Section description

Purulent diseases of the skin and subcutaneous tissue are a large group of pathologies of various types, including lesions of the skin by a wide variety of infectious agents. Anyone can encounter purulent pathologies.

Causes

Many patients wonder why inflammation occurs under or on the skin? The reasons are usually the following factors:

• penetration of various infectious agents under the skin, which are often pathogenic microorganisms;
• exposure to various physical irritants followed by the addition of an infectious process;
• various mechanical injuries, such as bruises, sprains, can lead to a purulent process;
• Contact with chemical agents is another common cause of skin problems.

Doctors believe that another key factor that is necessary for the development of infection under the skin or on it is a decrease in the body’s immune defense. Often, if immunity is not reduced, the disease simply does not develop even if the infection is in the affected area.

Symptoms

If an area under or on the skin becomes inflamed, patients usually complain of a number of characteristic symptoms, which are difficult to confuse with other diseases. Noteworthy:

• the presence of local redness, strictly limited, without spreading in the initial stages;
• the presence of pain, which can be felt both at rest and when, for example, pressing on the problem area;
• formation in the affected area of ​​a specific red protrusion, at the end of which there may be a white blotch (indicating the presence of a purulent core);
• local hyperthermia (increased skin temperature);
• with active processes affecting large areas, general symptoms may appear, such as increased body temperature, weakness, malaise, nausea, etc.

If general symptoms appear during infection, it is recommended to consult a doctor immediately, as this indicates the progression of the disease.

Kinds

Doctors today distinguish various types of skin inflammation. The division occurs based on the prevalence of the process, the location of the pathological focus and other data.

Abscess

An abscess is a purulent-necrotic process, which is often accompanied by the formation of a cavity, which is limited to the capsule.

Acne

Acne is a disease that most often develops on the face, accompanied by the formation of purulent foci due to improper functioning of the sebaceous glands and hair follicles.

Hidradenitis

Hidradenitis is an inflammation not of adipose tissue, but of the sweat gland, which is often accompanied by the formation of an abscess (the sweat glands in the armpits and groin are mainly affected if the patient neglects the rules of hygiene).

Atheroma

Atheroma is a type of inflammation under the skin that develops as a result of blockage of the sebaceous gland and is considered a tumor-like process.

Impetigo

Impetigo is a type of infectious skin lesion in children and adults, which is provoked by contact with streptococci or staphylococci.

Carbuncle

A carbuncle is a large abscess, most often located on the surface of the skin (several hair follicles are involved in the pathological process).

Felon

Panaritium is an inflammation of the skin that affects only the fingers or toes (the upper extremities are more often affected; the nail plate may be involved in the process).

Paronychia

Paronychia is the localization of an infectious process in the area of ​​the nail fold.

Pyoderma

Pyoderma is a complication that can result from dermatitis, minor injuries and skin cuts of various origins if an infection settles on the wounds.

Bedsores

Bedsores are necrotic changes in tissue due to constant pressure placed on them, often accompanied by a purulent process.

Pimples

Pimples are small formations on the skin filled with purulent contents.

Sycosis

Sycosis is an inflammatory process in the hair follicles that occurs chronically, with regular relapses.

Streptoderma

Streptoderma is an infectious skin disease caused by streptococci, which mainly affects young children.

Trophic ulcers

Trophic ulcers are initially not an infectious, but a trophic process, which over a long period can be complicated by the addition of pathogenic microflora.

Folliculitis

Folliculitis is the involvement of hair follicles in the pathological process, which is accompanied by the formation of small heads on the skin filled with pus.

Furuncle

Furuncle is a melting of the sebaceous gland and hair follicle, which is purulent-necrotic in nature.

Which doctor treats purulent inflammations on the skin?

If purulent-inflammatory skin diseases develop, it is first recommended to consult a dermatologist, since he is the one who treats the skin. A dermatologist, if necessary, can involve a surgeon, infectious disease specialist, allergist and other doctors in working with the patient.

