas (ICD-10: A46) is short, the inflammation develops rapidly.

At the initial stage, the following symptoms appear:

• body temperature rises to 39 degrees, which lasts up to ten days;
• chills, weakness appear;
• breaks joints and bones;
• convulsions are possible;
• clouding of consciousness (rare);
• bouts of nausea or vomiting.

On the first day of the disease, the places where there are wounds and scars swell, turn red, there is a burning sensation and pain. Lymph nodes located near the affected area enlarge and become painful. Possible formation of blisters and hemorrhages in the wound area.

Further, the disease progresses, the symptoms increase. Apathy develops, sleep is disturbed. The affected area becomes hot, painful, edematous, dense to the touch with clear curved borders resembling flames. Lymph nodes are painful, hard, and limit mobility. From the site of the lesion to the lymph nodes, a strip of pale pink staining appears. Possible increase in pressure, tachycardia. After a few days (about seven), the temperature decreases, the affected area becomes paler, the swelling subsides, the size of the lymph nodes decreases, and there is peeling of the dermis.

Is erysipelas contagious or not? It is contagious to others throughout the entire period while therapy is being carried out.

Various localizations of erysipelas

Erysipelas of the face. It develops both in the primary and in the secondary episode of the disease.

With simultaneous damage to the forehead, cheeks and nose, significant visible changes are observed, the face is distorted. Puffiness of the eyelids during inflammation leads to a narrowing of the palpebral fissures. In some cases, the patient cannot open his eyes. Submandibular lymph nodes enlarge and become painful.

Erysipelas of the scalp. Severe pain in the area of ​​​​inflammation is noted. There is infiltration, redness is rare.

Erysipelas of the upper limbs. Rarely diagnosed. Postoperative lymphostasis of the hand in women after surgery to remove a neoplasm of the mammary gland is a predisposing cause of erysipelas.

Erysipelas of genital organs and perineum. There is extensive swelling of the scrotum and penis in men, labia majora in women. Erythema is localized on the abdomen and pubic region, rarely on the thighs and buttocks.

Erysipelas of mucous membranes. Occurs rarely. The most dangerous is erysipelas and pharynx.

Types of erysipelas

• Wandering or migrating. In this case, the infection spreads through the blood lymph. The lower extremities are primarily affected. The duration of the course is up to several months.
• Metastatic. Inflammatory foci are formed in remote places from the primary localization. The reason is the hematogenous spread of streptococcal infection.
• Periodic. Develops during menstruation. During menopause, regular relapses are noted.
• Recurrent. Occurs frequently. Localization of inflammation is observed at the site of the primary lesion. Remission lasts from several weeks to two years. The development of chronic recurrent erysipelas contributes to improper treatment, diseases of the dermis of a chronic nature (mycosis), the presence of streptococcal infection in the body, frequent hypothermia, microtrauma.
• Repeated. It is diagnosed two years after the primary with a different localization.
• Erysipelas Vikhrov or "gelatinous" recurrent. It develops against the background of elephantiasis. Erythema is mild, there is no clear boundary between healthy and affected dermis.
• White mug Rosenberg-Unna. It is detected in patients with leprosy, tuberculosis, syphilis and other diseases. It is manifested by a sharp swelling of the dermis, soreness. Erythema is absent due to squeezing of blood vessels and intense exudation in the lymph nodes.

Treatment

Immediately after the diagnosis is made, treatment of this disease should begin. First of all, the doctor prescribes antibiotics for erysipelas:

• "Amoxicillin".
• "Ceftriaxone".
• "Bicillin". This drug is also used for prevention.

In addition to antibiotics, doctors prescribe the following groups of drugs:

• antipyretic;
• antihistamines;
• sulfonamides, and in case of intolerance to antibiotics, these are the drugs of choice;
• immunostimulants.

For compresses apply:

• "Furacillin".
• "Dimexide".
• "Enteroseptol".

Do them until complete healing of the wound surface every day.

• "Levomekol". Used as an independent tool.
• Naftalan. It is used together with physiotherapy treatment.

