Treating a rash

Etiotropic treatment of erysipelas

Treatment of erysipelas in a polyclinic setting involves prescribing one of the following antibiotics orally: azithromycin - 0.5 g on the 1st day, then 0.25 g once a day for 4 days (or 0.5 g for 5 days); spiramycin - 3 million IU twice a day; roxithromycin - 0.15 g twice a day; levofloxacin - 0.5 g (0.25 g) twice a day; cefaclor - 0.5 g three times a day. The course of treatment is 7-10 days. In case of intolerance to antibiotics, chloroquine is used at 0.25 g twice a day for 10 days.

In a hospital setting, treatment of erysipelas is carried out using benzylpenicillin at a daily dose of 6 million IU intramuscularly for 10 days.

Reserve drugs - first-generation cephalosporins (cefazolin in a daily dose of 3-6 g or more intramuscularly for 10 days and clindamycin in a daily dose of 1.2-2.4 g or more intramuscularly). These drugs are usually prescribed for severe, complicated erysipelas.

In severe cases of erysipelas and development of complications (abscess, phlegmon, etc.), a combination of benzylpenicillin (in the indicated dose) and gentamicin (240 mg once daily intramuscularly), benzylpenicillin (in the indicated dose) and ciprofloxacin (800 mg intravenously by drip), benzylpenicillin and clindamycin (in the indicated doses) is possible. Prescription of combined antibacterial therapy is justified for bullous-hemorrhagic erysipelas with abundant fibrin effusion. In these forms of the disease, other pathogenic microorganisms are often isolated from the local inflammatory focus (beta-hemolytic streptococci of groups B, C, D, G; Staphylococcus aureus, gram-negative bacteria).

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Pathogenetic treatment of erysipelas

In case of pronounced skin infiltration in the inflammation focus, NSAIDs (diclofenac, indomethacin) are indicated for 10-15 days. In case of severe erysipelas, parenteral detoxification treatment of erysipelas is performed (polyvidone, dextran, 5% glucose solution, polyionic solutions) with the addition of 5-10 ml of 5% ascorbic acid solution, 60-90 mg of prednisolone. Cardiovascular, diuretic, antipyretic agents are prescribed.

Pathogenetic treatment of erysipelas, namely local hemorrhagic syndrome, is effective when started early (in the first 3-4 days), when it prevents the development of extensive hemorrhages and bullae. The choice of drug is carried out taking into account the coagulogram data. In case of severe hypercoagulation, treatment with heparin sodium (subcutaneous administration at a dose of 10-20 thousand U or 5-7 electrophoresis procedures), pentoxifylline 0.2 g three times a day for 2-3 weeks is indicated. In the absence of hypercoagulation, it is recommended to administer directly into the inflammation site by electrophoresis of the protease inhibitor - aprotinin (the course of treatment is 5-6 days).

Treatment of patients with recurrent erysipelas

Treatment of this form of erysipelas is carried out in a hospital setting. It is necessary to prescribe reserve antibiotics that were not used to treat previous relapses. First-generation cephalosporins are prescribed intramuscularly 0.5-1 g 3-4 times a day. The course of antibacterial therapy is 10 days. In case of frequently recurring erysipelas, a 2-course treatment is advisable. First, antibiotics that are optimally effective against bacterial forms and L-forms of streptococcus are prescribed. Thus, cephalosporins are used for the first course of antibiotic therapy (10 days), after a 2-3-day break, a second course of treatment with lincomycin is carried out - 0.6 g three times a day intramuscularly or 0.5 g orally three times a day (7 days). In case of recurrent erysipelas, immunocorrective therapy is indicated (methyluracil, sodium nucleinate, prodigiosan, thymus extract, azoximer bromide, etc.). It is advisable to study the immune status dynamically.

Local treatment of erysipelas is carried out for the bullous form of erysipelas with the process localized on the extremities. The erythematous form of erysipelas does not require the use of local agents (bandages, ointments), and many of them are contraindicated (ichthammol, Vishnevsky ointment, ointments with antibiotics). Intact blisters are carefully cut at one of the edges and after the exudate comes out, bandages with a 0.1% solution of ethacridine or 0.02% solution of furacilin are applied, changing them several times a day. Tight bandaging is unacceptable. In case of extensive weeping erosions, local treatment begins with manganese baths for the extremities and then the above-mentioned bandages are applied. For the treatment of local hemorrhagic syndrome in erythematous-hemorrhagic erysipelas, 5-10% butylhydroxytoluene liniment (twice a day) or 15% aqueous solution of dimephosphone (five times a day) are used in the form of applications for 5-10 days.

Additional treatment for erysipelas

In the acute period of erysipelas, suberythemal doses of ultraviolet radiation are traditionally prescribed to the area of inflammation and exposure to ultra-high frequency currents to the area of regional lymph nodes (5-10 procedures). If skin infiltration, edematous syndrome, and regional lymphadenitis persist during the convalescence period, ozokerite applications or bandages with heated naphthalan ointment (on the lower extremities), paraffin applications (on the face), lidase electrophoresis (especially in the initial stages of elephantiasis), calcium chloride, radon baths, and magnetotherapy are prescribed.

