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Furunculosis


Multiple boils with lesions that appear simultaneously or sequentially one after the other in different parts of the body are called boils. When it lasts with minor remissions for several years, it is chronic, recurring.
In places lacking hair (palms and the palmar surface of the fingers, soles), boils do not develop. Most often observed in areas of skin exposed to contamination (forearms, rear of the hand) and friction (back of the neck, lower back, gluteus, hips). Usually FURUNCUL does not cause significant disturbances in well-being. The pains are moderate, but with localization, for example, in the external auditory canal, in the nose - significant. In the face (lips, forehead), as well as on the scrotum, boils are accompanied by significant swelling of the surrounding tissues, which is explained by the friability of the subcutaneous tissue here.
A severe clinical course is often observed with boils of the upper lip, nasolabial fold, nose, suborbital (peri-ocular) region. Features of the development of venous and lymphatic networks on the face contributes to the rapid spread of microbes. Vein thrombophlebitis with a facial boil can spread through anastomoses to the venous sinuses of the dura mater, which leads to thrombosis, creating a threat of purulent basal meningitis. Facial edema quickly increases, dense painful veins are palpated, the general condition of the patient sharply worsens, body temperature reaches a high level (40-41 ± C), stiff neck, visual impairment (damage to chiasm) can be expressed.
Complications of boils include lymphangitis and regional lymphadenitis.
Of particular danger are rapidly progressing acute thrombophlebitis and sepsis. Acute thrombophlebitis usually develops with boils located near the large saphenous veins, and sepsis with boils. They are often the result of attempts to squeeze the contents of the boil, cutting it off during shaving, and injury during massage. The prognosis for these complications is very serious.
Treatment:
A thorough skin toilet around the site of inflammation: rubbing with 70% alcohol, 2% salicylic alcohol or lubricating with 1-3% alcohol solution of methylep blue, brilliant green, etc. Hair around the infiltrate is carefully cut. At the very beginning of the process, an abortive effect is sometimes exerted by repeated lubrication of the pustule with tincture of iodine. Ointments with various antiseptics are used only when the focus is opened and emptied from pus. In the presence of necrotic masses hypertonic solutions of sodium chloride are advisable.
Dry heat (heating pad, solux, Minin lamp), as well as UHF, which has a painkiller effect, is shown.
Compresses should not be done, as they contribute to the formation of multiple infiltrates. With boils of the trunk, neck and limbs, stickers should be applied that protect the skin in the area of ​​inflammation from friction. Sometimes at an early stage, the boils are injected with an antibiotic with novocaine or electrophoresis is done with it, however, many surgeons prefer intramuscular injections.
For boils of the face, dressings are usually not applied. Squeezing the contents of the boil and massage in the area of ​​the focus of inflammation is strictly prohibited. At high temperatures, strict bed rest is prescribed, liquid food, the patient is forbidden to talk, chew. It is necessary to begin vigorous antibiotic treatment as soon as possible, and it is advisable to combine them with the intake of sulfa drugs. Surgery is rarely used. However, with the development of phlegmon, it is subject to immediate opening.
In case of recurring boils, nonspecific stimulating therapy is carried out in the form of autohemotherapy (intramuscular injections of auglove in 5-10 ml after 1-2 days, 3-5 injections in total), small doses of canned blood are transfused. In chronic furunculosis, immunization with staphylococcal toxoid, administration of serum hyperimmune, gamma globulin and repeated transfusions of small doses of blood are effective.