Timely and properly selected therapy leads to a complete recovery. The way of life with this disease does not differ from the usual. For preventive purposes, it is recommended to keep the skin clean. When abrasions, wounds or cracks form, treat them with antiseptic agents.

Folk ways

Treatment of erysipelas at home is possible only after consultation with your doctor. The most popular remedy is Kombucha.

Moisten a piece of gauze with a well-infused and filtered solution and wipe the affected area. Using medicinal for example, coltsfoot, you can make a compress. Impose it daily or alternating with the drug "Levomekol". In addition, some doctors recommend various homeopathic remedies, both for the treatment of erysipelas and its relapses. However, we must remember that the use of the above methods gives a good effect only in combination with traditional therapy.

Preventive action

These include:

• personal hygiene;
• treatment of damaged areas of the dermis with antiseptic agents;
• timely treatment of fungal infections of the feet, nails;
• maintaining immunity;
• wearing loose clothing made of cotton materials;
• health promotion;
• patients with diabetes, follow all the doctor's recommendations;

Important: a prerequisite for the formation of a dangerous form of the disease, namely gangrenous erysipelas, is diabetes mellitus.

If relapse occurs, doctors recommend antibacterial agents to prevent secondary infections. For these purposes, the drug "Bicillin" is usually prescribed. The scheme and duration of its administration is determined by the attending physician and depends on the frequency of relapses.

The whole complex of measures for the prevention of erysipelas is aimed at protecting the body from the pathogen.

Child's erysipelas

According to statistics, boys get this infectious skin disease less often than girls. The disease is characterized by seasonality, and infection occurs mainly in the autumn-summer period. Some selective predisposition or even susceptibility to this streptococcal infection that affects soft tissues is noted. In some children, after the illness, an unstable immunity is formed, and they can get sick more than once. The route of transmission of erysipelas or streptococcus infection occurs:

• through damaged mucous membranes or dermis;
• when using contaminated medical devices or dressing materials;
• in the presence of a streptococcal focus of infection in the body.

The incubation period lasts from several hours to five days. In children, who often suffer from this disease, hypothermia and stress are a prerequisite for its development.

Signs of the disease in children

Erysipelas disease begins acutely, a significant development of intoxication occurs in the initial stage. These symptoms precede the first signs of the disease from several hours to days. During this period, the baby appears:

• general malaise;
• pain syndrome in the muscles;
• chills;
• vomit;
• nausea;
• hypothermia;
• in areas of the dermis, where local manifestations of the disease subsequently appear, pain, burning, and bursting are observed.

The disease progresses quite quickly. Local reactions appear immediately after reaching the peak of fever and intoxication of the body. The most common location for erysipelas is the lower extremities. Initially, a small pink or red spot is formed, which after a few hours takes on a specific appearance. The dermis in the affected area is edematous, hot to the touch, painful on palpation, the existing blisters are filled with fluid and may burst. In their place, yellowish-brown traces remain, which eventually disappear.

Therapy in children

With a mild form of erysipelas and no complications, treatment is carried out on an outpatient basis. Hospitalization is indicated in the following cases:

• small age of the child;
• frequent relapses;
• the presence of serious comorbidities;
• severe course.

For treatment, courses are prescribed using different groups: macrolides, fluoroquinolones, tetracyclines, combined and broad-spectrum drugs. In case of intolerance to antibiotics, ten-day courses of Furazolidone and Delagil are prescribed. In hospital conditions, drugs of the penicillin group, aminoglycosides and cephalosporins are used. If necessary, carry out detoxification therapy. Regardless of where the child is being treated, according to medical indications, the following is prescribed:

• vitamin complexes;
• antipyretics;
• anti-inflammatory drugs;
• diuretics;
• cardiovascular drugs;
• physiotherapy treatment.

Preventive actions

In order to prevent erysipelas in children, parents should follow some recommendations:

• avoid injuries and abrasions of the lower extremities;
• with frequent relapses, carry out prophylaxis with antibacterial drugs that can stop the spread of infection in the child's body;
• if a staphylococcal infection is detected, treat it in a timely manner.

The duration of the medication is determined by the attending physician.

