FURUNCLE

FURUNKUL - acute purulent-necrotic inflammation of the hair follicle and surrounding connective tissue. The development of furuncles is caused by golden, less often white staphylococcus. An important role in their occurrence is played by predisposing factors: skin lesions (scratching, abrasions, dermatitis, etc.), contamination by its particles of dust, coal, etc., pyoderma; Endocrine diseases (diabetes, obesity), hypovitaminosis, anemia, alcoholism , hypothermia, etc. About furunculosis speak for multiple and recurring appearance and development of furuncles. Frequently furunculosis occurs against the background of concomitant diabetes.

A furuncle can develop on any site of a skin where there are hair follicles. The most frequent localization is the face, the skin of the neck, the rear of the hands, the waist. First, a dense bright red color inflammatory infiltrate appears, rising above the skin level with a small cone. Patients report slight itching, moderate pain. As the furuncle develops, the infiltrate increases, hyperemia increases, peripheral edema joins. On the 3rd-4th day, necrosis and softening of tissues appear in the center of the infiltrate, which acquire a greenish color, a necrotic stem of the furuncle is formed. During this period, pain is sharply increased, especially when localized in a physiologically active area (for example, in the joint region), there may be fever, headache , malaise. With a favorable course after 2 - 3 days, the purulent-necrotic stem itself is rejected with the formation of a deep moderately bleeding wound. After 2-3 days the wound heals. With the erased flow of the process, a painful infiltrate without suppuration and necrosis is formed. A purulent-necrotic process can spread beyond the hair follicle with the development of a purulent cavity or phlegmon. Single furuncles usually do not cause a general reaction and do not give complications, however in patients with diabetes mellitus it is possible a difficult course of the process. Furuncul can be complicated by lymphangitis, regional lymphadenitis, thrombophlebitis.

The local treatment consists of a thorough dressing of the skin around the focus of inflammation - wiping 70% with a solution of ethyl alcohol, 2% alcohol solution of salicylic acid or smearing with 3% alcohol solution of methylene blue, brilliant green. Hair around the infiltration on the scalp and neck carefully cut. At the very beginning of the process, sometimes it can be stopped by applying a 5% alcohol solution of iodine. Apply obkalyvanie infiltration solutions of antibiotics with novocaine or electrophoresis of antibiotics, which sometimes allows you to prevent abscessing. On the area of ​​a purulent-necrotic stem, a crystalline salicylic sodium or salicylic acid is applied in the center of the furuncle and fixed with a dry bandage, which promotes accelerated rejection of the rod (keratolytic action). With abscessed boils under local anesthesia, an abscess is opened and a careful removal of purulent necrotic masses is performed. After rejection of the rod or removal of necrotic masses, the wound is treated with hydrogen peroxide, a solution of furacilin 1: 5000, and a patch with proteolytic enzymes or with ointment (tetracycline, erythromycin, gentamicin, and synthomycin) is applied. After purification of the wound from purulent necrotic masses, ointment dressings (vinyllin, 5% sintomycin emulsion) are used; Dressings are performed every other day. Assign physiotherapy procedures: ultraviolet irradiation, UHF-therapy, sollyx, etc. When localizing the boil on the limb, it is recommended to ensure its rest. It is forbidden to extrude the contents of the boil and massage in the area of ​​the inflammation focus.

Indication for the hospitalization of patients is the localization of the process on the face because of the danger of drifting the infection through the anastomoses into the cerebral vascular system. In such cases, patients with high body temperature are prescribed strict bed rest, liquid food, prohibit talking, chewing. It is necessary to start antibiotic and detoxification therapy as soon as possible. With recurrent furunculosis, general restorative therapy, specific immunotherapy (antistaphylococcal gamma globulin and staphylococcal anatoxin) are shown.

The furuncle of the vestibule of the nose arises as a result of trauma and scratching with the introduction of infectious agents into the hair follicles. Especially often observed in individuals prone to general furunculosis, in childhood - more often in weakened children.

In the initial stage there is a strong local pain, often giving in the temple, teeth, eyes. The skin on the tip and wing of the nose is swollen, hyperemic, tense and very painful when touching. The body temperature can be increased. When examining the vestibule of the nose, one can see a conical elevation with pronounced hyperemia and swelling of the tissues. Inflammatory swelling can spread to surrounding tissues of the face. Regional lymph nodes (submandibular) slightly increase and become painful on palpation. On the 4th-5th day after the furuncle maturation its spontaneous dissection occurs with the rejection of the necrotic stem. Sometimes severe complications occur (thrombosis of the cavernous sinus, meningitis, phlegm of the orbit), especially after puncturing or squeezing out the furuncle, which leads to the spread of pathogens through the blood vessels to the orbit, cavernous sinus, and the skull cavity.

Treatment at the beginning furuncle is out-patient. On the threshold of the nose every 3 to 4 hours, a sterile gauze turunda moistened with a synthomycin emulsion or Burov liquid solution is administered. You can also use 3% yellow mercury or 1% tetracycline ointment. Rest is necessary; Or parenterally prescribe antibiotics (penicillin, oletetrin, tetracycline , etc.). UHF-therapy, ultraviolet irradiation, autohemotherapy, restorative treatment, gamma globulin, staphylococcal anatoxin are also used. In case of severe course, with the spread of inflammatory swelling to the surrounding areas of the nose and face, urgent hospitalization is necessary.

Furuncle of external auditory canal (limited external otitis) occurs as a result of the introduction of pathogens into the hair follicles and sebaceous glands of the fibrous cartilaginous part of the external auditory canal, facilitated by minor injuries when manipulating the ear with matches, pins, etc. More common in people with diabetes, gout, hypovitaminosis. There are pains in the ear, intensifying with pressure on the tragus, chewing (with the localization of the furuncle on the front wall), stretching the back of the auricle (when localized on the back wall). Regional lymph nodes in the tail area and in front of the tragus increase and become painful on palpation. Sometimes the inflammatory process can spread to the parotid gland. When otoscopy, the furuncle is defined as the elevation of the hyperemic skin. With suppuration in the top of the elevation, a yellow dot is found. Hearing does not suffer. Body temperature usually rises slightly. With therapeutic purpose, the gauze turundas moistened with 70% ethanol solution are administered to the external auditory canal, a warming compress, physiotherapy (solux, UHF currents), autohemotherapy, vitamins are prescribed. Antibiotics and sulfonamide drugs are used in cases of severe inflammatory infiltration and elevated temperature. When an abscess is formed, its opening is shown.