Diagnostics

Diagnosis of the disease is often not difficult, since the pathological focus is located close to the surface of the skin and is visible to the naked eye. To make a diagnosis, a doctor usually needs to visually identify the pathological area.

Additionally, if necessary, it is possible to take discharge and ulcers with subsequent examination to identify the causative agent. Once the causative agent is known, antibiotic susceptibility testing is recommended to improve the effectiveness of therapy.

General principles of treatment

Purulent skin pathologies are not always easy to treat. In this regard, it is recommended to use different tactics for treating children and adults.

Children

• local antibiotic therapy aimed at eliminating the infection;
• active vitamin therapy;
• prescribing a diet that will reduce the likelihood of relapses;
• physiotherapeutic and rehabilitation measures.

Adults

In adults, as in children, conservative treatment is preferred. It is possible to use antibiotics not only locally, but also systemically to achieve the best therapeutic effects. Symptomatic therapy is also carried out, aimed at eliminating signs of the disease that cause inconvenience to the patient (pain relief, dressings, eliminating symptoms of intoxication during an extensive process, etc.).

If the area of ​​inflamed skin is very large, and the pus cannot be removed using conservative methods, surgical intervention is used.

Prevention

Since purulent inflammation of the skin and subcutaneous tissue is often infectious in nature, to prevent pathology it is recommended:

• promptly treat all skin lesions;
• treat chronic diseases that can cause skin damage with the subsequent development of an infectious process;
• observe the rules of hygiene;
• Perform manicures and other similar manipulations with care.

An inflamed area of ​​skin is always unpleasant, especially if the process is accompanied by the release of pus. A timely visit to a doctor will allow you to stop the process in time, preventing it from progressing too much.

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A skin abscess is an intradermal inflammatory process caused by bacterial flora, most often a combination of various microorganisms. Purulent melting affects the hair follicle, the sweat and sebaceous glands next to it, and the surrounding connective tissue. Moreover, it is clearly delimited from healthy structures by a capsule, without a tendency to spread to the sides, causing a deterioration in the general condition of a person when the products of inflammation and pyogenic flora enter the blood. Most often, an abscess develops in the scalp, armpits, neck, lower extremities, area around the anus, and in women also on the labia majora.

Attempts to treat a skin abscess in its initial stages can be made at home. But this is possible if the purulent cavity is not located on the face or neck. In such localization, as well as in the case of a violation of the person’s general condition or the presence of diseases such as diabetes mellitus or various types of immunodeficiencies, treatment is carried out in a surgical hospital.

How does a skin abscess appear?

To imagine the processes that lead to disease, consider the structure of the skin.

Human integumentary tissue is a two-layer organ. On top is the epidermis - a series of cells that protect against microbes, thermal and chemical damage. The lower layer is the dermis.

In the lower layer of the dermis, at the border of the skin and subcutaneous tissue, lie hair follicles formed by connective tissue and blood capillaries. They give rise to hair roots that pass through the dermis and epidermis, protruding outward in the form of hair shafts. In the place where the root passes into the shaft, 2-3 sebaceous glands flow into the area between the outer and middle hair coats. Near the place where the hair comes to the surface, the mouth of the sweat gland opens. All this glandular tissue works to form a protective film on the surface of the skin.

In light of this knowledge, what is a skin abscess? This is a purulent inflammation that develops immediately in a large volume of tissue, which affects the follicle, the sebaceous glands, and the nearby sweat gland. This process develops in stages:

1. Bacterial flora enters places where the integrity of the skin is compromised. A focus of inflammation forms around this place, accompanied by swelling and redness, resulting in a raised area around the follicle.
2. The flow of lymph and tissue fluid into the infected area increases. These fluids attempt to clear the infection from the site.
3. The immune system is activated, which tries to simultaneously kill bacteria and separate the source of inflammation from healthy tissue. As a result, pus is formed - a mixture of leukocytes and other immune cells, dead bacteria, and proteins.
4. Increasing in volume, this content increases interstitial pressure, and when it reaches a critical value, the abscess breaks through. At this stage, complications associated with the entry of foreign proteins and infections into the blood may develop.
5. After opening the abscess, a crater remains, which gradually closes. If purulent inflammation has penetrated into the layers below the skin, a scar will form as a result of healing.