Erysipelas in newborns

In babies, this pathology develops very quickly. Initially, the navel is affected, then the infection spreads throughout the body, capturing the joints and limbs. Develops Erysipelas with lesions of the nose and ears is quite rare. In these cases, a complication in the form of meningitis almost always develops. Perhaps the development of pathology against the background of diaper rash. When pregnant with erysipelas, the fetus develops septic intrauterine infection.

Erysipelas on the leg

The cover of the lower extremities appears. Most of all, individuals who work in unsanitary conditions, who are outdoors for a long time, are susceptible to it. As a result, contact with dust and dirt occurs, which contributes to the entry of streptococcal infection into the body.

The place where the pathological process appeared becomes hot and turns red. Delayed treatment is fraught with serious complications. There are several ways of penetration of staphylococcus, as well as the reasons for the development of this pathology:

• trauma;
• burns;
• insect bites;
• combing;
• chronic tonsillitis;
• untreated caries;
• reduced immunity;
• regular hypothermia of the legs;
• stressful situations;
• excess ultraviolet;
• thrombophlebitis or varicose veins of the lower extremities;
• ulcerative lesions;
• alcoholism.

Causes of the disease

After the incubation period, initial signs begin to appear:

• general weakness;
• temperature rise;
• severe headaches;
• nausea;
• vomit;
• diarrhea;
• muscles feel sore and tired.

Local manifestations appear immediately or after a day.

Forms of the inflammatory process

There are several forms of erysipelas:

• Erythematous. The affected area acquires a reddish even shade, has clear boundaries, the shape of the edges of the spot is irregular.
• Erythematous bullous. Unlike the previous form, after two days the dermis begins to exfoliate and blisters form, inside of which there is a colorless liquid. When the bubble bursts, a crust forms in its place, which has a light brown color. If the disease is not treated, then the blisters, corroding the skin, form trophic ulcers.
• Erythematous-hemorrhagic. This form differs from those described above in that hemorrhages may occur on the affected areas.
• Bullous-hemorrhagic. Unlike erythematous bullous blisters, they fill with blood.

Treatment of erysipelas on the leg

At the first sign of illness, you should contact your local doctor. Self-medication is strictly not recommended. Treatment of erysipelas can be carried out in both inpatient and outpatient settings. In all severe cases, the patient is hospitalized in the surgical department of the hospital. For therapy, the following groups of drugs are prescribed:

• antibacterial;
• sulfanilamide;
• anti-inflammatory;
• diuretics;
• vascular;
• vitamins A, B, C;
• angioprotectors.

Of the physiotherapy procedures, the most effective for erysipelas on the leg are:

• ultraviolet irradiation;
• laser therapy;
• exposure to high frequency current.

Alternative medicine

Folk recipes:

1. Leaves of coltsfoot and chamomile flowers, taken in equal parts, mixed with honey. Treat the affected area with the resulting composition. Do not use in case of allergic reactions to bee products.
2. Prepare a mixture of sour cream and chopped burdock leaf. Apply to the damaged area of ​​the skin.
3. Prepare an infusion of plantain leaves, add honey. Treat the affected areas with the resulting solution.
4. Treating the diseased area with pork fat every two hours will help relieve inflammation.
5. Pound the chalk and sprinkle it on the sore spot of the dermis, apply a compress. The procedure is carried out before going to bed. This method is considered very effective.

Finally

All pathologies caused by streptococcal infection, if left untreated, can lead to serious consequences. The disease of erysipelas in this case is no exception. Complications of the disease: blood poisoning, abscesses, phlegmon, thrombophlebitis, elephantiasis. Thus, only timely provided qualified medical assistance will help to successfully cope with this disease.

Erysipelas (erysipelas) is an infectious-allergic disease that affects the mucous membranes, subcutaneous fat, and skin. It is caused by beta-hemolytic streptococcus, which is why it often recurs. A contagious infectious disease is accompanied by a bright red edema of the affected tissues, intoxication, fever, high temperature. With improper or delayed treatment, erysipelas is complicated by an abscess, secondary pneumonia, purulent inflammation of the fiber (phlegmon).

Erysipelas disease - what is it

Infectious pathology is provoked by pyogenic streptococcus, which affects:

• mucous membranes;
• skin;
• subcutaneous fat.

