Erysipelas is a chronic form. Erysipelas are infectious diseases. List of preventive measures after recovery

Erysipelas is a bacterial infection of the skin involving its upper layer - the dermis. The spread of pathological processes into the superficial skin lymphatic vessels is characteristic. Erysipelas is a sensitive, highly erythematous, dense surface on the skin with sharply defined boundaries. The specific symptoms of the disease make it possible to differentiate it well from other skin infections, for example, cellulite.

Erysipelas has been known since the Middle Ages, where it was called St. Anthony's fire, in honor of the Christian saint who suffered from this disease and tried to be healed. Around 1095, in France, the Order of St. Anthony was created - a Roman Catholic community dedicated to caring for those suffering from erysipelas.

Causative agents of erysipelas and its classification

Streptococci are the main causative agents of erysipelas. Most infections of the facial areas belong to this group of microorganisms, while the development of erysipelas on the lower extremities is now also associated with this pathogen. Streptococcal toxins are thought to contribute to the site of inflammation, which is very characteristic of this infection. There is no clear evidence that other bacteria cause erysipelas, although they coexist with streptococci at erysipelas sites.

The role of Staphylococcus aureus remains controversial. There is no convincing evidence showing the pathogenic role of staphylococci in the development of typical erysipelas. A predictable negative reaction of infection to penicillin, even in the presence of Staphylococcus aureus, opposes this microorganism as an etiological agent.

Risk factors for the development of erysipelas are:

• Lymphatic obstruction or edema.
• Injections into the saphenous veins of the lower extremities.
• Post-radical mastectomy status.
• Decreased immunity, including in patients with diabetes, alcoholism, or who are infected with the human immunodeficiency virus (HIV).
• Arteriovenous insufficiency.
• Paretic limbs.
• Nephrotic syndrome.
• Wandering lifestyle.

Bacterial contamination in the area of ​​injury on the skin is the initial event in the development of erysipelas. Thus, additional factors can play the role of a gateway to infection, these are:

• Venous insufficiency.
• Trophic ulcers.
• Inflammatory dermatoses,
• Dermatophytosis,
• Insect bites.
• Surgical incisions.

The source of bacteria on the face is often the nasopharynx and a history of recent streptococcal pharyngitis. Pre-existing lymphedema is a common risk factor for the incidence of erysipelas. Recurrent erysipelas complicating lymphedema due to breast cancer treatment are well known. Thus, subclinical lymphatic dysfunction is also a risk factor for the development of the disease.

How to recognize an erysipelas on the leg - the main symptoms

Patients often cannot remember the event preceding the development of erysipelas, but a history of recent trauma or pharyngitis is often mentioned. Prodromal symptoms such as malaise, chills, and high fever often develop before the onset of lesions within 48 hours. Itching, burning, pain and swelling in the future erysipelas are typical complaints.

Other symptoms may include the following:

• Muscle and joint pain.
• Nausea.
• Headache and other systemic manifestations of the infectious process.
• Concomitant diseases often include diabetes mellitus, hypertension, chronic venous insufficiency and other cardiovascular diseases.

The development of erysipelas on the lower extremities accounts for 70-80% of the total number of patients, and the facial part accounts for 5-20%.

The patient's condition may be satisfactory or show signs of serious toxicity depending on the extent of infection. Erysipelas begins as a small spot that progresses erythematous to a fiery red, firm, tense, shiny area.

The lesion of the classic appearance has sharply defined boundaries with clear demarcations from healthy skin, in contrast to cellulite, when the boundaries of redness are smoother. Local signs of inflammation, such as local warmth, swelling and tenderness, are universal. Lymphatic involvement often manifests as overlying streaks of skin and regional lymphadenopathy. The erythema is irregular, with extensions that may cross the lymphatic channels - lymphangitis.

More severe manifestations of infection may include numerous blisters and blisters along with petechiae and even outright necrosis.

Methods for diagnosing erysipelas

With the classic manifestation of erysipelas, no additional laboratory tests are required for diagnosis. However, leukocytosis and elevated erythrocyte sedimentation rate and C-reactive protein are common features. Regular testing of blood and tissue cultures is not effective, since such methods are not very informative in indicating the status of disease development.