Why does skin purulent inflammation develop?

A skin abscess develops as a result of pathogenic microorganisms entering the skin tissue. This occurs due to injury, friction or severe contamination of the skin. This situation especially often occurs in men when shaving their face and armpits. In women, the cause of infection in the skin is also shaving the legs, as well as removing hair or frequent rubbing when performing hygiene measures in the genital area. Pathology can be caused by festering hematomas and cysts. Often, skin abscesses appear at the site of intradermal (less often) or subcutaneous (more often) injections performed inappropriately.

Local and systemic factors increase the likelihood of infection penetrating the skin. Local ones include:

• increased sweating ();
• hyperactivity of the sebaceous glands (this is typical for conditions accompanied by an increase in the content of male sex hormones in the blood);
• penetration of a foreign object under the skin.

Systemic risk factors are mainly those that cause a decrease in immunity:

• long-term treatment with steroid hormones (dexamethasone, prednisolone, for example, for lupus erythematosus or rheumatoid arthritis);
• diabetes;
• after chemotherapy;
• against the background of hemodialysis sessions for chronic renal failure;
• for HIV infection;
• unbalanced diet;
• hypothermia;
• Crohn's disease and ulcerative colitis.

The infection that is the actual cause of a skin abscess is the flora that is in the air, on human skin, in the secretion of sweat or sebaceous glands, vaginal secretions, or particles of physiological waste remaining on the skin. Most often it is Staphylococcus aureus. It is the most dangerous microbe: it tends to quickly spread into the blood, and from it into the internal organs, causing the appearance of abscesses in them. An abscess can also cause:

1. streptococcus;
2. Protea family;
3. coli;
4. most often – a combination of staphylococcal, streptococcal flora and E. coli.

Skin abscess symptoms

In its development, the disease goes through several stages, which differ in their external manifestations.

At the first stage, redness, dense and painful, appears at the site of injury, injection or former hematoma. At first it is small, but gradually increases in size, reaching even 3 cm. There is always hair in the middle of this infiltration (compaction).

After 3-4 days, the center of the compaction softens and a yellow or white abscess appears in its place, the redness around which no longer spreads, but is still hot to the touch and painful. At this stage, the condition may worsen: the temperature rises (sometimes up to 40°C), appetite decreases, and weakness appears.

Most often, the abscess spontaneously opens and purulent masses are released from it. This is accompanied by an improvement in the condition of both the tissues at the site of formation (they lose pain), and a decrease in temperature, and the disappearance of symptoms of intoxication. If complications develop at this stage, then even after spontaneous opening of the purulent cavity there is no improvement.

When the pus is rejected, the wound remaining in this place heals. If the inflammation has affected only the skin layers, after healing, a small light or dark spot remains, which soon disappears. If deeper layers are destroyed, or if the abscess was located at a site above the bone, a scar will remain due to healing.

Features of the localization of some skin abscesses

Facial skin abscess occurs very often. This is the most common location of the abscess, since the skin of the face is richest in sebaceous glands. Most often, abscesses appear on the lip, nose, and in the area of ​​the ear canal. Located in the area of ​​the nasolabial triangle, they are dangerous for the spread of infection into the cranial cavity. Like an abscess of the scalp, its facial localization is often accompanied by headache, fever, and general malaise. Here, such symptoms, unlike abscesses of other localizations, do not always mean the development of complications, but still require examination.