In the people, erysipelas is called erysipelas. The incubation period ranges from 5-6 hours to 5 days.

What does the lesion look like:

• erythematous (red) spots form on the skin;
• infected tissues swell;
• serous-hemorrhagic foci with vesicles are formed.

In terms of prevalence, erysipelas ranks fourth among other infectious pathologies.

Causes leading to erysipelas

Streptococcus pyogenes is the causative agent of erysipelas, which belongs to opportunistic pathogens. It is a representative of the normal microflora of the laryngopharynx and skin of more than 75% of people. The main source of infection is a carrier of pyogenic streptococci or a person with erysipelas.

Pathogenic microorganisms are transmitted by contact and aerosol, that is, by airborne droplets. The risk of penetration of erysipelas into the body increases when the integrity of the skin is violated. The entry gate for Streptococcus pyogenes is:

• scratches;
• abrasions;
• ulceration on mucous membranes;
• microcracks on the genitals, etc.

With proper timely therapy, erysipelas ends in complete recovery. But with complications, the prognosis is not so optimistic. The disease occurs with a strong weakening of the immune defense. The provocateurs of erysipelas include:

• vitamin deficiency;
• chronic tonsillitis;
• rheumatism;
• scarlet fever;
• myocarditis;
• hypovitaminosis;
• glomerulonephritis.

Streptococci secrete toxic substances (pyrogenic exotoxins, streptolysin), which destroy the cells of the body. They increase vascular permeability, so severe swelling occurs in the affected areas.

Who is more susceptible to the disease

The incidence of erysipelas is on average 20 cases per 10,000 population. Women get sick much more often than men, which is associated with the instability of the hormonal background, the use of contraceptives. In 30% of cases, the pathology is caused by impaired lymph flow and blood flow in the lower extremities.

The risk group includes:

• women after 55-60 years;
• newborns with an umbilical wound;
• suffering from chronic diseases;
• people with the third blood group.

Much more often, erysipelas occurs in people with varicose veins, pathologies of the upper respiratory tract - tonsillitis, sinusitis, chronic rhinitis. Erysipelatous infection enters the body through postoperative wounds, post-traumatic scars, etc.

Classification and symptoms of erysipelas

The modern clinical classification includes various forms of erysipelas, depending on the location, the extent of the foci, the nature of local manifestations, etc. According to the multiplicity of the flow, the following types of erysipelas are distinguished:

• primary - manifests itself for the first time, affects mainly the skin of the face;
• repeated - occurs 2-3 years after the primary infection, but with a different localization;
• recurrent - the infection worsens at intervals of 3-4 months, sometimes more often.

Depending on the localization, there is an erysipelas on the face, legs, back, arms. In adults, the first two types of pathology are more common.

According to the nature of local symptoms, the following forms of erysipelas are distinguished:

• erythematous form. It begins with severe itching, redness and pain in the infected tissues. The first signs appear within 5-6 hours after the penetration of streptococcus into the skin. A day later, a spot with uneven edges forms in the lesion. Due to severe redness and swelling, pain worsens, a feeling of fullness. The patient feels unwell, fever, weakness in the body. In the acute period, an increase in lymph nodes is possible, which are located next to the focus of erysipelas.
• Erythematous bullous. Bubbles with a clear (serous) fluid appear on the skin and mucous membranes. The bullous form is characterized by ulceration of the tissues against the background of the opening of the vesicles. There are also symptoms of fever and lymphadenitis, that is, inflammation of the lymph nodes.
• Erythematous-hemorrhagic. It is diagnosed most often in women over 50 years of age. Erysipelas often affects the perineum, face, and legs. At the site of erythematous spots, hemorrhages occur, which is associated with damage to superficial vessels. The hemorrhagic form is characterized by prolonged fever (up to 14 days).
• Bullous-hemorrhagic. The most severe form of erysipelas, in which vesicles with serous-bloody contents form in the lesions. When the cheeks are infected, areas of necrosis are formed. Because of this, noticeable scars and scars remain, which do not resolve for a long time.