Imaging studies are also performed due to unnecessary reasons. Magnetic resonance imaging (MRI) and bone scintigraphy are useful if bone involvement is suspected. Under these conditions, standard radiographic findings are usually normal.

Histological signs of erysipelas are expressed in the form of cutaneous edema, vasodilation and streptococcal invasion of lymphatic tissues. The results of such an attack are the appearance of a skin inflammatory infiltrate consisting of neutrophils and mononuclear cells. Often the involvement of the epidermis is secondary. Bacterial invasion of local blood vessels is rarely seen.

Bacterial cultures show a positive result in only 5% of cases. However, cultures are useful when the diagnosis or treatment of bacteremia is in terms of metastatic infection.

In addition, bacterial cultures may be effective in patients with prosthetic heart valves or intravascular devices, as well as those suffering from weakened immunity or severe toxic manifestations.

How to treat legs if erysipelas is diagnosed

The symptoms of erysipelas do not threaten the patient’s life and, in most cases, disappear after antibiotic therapy without complications. However, prompt treatment of the condition is very important as the disease has a potentially rapid progression. In addition to administering antibiotics, patient care includes the following:

• Symptomatic treatment of pain and fever.
• Hydration (oral if possible).
• Cold compresses.
• Placing the affected leg above the spinal line in a supine position is recommended to reduce local swelling, inflammation and pain.
• Salty wet dressings should be applied to ulcerated and necrotic lesions, with periodic replacement every 2-12 hours, depending on the severity of the infection.

Surgical debridement is only necessary for severe infections with necrosis or gangrene.

Hospitalization for close monitoring and administration of intravenous antibiotics is recommended in severe cases, as well as in children, the elderly and immunocompromised patients. Inpatient treatment is also recommended for patients who are unlikely to complete treatment on their own as a result of psychosocial or economic circumstances, or the presence of a significant underlying medical condition.

Patients suffering from acute infections involving the extremities should be limited in physical activity and should keep their extremities elevated in a more elevated position to reduce swelling.

Most patients suffering from erysipelas respond very well to conventional antibiotic therapy. However, for atypical infections that are resistant to first- and second-line drugs, additional adjustments to therapeutic regimens may be useful. Consultation with a dermatologist may be necessary if the diagnosis is unclear.

As already noted, streptococci are the main causative agent of erysipelas in most cases. Thus, penicillin remains the first-line antibiotic of treatment. The drug is administered orally or intramuscularly, which is quite sufficient for most cases of classic manifestations of erysipelas, and is continued for 5 days. If the patient's condition does not improve, the duration of treatment should be increased.

First generation cephalosporins or macrolides such as erythromycin or azithromycin may be used if the patient is allergic to penicillin. Cephalosporins may cross-react with penicillin and should be used with caution in patients with a history of severe penicillin allergy, such as anaphylaxis.

Staphylococcus aureus-specific agents are usually not required, but should be considered in patients who do not improve with penicillin or with atypical forms of erysipelas, including bullous erysipelas. Some authors believe that facial erysipelas should be treated with antibiotics such as dicloxacillin or nafcillin.

Drugs such as roxithromycin and pristinamycin can be extremely effective in treating erysipelas. Several studies have demonstrated greater effectiveness of these agents and fewer side effects compared to penicillin.

Patients with recurrent erysipelas should be aware of local antiseptic and general wound care options. Predisposing diseases of the lower extremities associated with skin lesions, for example, herpes zoster, leg rash, trophic ulcers, dermatitis, require special attention in order to prevent the development of severe consequences. The use of compression stockings should be continued until one month after the erysipelas have disappeared.

Long-term prophylactic antibiotic treatment is often used, and treatment regimens must be tailored to the patient. For these purposes, benzathine, penicillin or erythromycin are used for 4-52 weeks.