Local symptoms of a skin abscess on the leg correspond to those described above. In addition to them, inflammation of the lymph nodes and lymphatic vessels often develops, through which lymph flows away from the source of infection.

Diagnostics

The fact that a formation on the skin discovered by a person is a skin abscess can be said by a surgeon, therapist or dermatologist already during the initial examination. But to prescribe the correct treatment, the doctor will need to open the formation and culture its contents on various nutrient media in order to determine the pathogen and its sensitivity to antibiotics. Simply performing a puncture (puncture) of the abscess for the purpose of sowing is inappropriate - this can spread the infection to the underlying tissues.

If there is a general disturbance in the condition: fever, cough, loss of appetite or decrease in the amount of urine, diagnostics (ultrasound, X-ray and laboratory) of the condition of the kidneys, liver, and lungs are carried out.

Treatment

Therapy at home

Skin abscess can often be treated at home. To do this, it is recommended to first test with the drug “Dimexide”, diluting it four times with boiled water and applying it to the skin of the inside of the forearm. If there is no visible redness, blister or itching after 15 minutes, this drug can be used to treat the purulent process. For this:

1. Dilute “Dimexide” (“Dimethyl sulfoxide”) 3-4 times with boiled water.
2. Wet sterile gauze with the solution (it will be hot).
3. Apply gauze to the abscess and cover with polyethylene on top.
4. Secure the compress with a bandage or gauze bandage.

To improve the effect, and in the absence of an allergy to antibiotics, you can sprinkle the gauze with Penicillin, Ceftriaxone, Gentamicin or Ampicillin before applying cellophane.

You can do similar manipulations with:

a) saline solution: 1 tsp. salt per glass of boiled water;

b) peel of baked onion;

c) fresh grated raw potatoes;

d) grated laundry soap, which is mixed with 2 parts of warm milk, boiled for 1.5 hours over low heat until the consistency of sour cream. After cooling it can be used.

Similar compresses, except for the one with baked onion peel, are used throughout the whole day, changing the composition to a new one every 3-4 hours. Onion is applied for 1 hour 3 times a day.

Attention! Compresses should not be warm!

Surgical removal

Treatment of a skin abscess by a surgeon is carried out in cases where:

• a skin abscess appeared in a patient with diabetes mellitus;
• an abscess appeared on the face, especially in the area of ​​the nasolabial triangle;
• the boil does not go away within 3 days or there is a tendency for it to increase;
• body temperature increased;
• the abscess does not open;
• new skin abscesses have appeared;
• localization of the abscess - on the spine, in the buttocks or around the anus.

In these situations, the doctor resorts to opening the abscess with a scalpel, under local anesthesia. The abscess cavity is washed out of pus with antiseptics, but then not sutured to prevent re-suppuration, and a piece of sterile glove is inserted into it, through which the pus will come out. After such a minor operation, antibiotic tablets are prescribed.

Pathological anatomy Marina Aleksandrovna Kolesnikova

15. Purulent inflammation

15. Purulent inflammation

In purulent inflammation, the exudate is represented by polymorphonuclear leukocytes and includes dead leukocytes and destroyed tissue. Color ranges from white to yellow-green. Ubiquitous localization. The reasons are varied; First of all, coccal flora. The pyogenic flora includes staphylococci and streptococci, meningococci, gonococci and coli - intestinal, pseudomonas. One of the pathogenicity factors of this flora is the so-called leukocidins; they cause an increase in the chemotaxis of leukocytes towards themselves and their death. Subsequently, when leukocytes die, factors are released that stimulate the chemotaxis of new leukocytes at the site of inflammation. Proteolytic enzymes, which are released during destruction, are capable of destroying both their own tissues and those of the body. Therefore, there is a rule: “if you see pus, release it” in order to prevent the destruction of your own tissues.

The following types of purulent inflammation are distinguished.