Erysipelas goes through four stages: redness, blistering, ulceration, wound healing. The likelihood of complications depends on the severity:

• Light. Erythematous rashes are limited to small areas of the skin, the symptoms of intoxication are mild. Feverish condition with subfebrile temperature (up to 38°C) lasts no more than 3 days.
• Average. The fever lasts up to 5 days, and the temperature rises to 40°C. Other manifestations of erysipelas are pronounced: weakness, vomiting, headache. The lesions are represented by bullous-hemorrhagic or erythematous-bullous rashes.
• Heavy. Intoxication is pronounced strongly, due to which loss of consciousness is possible. High temperature lasts more than 5 days. In places of tissue infection, complications arise - phlegmon, gangrenous changes.

If the focus goes beyond the anatomical zone, erysipelas infection is considered common (diffuse). A migratory form of erysipelas is also distinguished, in which inflammation subsides in one and aggravates in another part of the body. The most dangerous is metastatic erysipelas. It is characterized by simultaneous damage to tissues remote from each other.

Possible Complications

Hemolytic streptococcus provokes inflammation of damaged blood vessels and tissues. In this regard, erysipelas are complicated:

• purulent pustules;
• phlebitis;
• secondary pneumonia;
• sepsis.

The recurrent form is accompanied by stagnation of the lymph, which causes lymphedema. Also, the possible consequences of erysipelas include phlegmon, persistent skin pigmentation, hyperkeratosis (thickening of the outer layer of the epidermis), eczema. If untreated, erysipelas infection leads to gangrenous changes in the skin and mucous membranes.

Diagnosis of erysipelas

At the first symptoms of erysipelas, they turn to a dermatologist or an infectious disease specialist. The doctor draws attention to the acute onset of pathology, intoxication, severe edema, reddening of tissues, regional lymphadenitis. To determine the causative agent of infection is carried out:

• PCR diagnostics;
• blood chemistry;
• general urine analysis.

The presence of beta-hemolytic streptococcus is indicated by a decrease in the level of antistreptococcal antibodies. Erysipelatous infection should be distinguished from anthrax, scleroderma, dermatitis, Lyme disease, thrombophlebitis, lupus erythematosus.

How is erysipelas treated

The first manifestations of erysipelas are a significant reason for going to the doctor. In 73% of cases, pathology is treated on an outpatient basis. With a severe course of pathology, purulent-necrotic complications, patients are placed in a hospital.

Specific therapy involves taking systemic antibiotics. In the bullous form, physiotherapy is prescribed with the opening of the blisters and local treatment of wounds with antiseptics.

How to treat erysipelas with antibiotics

Treatment of erysipelas is carried out with antibiotics from the group of fluoroquinolones, macrolides, tetracyclines, penicillins, cephalosporins. To destroy a streptococcal infection, the following drugs are used:

• Erythromycin;
• doxycycline;
• Ciprofloxacin;
• Benzylpenicillin;
• Levomycetin;
• Sulfadiazine;
• Azithromycin.

With frequent relapses of erysipelas, antibiotics of two different groups are used simultaneously. Bullous erysipelas is treated with beta-lactams and lincosamides, which include Lincomycin, Clindamycin, Dalacin, etc. The course of antibiotic therapy is from 5 to 10 days.

Medications to relieve symptoms

Pathology is accompanied by severe pain, nausea, itching, malaise, fever. To stop the main manifestations of erysipelas, the following are used:

• antiallergic drugs (Diazolin, Zirtek) - reduce swelling, itching and burning;
• nitrofuran antibiotics (Furadonin, Furazolidone) - inhibit the reproduction of streptococci, destroy their membrane membranes;
• glucocorticosteroids (Betamethasone, Prednisolone) - eliminate puffiness, normalize the outflow of lymph from the lesions;
• proteolytic enzymes (Hyaluronidase, Trypsin) - improve tissue nutrition, dissolve infiltrates.

Also, the treatment of erysipelas involves the use of biostimulants that accelerate tissue healing - Pentoxyl, Methyluracil, etc.

Treatment of the skin around the lesion

To prevent the spread of streptococcal infection, topical antimicrobials are used. For the treatment of the skin of the face and body with erysipelas, the following are used:

• Enteroseptol;
• Oxycyclosol;
• Dimexide;
• microcide;
• Furacilin.