Possible complications, prognosis and prevention

The prognosis for patients cured of erysipelas is usually favorable. Infectious complications are not life-threatening and in most cases can also be eliminated with antibiotic therapy without much difficulty. In addition, the disease can also go away on its own, without any therapeutic intervention.

Complications of erysipelas if treatment is neglected may include the following:

• Gangrene followed by amputation.
• Chronic edema.
• Formation of scar tissue at the site of erysipelas.
• Bacterial sepsis in cases with reduced immunity.
• Scarlet fever.
• Pneumonia.
• An abscess at the site of an erysipelas or in other areas where pathogens can penetrate with lymph flow.
• Embolism.
• Meningitis.
• Death.

The most common complications of erysipelas include abscess, gangrene and thrombophlebitis. To a lesser extent - glomerulonephritis, endocarditis, sepsis and streptococcal acute toxic shock syndrome. Very rare complications are associated with osteoarticular pathologies - the formation of erysipelas, bursitis, osteomyelitis, arthritis and tendonitis.

RCHR (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical protocols of the Ministry of Health of the Republic of Kazakhstan - 2016

Short description

Approved
Joint Commission on Healthcare Quality
Ministry of Health and Social Development of the Republic of Kazakhstan
dated June 9, 2016
Protocol No. 4

Erysipelas(English erysipelas) is a human infectious disease caused by β-hemolytic streptococcus of group A and occurs in an acute (primary) or chronic (recurrent) form with severe symptoms of intoxication and focal serous or serous-hemorrhagic inflammation of the skin and mucous membranes.

The ratio of ICD-10 and ICD-9 codes (in the case of more than 5 codes, add to the appendix to the clinical protocol):

ICD-10		ICD-9
Code	Name	Code	Name
A46.0	Erysipelas	035	Erysipelas

Date of development of the protocol: 2016

Protocol users: infectious disease specialists, therapists, general practitioners, emergency physicians, paramedics, surgeons, dermatovenerologists, obstetricians-gynecologists, physiotherapists.

Level of evidence scale:

A	A high-quality meta-analysis, systematic review of RCTs, or large RCTs with a very low probability (++) of bias, the results of which can be generalized to an appropriate population.
IN	A high-quality (++) systematic review of cohort or case-control studies, or a high-quality (++) cohort or case-control study with a very low risk of bias, or an RCT with a low (+) risk of bias, the results of which can be generalized to an appropriate population .
WITH	Cohort or case-control study or controlled trial without randomization with low risk of bias (+), the results of which can be generalized to the relevant population or RCT with very low or low risk of bias (++ or +), the results of which cannot be directly distributed to the relevant population.
D	Case series or uncontrolled study or expert opinion.

Classification

Clinical classification of erysipelas(Cherkasov V.L., 1986).

By flow rate:
· primary;
· repeated (when the disease recurs two years or more after the primary disease or at an earlier date, but with a different localization of the process);
· recurrent (relapses occur within a period of several days to 2 years with the same localization of the process. Often recurrent erysipelas - 3 relapses or more per year with the same localization of the process). Early relapses of erysipelas occur in the first 6 months from the onset of the disease, late relapses - after 6 months.

According to the nature of local manifestations:
· erythematous;
· erythematous-bullous;
· erythematous-hemorrhagic;
· bullous-hemorrhagic.

By localization of the local process:
· faces;
· scalp;
· upper extremities (by segments);
· lower extremities (by segments);
· torso;
· genital organs.

By severity:
· light (I);
· moderate (II);
· heavy (III).

According to the prevalence of local manifestations:
· localized (the local process affects one anatomical area (for example, lower leg or face));
· widespread (migratory) (the local process involves several adjacent anatomical areas);
· metastatic with the appearance of distant foci of inflammation (for example, lower leg, face, etc.).

Complications of erysipelas:
· local (abscess, phlegmon, necrosis, phlebitis, periadenitis, etc.);
· general (sepsis, ITS, pulmonary embolism, nephritis, etc.).

Consequences of erysipelas:
· persistent lymphostasis (lymphatic edema, lymphedema);
Secondary elephantiasis (fibredema).
A detailed clinical diagnosis indicates the presence of concomitant diseases.

