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Erysipelas - an infectious disease characterized by focal serous or serous-hemorrhagic inflammation of the skin, fever and intoxication .. More common in women. The pathogen - beta-hemolytic Streptococcus group A - is located in the body of patients in bacterial, or in L-form.

The source of infection of the pathogen may be sick any streptococcal disease (eg, angina, scarlet fever) and streptococcus carrier. The main route of transmission of the causative agent - contact-household. Infection occurs through broken skin - usually microtrauma. Additional important airborne route of transmission.

In most cases, there is self-infection . Sick little contagious. Contributing factors are the persistent violations of lymph circulation, chronic venous insufficiency, fungal skin diseases. Typical summer-autumn season.

The clinical picture. The incubation period - from several hours to 3 - 5 days. By the nature of the local manifestations distinguish erythematous, erythematous-bullous, erythematous-hemorrhagic, bullous-hemorrhagic erysipelas. Depending on the severity of the disease was isolated for easy, moderate and severe. The most common process is localized on the lower limbs and in the face, at least - the upper limbs, very rarely - in the trunk, genitals. The disease begins acutely. In the most typical to moderate having a headache , feeling of fever, weakness, chills, muscle aches. Body temperature rises for several hours to 38 - 39,5 ° C. In some cases there are nausea and vomiting . More than half of patients with the appearance of symptoms of intoxication on 12 - 48 hours ahead of the inflammatory focus development, especially in the localization process in the lower extremities.

The main feature of erysipelas with erythema is clearly demarcated from the unaffected skin uneven winding scalloped edges. Characterized by inflammatory roller on the edge of erythema. The skin in the area of ​​erythema intensely hyperemic, pain on palpation are usually small, mostly on the periphery of the erythema. The skin is tense, hot to the touch, is infiltrated. At the same time there is soft tissue swelling, erythema spreads beyond. Marked regional lymphadenitis . When erythematous-bullosa erysipelas on the background of erythema appear blisters (bullae) containing a transparent yellowish liquid. When erythematous-hemorrhagic erysipelas occur hemorrhages of various sizes - from punctate hemorrhages to extensive and discharge, applicable to all erythema. Bullous-hemorrhagic erysipelas characterized by the presence of haemorrhagic and fibrinous exudate in the bubbles. Bubbles may contain predominantly fibrinous exudate, have flattened character and be tight on palpation.

In less severe disease within a temperature of 38.5 ° C, mild headache . In severe cases the temperature reaches 40 ° C and above, marked a stunning chills, vomiting , delusions , disorders of consciousness, meningeal syndrome, severe tachycardia , hypotension.

Feverish period in patients with erysipelas lasts an average of 4 - 5 days. Acute inflammatory changes in the hearth disappear within 5 - 7 days at erythematous erysipelas, up to 10 - 12 days or more, bullous-hemorrhagic erysipelas. Local changes regress after 7 - 14 days, skin peeling, swelling may persist for up to 1.5 months. Continued during convalescence enlarged regional lymph nodes, skin infiltration at the site of inflammation focus, low-grade fever are prognostically unfavorable for the development of early relapse. Re erysipelas occurs after 2 or more years after a previous disease and has a different localization.

Recurrent erysipelas is usually observed in the localization of inflammatory lesions on the lower limbs. The transition to the primary faces recurrent contribute to chronic skin diseases, especially fungal (athlete, rubrofitii), previous venous insufficiency, lymphostasis, the presence of foci of chronic streptococcal infection. Recurrences developed in a period of several days or weeks to 1 -2 years, their number may reach several tens. Frequent relapses lead to severe disturbances of lymph circulation.

Complications are usually local in nature: skin necrosis, abscesses, cellulitis, thrombophlebitis, lymphangitis, periadenity. When concomitant severe diseases and late begun treatment may develop sepsis , infectious-toxic shock . With frequent relapses are possible lymphostasis and secondary elephantiasis.

Diagnosis is made on clinical grounds. In most patients the blood neutrophilic leukocytosis with stab shift, increased ESR.

The differential diagnosis is carried out with phlegmon, thrombophlebitis, eczema, dermatitis, herpes zoster, erythema nodosum, pseudoerysipelas, cutaneous anthrax, and others.

Treatment in most cases is carried out on an outpatient basis. Indications for hospitalization are severe course of the disease, a common local process, it bullous-hemorrhagic in nature and recurrent erysipelas. When treating patients at home and prehospital administered within 7 - 10 days of antibiotic in tablets and capsules: oletetrin 0.25 g 4 - 6 times a day, methacycline hydrochloride, 0.3 g of 2 - 3 times a day, erythromycin or oleandomitsina phosphate at daily doses up to 2 g, Bactrim (Biseptol) Sulfaton - 2 tablets 2 times a day, morning and evening after meals. In the hospital setting and serious disease shows intramuscular injection of penicillin, with recurrent erysipelas - cephalosporins (cefazolin, klaforan et al.), Lincomycin. Pathogenetic treatments include non-steroidal anti-inflammatory drugs, Ascorutinum complex vitamins. With frequent recurrences of erysipelas shows nonspecific stimulating and immunotherapy (pentoksil, Methyluracilum sodium nukleinat) and prodigiozan, levamisole. The latter two drugs are prescribed only in a hospital. When recurrent erysipelas in some cases used autohemotherapy.

Local treatment of erysipelas is performed only when it bullous forms and localization process on the limbs. Bubbles incision from one of the edges and in the center of inflammation bandage with ethacridine lactate solution (1: 1000) or furatsilina (1: 5000), changing them several times a day. Subsequently, apply a bandage with ekteritsidom, Vinylinum. In the acute phase of the disease can be used ultraviolet irradiation and UHF-therapy, and after calming down of the acute inflammatory process naftalannoy bandage with ointment, applications with paraffin and ozocerite, radon baths, electrophoresis lidazy or calcium chloride to prevent persistent lymphostasis. Patients prescribed not earlier than 7 days after the normalization of body temperature. Underwent a face are registered in the study of infectious diseases for 3 months, and suffering from recurrent rozhey- at least 2 years.

Prevention is a careful personal hygiene, prevention of micro traumas, the processing of micro traumas antiseptics (eg, 5% alcoholic solution of iodine, a solution of brilliant green), readjustment of foci of chronic streptococcal infection. Prevention of recurrent erysipelas provides treatment to relapse predisposing diseases (fungal skin lesions, lymphovenous failure). With frequent, persistent recurrence prophylactically administered bicillin 5 to 1 500 000 IU intramuscularly every 3-5 weeks for 2-3 years. In cases of severe relapse and seasonality of significant residual effects recommended the appointment bitsillina 5-prevention courses lasting 3-4 months.