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Furuncle is a purulent-necrotic inflammation of the hair follicle and surrounding tissues. Localization of boils is diverse, it cannot be only in the area of the palms and soles, as there are no hair follicles there. Favorite localization are: forearm: lower leg, neck, face, buttocks. The diagnosis is made simply - on the basis of inspection and palpation.
Causes of the furunkula
Boils go through several stages of development. The process begins with ostiofolliculitis: a small, painful nodule (follicle) forms in the thickness of the dermis, and a small abscess (pustule) forms at the mouth of the hair. Inflammation can be stopped conservatively.
When extruded, the process deepens, spreading to the hair follicle and surrounding tissue. The stage of infiltration is developing. Pustula is opened, hair falls out. Edema and hyperemia with blurred edges; an infiltrate forms in the center, which rises conically above the skin — it is purple-red above it and thinned. The size of the boil varies from 1 to 2 cm, reactive inflammation of the surrounding tissues may be more extensive.
On the 3-4th day, the stage of abscess formation develops: the infiltration softens, the skin above it breaks out with a release of a small amount of purulent contents and the top of the purulent-necrotic rod is exposed. He can reject with self-healing. The pronounced edema and hyperemia around the boil, the rod intimately welded to the tissues, and localization on the face indicate a “malignant” course of the boil and possible complications. The patient should be referred to a hospital. Of particular danger are boils, localized in the middle part of the face (from the eyebrows - to the corners of the mouth).
Venous blood from this zone enters through the angular veins of the face (vena oftalmiha) directly into the cavernous sinuses of the skull, which can give rise to purulent meningitis. Often, boils on the face are complicated by submandibular abscesses, as the outcome of lymphadenitis.
Boils of other sites, although rare, can cause other complications: lymphangitis and lymphadenitis, more often with limb localization; osteomyelitis, especially when it is localized on the anterior surface of the tibia, with the transition of purulent inflammation to the periosteum; sepsis, when attempting to extrude a rod or scraping granulations, the spread of suppuration as a phlegmonous process with the transition to the carbuncle, the development of phlebitis, thrombophlebitis, in cases of involvement in the inflammatory process of the veins.
Diagnostics of the furunkula
The formation of the diagnosis is made according to the following principles: the diagnosis is indicated - “furuncle”; localization only on a segment of the body, without clarification; stage of the process.
For example: “right lower leg furuncle, stage of infiltration”; "Facial boil, stage of abscess formation." If there are several boils in the same anatomical region, the diagnosis indicates: "multiple boils", the name of the anatomical region and the stage of the process; for example, “multiple body boils in the infiltration stage”.
With multiple boils throughout the body, usually in equal stages of development, which indicates the systemic nature of the disease, a diagnosis is made: "Furunculosis." These patients are referred to a dermatologist.
Treatment of the furunkula
Remediation of chronic infection foci, carbohydrate restriction diet is needed.
With a single furuncle, only local therapy is possible - pure ichthyol, dry heat, UHF, levomikol, levosin, etc., on the opened furuncle. Cloxacillin 500 mg 4 times a day, cephalosporins, syspres 500 mg 2 times a day, rifampia 600 mg / day, once for 7-10 days, clindamycin 150 mg / day, etc.). In case of recurrent chronic course of the process, specific (staphylococcal toxoid, aptifagine, vaccine) and non-specific immunotherapy, vitamins (A, C, B) are also used. In the case of a large boil and extensive necrosis, surgical intervention is used. Different antiseptics and antibacterial ointments are used externally. In case of poor rejection of a necrotic rod, proteolytic enzymes are used (1% trypsin, chemopsip, etc.).