1. Phlegmon - diffuse, diffuse, without clear boundaries, purulent inflammation. Diffuse infiltration of various tissues by leukocytes occurs (most often - subcutaneous fat, as well as the walls of hollow organs, intestines - phlegmonous appendicitis). Phlegmonous inflammation can occur in the parenchyma of any organ.

2. Abscess – focal, limited purulent inflammation. There are acute and chronic abscesses. An acute abscess has an irregular shape, an unclear, blurred border, and no disintegration is observed in the center. A chronic abscess has a regular shape, with clear boundaries and a zone of decay in the center. The clarity of the border is due to the fact that connective tissue grows along the periphery of the abscess. There are several layers in the wall of such an abscess - the inner layer is represented by a pyogenic membrane made of granulation tissue, and the outer part of the wall is formed by fibrous connective tissue. When the abscess is connected to the external environment through anatomical channels (in the lungs), an air space is formed in the cavity, and the pus is located horizontally (this is noticeable on the x-ray).

3. Empyema – purulent inflammation in anatomical cavities (empyema of the pleura, maxillary sinuses, gall bladder). The outcome of purulent inflammation depends on the size, shape, and location of the lesions. Purulent exudate can resolve, sometimes sclerosis develops - scarring of the tissue.

A complication in the form of erosion of surrounding tissues by proteolytic enzymes can lead to the formation of fistulas - channels through which the abscess empties outward (self-cleaning) or into the serous membrane (for example, a lung abscess can lead to the development of pleural empyema, liver - to purulent peritonitis, etc. ); bleeding; exhaustion; intoxication, etc.

13. Inflammation Inflammation is a complex protective stromal-vascular reaction of the body in response to the action of a pathological factor. According to the etiology, 2 groups of inflammation are distinguished: 1) banal; 2) specific. Specific is the inflammation that is caused

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Purulent diseases of the skin and subcutaneous tissue include pathological phenomena such as boils, abscess, hidradenitis, carbuncle, phlegmon, etc. Most often, the causative agent of such diseases is staphylococcal flora (70-90%), and factors in the development of purulent-inflammatory diseases of the skin and subcutaneous fat include a decrease in general and local resistance and immune defense of the body and the presence of a sufficient amount of microflora for the development of the disease.

Types of purulent skin inflammations and their treatment

Furuncle

A furuncle is a purulent-necrotic inflammation of the hair follicle, as well as the tissues that surround it. During development, inflammation covers the sebaceous gland and surrounding tissues. The causative agent is predominantly Staphylococcus aureus, and contributing factors are pollution and non-compliance with hygiene standards, cracks, hypothermia, vitamin deficiencies and a number of others. Boils do not develop on hairless skin.

Treatment of boils carried out according to the general canons of treatment of surgical infection. It is important that when the boil is located above the nasolabial fold, it is necessary to carry out active detoxification, antibacterial, anti-inflammatory, restorative therapy; bed rest is required, as well as a ban on chewing and talking. Food should only be served in liquid form. The ancient formula is especially important here - squeezing out a boil on the face is deadly!

In case of chronic recurrent furunculosis, in addition to general and local treatment, it is also important to undergo nonspecific stimulating treatment in the form of autohemotherapy. The method of transfusion of small doses of preserved blood, immunization with staphylococcal toxoid, γ-globulin, subcutaneous administration of an autovaccine or staphylococcal vaccine are also used. After immunogram analysis, immunostimulating treatment is often prescribed to correct immunodeficiency, laser irradiation of autologous blood and ultraviolet irradiation.

Carbuncle

The fact that confluent purulent-necrotic inflammation affects several hair follicles and sebaceous glands, resulting in extensive general necrosis of the skin and subcutaneous tissue. More often this pathology is provoked by staphylococcus, but infection with streptococcus is also possible. When extensive necrosis forms, suppuration develops around it. Signs of intoxication are noticeable. Complications in the form of lymphangitis, thrombophlebitis, lymphadenitis, sepsis and meningitis are also possible.