In recent years, high efficiency of low-intensity laser therapy in treatment of local inflammatory syndrome in various clinical forms of erysipelas has been established. Normalizing effect of laser radiation on altered hemostasis parameters in patients with hemorrhagic erysipelas has been noted. Usually, a combination of high and low frequency laser radiation is used in one procedure. In the acute stage of the disease (with pronounced inflammatory edema, hemorrhages, bullous elements), low-frequency laser radiation is used, in the convalescence stage (to enhance reparative processes in the skin) - high-frequency laser radiation. Duration of exposure to one radiation field is 1-2 minutes, and the duration of one procedure is 10-12 minutes. If necessary, before the laser therapy procedure (in the first days of treatment), the inflammation site is treated with a solution of hydrogen peroxide to remove necrotic tissue. The course of laser therapy is 5-10 procedures. Starting from the second procedure, laser exposure is carried out (using infrared laser therapy) on the projection of large arteries, regional lymph nodes.

Bicillin prophylaxis of erysipelas recurrences is an integral part of the complex treatment of patients suffering from the recurrent form of erysipelas. Preventive intramuscular administration of bicillin-5 (1.5 million U) or benzathine benzylpenicillin (2.4 million U) prevents relapses of the disease associated with reinfection with streptococcus. If foci of endogenous infection persist, these drugs prevent the reversion of L-forms of streptococcus to the original bacterial forms, which helps prevent relapses. Antihistamines (chloropyramine, etc.) are recommended to be administered 1 hour before the administration of bicillin-5 or benzathine benzylpenicillin.

In case of frequent relapses (at least three in the last year), the method of continuous (year-round) bicillin prophylaxis for one year or more with a 3-week interval of drug administration is advisable (in the first months, the interval can be reduced to 2 weeks). In case of seasonal relapses, the drug is administered 1 month before the onset of the season of the disease in the patient with a 3-week interval for 3-4 months annually. In the presence of significant residual effects after erysipelas, the drug is administered at an interval of 3 weeks for 4-6 months.

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Diet for erysipelas

The regimen depends on the severity of the course. Diet: general table (No. 15), plenty of fluids. In the presence of concomitant pathology (diabetes, kidney disease, etc.), an appropriate diet is prescribed.

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Approximate periods of incapacity for work

Inpatient and outpatient treatment of erysipelas lasts 10-12 days for primary, uncomplicated erysipelas and up to 16-20 days for severe, recurrent erysipelas.

Clinical examination

The following patients are given a medical examination:

• with frequent, at least three in the last year, recurrences of erysipelas:
• with a pronounced seasonal nature of relapses:
• having prognostically unfavorable residual effects upon discharge from the department (enlarged regional lymph nodes, persistent erosions, infiltration, swelling of the skin in the area of the lesion, etc.).

The duration of the medical examination is determined individually, but it should be at least one year after the illness, with a frequency of examination of at least once every 3-6 months.

Rehabilitation of patients who have had erysipelas (especially in the case of recurrent disease and the presence of underlying diseases) includes two stages.

The first stage is the period of early convalescence (immediately after discharge from the specialized department). At this stage, depending on the patient's condition, it is recommended:

• paraffin and ozokerite treatment:
• laser therapy (mainly in the infrared range);
• magnetic therapy:
• high-frequency and ultra-high-frequency electrotherapy (as indicated);
• local darsonvalization;
• ultra-high frequency therapy;
• electrophoresis with lidase, iodine, calcium chloride, sodium heparin, etc.;
• radon baths.

The necessary treatment of erysipelas is carried out differentially, taking into account the age of the patients (60-70% of all cases are people over 50 years old), the presence of severe concomitant somatic diseases,

An important factor that must be taken into account when carrying out rehabilitation measures is the presence of fungal skin diseases in patients (in most cases). In this regard, an essential element of complex rehabilitation after erysipelas is therapy for fungal skin diseases.

Treatment of erysipelas can be carried out with bicillin prophylaxis.

The second stage is the period of late convalescence.

Depending on the patient's condition and the presence of background diseases, the above-described complex of physiotherapeutic procedures can be used in this period. The frequency of rehabilitation courses (1-2 times or more per year) is determined by the doctor.

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Patient information sheet

It is advisable to change your lifestyle: avoid unfavorable working conditions associated with frequent hypothermia, sudden changes in air temperature, dampness, drafts; microtraumas of the skin and other occupational hazards; avoid stress.

To prevent relapses of the disease (on an outpatient basis or in specialized departments under the supervision of a specialist doctor), it is recommended:

• timely and complete antibiotic therapy for the primary disease and relapses;
• treatment of severe residual effects (erosions, persistent swelling in the area of the local lesion), consequences of erysipelas (persistent lymphostasis, elephantiasis);
• treatment of long-term and persistent chronic skin diseases (mycosis, eczema, dermatoses, etc.) leading to disruption of its trophism and serving as entry points for infection:
• treatment of foci of chronic streptococcal infection (chronic tonsillitis, sinusitis, otitis, etc.);
• treatment of disorders of lymph and blood circulation in the skin resulting from primary and secondary lymphostasis, chronic diseases of the peripheral vessels;
• treatment of obesity, diabetes mellitus (often decompensated during childbirth).

What is the prognosis for erysipelas?

Erysipelas has a favorable prognosis if treatment for erysipelas is started in a timely manner. However, in individuals with severe concomitant diseases (diabetes mellitus, cardiovascular failure), a fatal outcome is possible.