Examples of diagnosis formulation:
Primary erysipelas of the right half of the face, erythematous-bullous form, moderate severity.
Recurrent erysipelas of the left leg and foot, bullous-hemorrhagic form, severe. Complications: Phlegmon of the left leg. Lymphostasis.
Concomitant disease: Athlete's foot.

Diagnostics (outpatient clinic)

OUTPATIENT DIAGNOSTICS**

Diagnostic criteria

Complaints:
· increase in body temperature to 38 - 40°C;
· chills;
· headache;
· weakness, malaise;
· muscle pain;
· nausea, vomiting;
· paresthesia, feeling of fullness or burning, mild pain, redness in the skin area.

Anamnesis:
Acute onset of the disease.

Provoking factors:
· Violations of the integrity of the skin (abrasions, scratches, scratches, injections, abrasions, cracks, etc.);
· bruises;
· sudden change in temperature (hypothermia, overheating);
· insolation;
· emotional stress.

Predisposing factors:
· background (concomitant) diseases: mycoses of the feet, diabetes mellitus, obesity, chronic venous insufficiency (varicose veins), chronic (acquired or congenital) insufficiency of lymphatic vessels (lymphostasis), eczema, etc.;
· the presence of foci of chronic streptococcal infection: tonsillitis, otitis, sinusitis, caries, periodontal disease, osteomyelitis, thrombophlebitis, trophic ulcers (more often with erysipelas of the lower extremities);
· occupational hazards associated with increased trauma, skin contamination, wearing rubber shoes, etc.;
· chronic somatic diseases, as a result of which anti-infective immunity decreases (usually in old age).

Physical examination:

Erythematous form of erysipelas:
· erythema (a clearly demarcated area of ​​hyperemic skin with uneven boundaries in the form of teeth, flames, “geographic map”);
· infiltration, skin tension, moderate pain on palpation (more on the periphery), local increase in temperature in the area of ​​erythema;
· “peripheral ridge” in the form of infiltrated and raised edges of erythema;
· swelling of the skin extending beyond the erythema;
· regional lymphadenitis, pain on palpation in the area of ​​regional lymph nodes, lymphangitis;
· predominant localization of the local inflammatory process on the lower extremities and face;
· absence of severe pain in the area of ​​inflammation at rest.

Erythematous-bullousformfaces:
· blisters (bullas) against the background of erythema erysipelas (see above).

Erythematous-hemorrhagicformfaces:
· hemorrhages of various sizes (from small petechiae to extensive confluent hemorrhages) into the skin against the background of erythema erysipelas (see above).

Bullous-hemorrhagicformfaces:
· blisters (bulls) of various sizes against the background of erythema erysipelas, filled with hemorrhagic or fibro-hemorrhagic exudate;
· extensive hemorrhages into the skin in the area of ​​erythema.

Severity criteria faces:
· severity of symptoms of intoxication;
· prevalence and nature of the local process.

Light (I) form:
· subfebrile body temperature, mild symptoms of intoxication, duration of the febrile period is 1-2 days;
· localized (usually erythematous) local process.

Moderate (II) form:
· increase in body temperature to 38 - 40°C, duration of the febrile period is 3-4 days, symptoms of intoxication are moderately expressed (headache, chills, muscle pain, tachycardia, hypotension, sometimes nausea, vomiting),
· localized or widespread process involving two anatomical areas.

Severe (III) form:
· body temperature is 40°C and above, the duration of the febrile period is more than 4 days, symptoms of intoxication are expressed (adynamia, severe headache, repeated vomiting, sometimes delirium, confusion, occasionally meningismus, convulsions, significant tachycardia, hypotension);
· pronounced local process, often widespread, often with the presence of extensive bullae and hemorrhages, even in the absence of pronounced symptoms of intoxication and hyperthermia.

Laboratory research:
· complete blood count (CBC): moderate leukocytosis with a neutrophilic shift to the left, moderate increase in erythrocyte sedimentation rate (ESR);
· general urinalysis (UCA): in severe cases - oliguria and proteinuria, urine sediment - erythrocytes, leukocytes, hyaline and granular casts.