Treatment of carbuncle carried out in a hospital, and bed rest is required. Under general anesthesia, excision of the purulent-necrotic lesion is performed. In this case, restorative, detoxification, anti-inflammatory, antibacterial treatment is mandatory. If the process develops on the face, liquid nutrition and a ban on talking are prescribed.

Hidradenitis

Purulent inflammation of the apocrine sweat glands located in the armpits is called “hidradenitis.” The process can also develop in the perineum and in women in the nipple area.

An infection penetrates through the lymphatic vessels or through damaged skin through the ducts of the glands and a painful dense nodule appears in the skin, and the process ends with the spontaneous opening of the abscess with the formation of a fistula. The infiltrates merge and a conglomerate with multiple fistulas appears.

Hidradenitis differs from a boil in the absence of pustules and necrosis. In addition, hidradenitis develops in the thickness of the skin, and other types of lymph node damage develop in the subcutaneous tissue.

Mainly using radical surgery and excising conglomerates of inflamed sweat glands. Another option is anti-inflammatory radiation therapy. In case of relapses, specific immunotherapy and restorative drugs are prescribed.

Abscess or ulcer

An abscess, or abscess, is a limited accumulation of pus in various organs or tissues.

An abscess can develop as a result of infection penetrating through damaged skin, but it can also be the result of a complication of local infections such as boils, hidradenitis, lymphadenitis, etc., or metastatic abscesses due to sepsis.

Treatment of abscesses involves both drug therapy and surgery.

Phlegmon

Phlegmon is a diffuse inflammation of intermuscular, subcutaneous, retroperitoneal and other tissue. The development of phlegmon is initiated by both aerobic and anaerobic microbes. Phlegmons are divided into serous, purulent and putrefactive. For the serous form, conservative treatment is possible, but other forms are treated according to the general principles of treating surgical infections.

characterized by the formation of purulent exudate. It is a mass consisting of tissue detritus from the source of inflammation, cells, and microbes. The exudate contains granulocytes, lymphocytes, macrophages, and often eosinophilic granulocytes. The cause of purulent inflammation is pyogenic microbes - staphylococci, streptococci, gonococci, typhoid bacillus.

Purulent exudate has a number of qualities that determine the biological significance of this form of inflammation. It contains various enzymes, primarily proteases, capable of breaking down dead and dystrophically changed structures at the site of damage, including collagen and elastic fibers, therefore tissue lysis is characteristic of purulent inflammation.

The main forms of purulent inflammation are abscess, phlegmon, empyema, purulent wound.

Abscess

Phlegmon

Unlimited purulent diffuse inflammation, in which purulent exudate permeates and exfoliates the tissue. The formation of phlegmon depends on the pathogenicity of the pathogen, the state of the body's defense systems, as well as on the structural characteristics of the tissues in which it originated and where there are conditions for the spread of pus.

Phlegmon can be soft if lysis of necrotic tissue predominates, and hard when coagulative necrosis of tissues that are gradually rejected occurs in the phlegmon.

Phlegmonous inflammation can be complicated by thrombosis of blood vessels, resulting in necrosis of the affected tissues. Purulent inflammation can spread to the lymphatic vessels and veins, and in these cases purulent thrombophlebitis and lymphangitis occur. Healing of phlegmonous inflammation begins with its delimitation followed by the formation of a rough scar. If the outcome is unfavorable, generalization of the infection may occur with the development of sepsis.

Empyema

This is a purulent inflammation of body cavities or hollow organs. The cause of the development of empyemas is both purulent foci in neighboring organs (for example, a lung abscess and empyema of the pleural cavity), and a violation of the outflow of pus during purulent inflammation of hollow organs - the gallbladder, appendix, fallopian tube.

Purulent wound

A special form of purulent inflammation, which occurs either as a result of suppuration of a traumatic, including surgical, or other wound, or as a result of the opening of a focus of purulent inflammation into the external environment and the formation of a wound surface.