Sterile gauze soaked in an antiseptic is applied to the focus so that the edges of the bandage capture 2 cm of healthy skin. The procedure is performed twice a day for 1.5-2 hours. Erysipelas on the legs and back are treated with powder from crushed Enteroseptol tablets. If the lesion occupies more than 20 cm 2 of the skin, Oxycyclozol spray is used.

Local hygiene

During the period of exacerbation of erysipelas, the patient does not pose a danger to others. But to prevent the spread of infection, he must:

• Change underwear and bedding once a day;
• wear clothes only from natural fabrics;
• take a shower daily without using washcloths;
• wash the area of ​​​​inflammation with a decoction of coltsfoot three times a day;
• at the healing stage, treat ulcers with Kalanchoe juice.

It is undesirable to wet damaged tissues with water until they are completely healed. If an erysipelas infection is localized in the groin area, the skin is washed twice a day with a decoction of calendula.

Physiotherapy

The principles of physiotherapy treatment are determined by the stage of the disease. To combat erysipelas and local manifestations, apply:

• UVI - irradiation of blood with ultraviolet light. It is used at the first sign of erysipelas to reduce inflammation, fever, intoxication, and edema.
• Magnetotherapy - irradiation of the adrenal glands with electromagnetic radiation. Accelerates the production of steroid hormones that eliminate inflammation.
• Ronidase electrophoresis is the introduction of a drug into the body by means of an electric current. Stimulates the outflow of lymph from the affected areas, reduces swelling.
• UHF - heating of tissues with electromagnetic waves of ultrahigh frequency. It is prescribed on the 7th day of illness to improve blood circulation in superficial tissues.
• Infrared therapy - exposure of the skin with an infrared laser. Stimulates local blood circulation, increases the activity of immune cells.

At the healing stage, paraffin applications are used. They eliminate residual effects, prevent the exacerbation of inflammation.

How to boost immunity

Dermatological disease of erysipelas is prone to recurrence. The rate of recovery and the risk of re-infection of tissues depends on the immune status of the patient.

To prevent the reproduction of streptococci, it is necessary:

• Identify and eliminate foci of sluggish inflammation. Carry out antibacterial therapy of chronic tonsillitis, rhinorrhea, sinusitis.
• Restore the intestinal microflora. It is recommended to take drugs with lactobacilli, include fermented milk products in the diet.
• Stimulate the activity of immune cells. To strengthen the immune system, take supplements with echinacea, pink rhodiola.

To restore strength, you need to normalize sleep and wakefulness. At least 8 hours a day are allocated for rest.

How to get rid of erysipelas with folk remedies

Alternative medicine stimulates tissue healing and inhibits the reproduction of pyogenic streptococcus. To combat erysipelas, the following recipes are used:

• Beans. Dried fruits are crushed in a meat grinder. Wet wounds on the body are sprinkled with powder 2 times a day.
• A mixture of herbs. Celery juice and chamomile infusion are mixed in equal proportions. 1 tsp liquids are poured into 15 ml of melted butter. Leave the product in the refrigerator until completely solidified. Ointment is used to treat wounds with severe pain.
• Celery. A bunch of greens is crushed in a blender. The pasty mass is wrapped in gauze and applied to the lesion for 1 hour. Perform the procedure twice a day.

It is undesirable to use folk remedies for purulent and hemorrhagic complications.

Prognosis of treatment and prevention of erysipelas

Erysipelatous disease with adequate antibiotic therapy ends in complete recovery. The prognosis worsens with weakened immunity - hypovitaminosis, HIV infection, chronic pathologies. Mortality from complications (gangrene, phlegmon, sepsis) does not exceed 4.5-5%.

To prevent recurrence of erysipelas, you must:

• observe personal hygiene;
• avoid diaper rash;
• prevent trophic ulcers;
• wear loose clothing;
• use shower gels with pH up to 7.

Personal prevention consists in the timely disinfection of lesions of the mucous membranes and skin. Compliance with the rules of antiseptics when treating abrasions, eliminating foci of sluggish inflammation in the body prevents exacerbation of erysipelas.