Instrumental studies: not specific.

Diagnostic algorithm:(scheme)

Diagnostics (hospital)

DIAGNOSTICS AT THE INPATIENT LEVEL**

Diagnostic criteria at the hospital level[ 1,2]

Complaints:
· fever (T 38-40 o C);
· chills;
· weakness;
lethargy;
· malaise;
· headache;
· sleep disturbance;
· decreased appetite;
body aches;
· nausea and vomiting;
· disturbance of consciousness;
· convulsions;
· paresthesia, feeling of fullness or burning, mild pain, redness, presence of rashes in the skin area.

Anamnesis:
Acute onset of the disease.
Presence of provoking factors:
· Violations of the integrity of the skin (abrasions, scratches, wounds, scratches, injections, abrasions, cracks, etc.);
· bruises;
· sudden change in temperature (hypothermia, overheating);
· insolation;
· radiation therapy;
· emotional stress.
Presence of predisposing factors:
· background (concomitant) diseases: mycoses of the feet, diabetes mellitus, obesity, chronic venous insufficiency (varicose veins), chronic (acquired or congenital) insufficiency of lymphatic vessels (lymphostasis), eczema, etc.;
· the presence of foci of chronic streptococcal infection: tonsillitis, otitis, sinusitis, caries, periodontal disease, osteomyelitis, thrombophlebitis, trophic ulcers (more often with erysipelas of the lower extremities);
· occupational hazards associated with increased trauma, skin contamination, wearing rubber shoes, etc.;
· chronic somatic diseases, as a result of which anti-infective immunity decreases (usually in old age).

Physical examination:
· Local process (occurs 12-24 hours from the onset of the disease) - pain, hyperemia and swelling of the affected area of ​​the skin (in the face, torso, limbs and in some cases - on the mucous membranes).

Erythematous form:
· The affected area of ​​skin is characterized by erythema, swelling and tenderness. Erythema of uniform bright color with clear boundaries with a tendency to peripheral distribution, rises above intact skin. Its edges are irregularly shaped (in the form of “tongues of flame”, “geographical map”). Subsequently, peeling of the skin may appear at the site of erythema.

Erythematous-bullous form:
· Begins in the same way as erythematous. However, after 1-3 days from the moment of illness, epidermal detachment occurs at the site of erythema and blisters of various sizes filled with serous contents form. Subsequently, the bubbles burst and a brown crust forms in their place. After their rejection, young, delicate skin is visible. In some cases, erosions appear in place of the blisters, which can transform into trophic ulcers.

Erythematous-hemorrhagic form:
· Against the background of erythema, hemorrhages appear in the affected areas of the skin.

Bullous-hemorrhagic form:
· It proceeds similarly to the erythematous-bullous form, however, the blisters formed during the disease at the site of erythema are filled not with serous, but with hemorrhagic exudate.
· Regional lymphadenitis (enlarged and painful lymph nodes regional to the affected area of ​​the skin).
· Lymphangitis (longitudinal changes in the skin, accompanied by hyperemia, thickening and pain).

Severity criteria faces:
· severity of symptoms of intoxication;
· prevalence and nature of the local process.

Light (I) form:
· subfebrile body temperature, mild symptoms of intoxication, duration of the febrile period is 1-2 days;
· localized (usually erythematous) local process.

Moderate (II) form:
· increase in body temperature to 38 - 40°C, duration of the febrile period is 3-4 days, symptoms of intoxication are moderately expressed (headache, chills, muscle pain, tachycardia, hypotension, sometimes nausea, vomiting);
· localized or widespread process involving two anatomical areas.

Severe (III) form:
· body temperature is 40°C and above, the duration of the febrile period is more than 4 days, symptoms of intoxication are expressed (adynamia, severe headache, repeated vomiting, sometimes delirium, confusion, occasionally meningismus, convulsions, significant tachycardia, hypotension);
a pronounced local process, often widespread, often with the presence of extensive bullae and hemorrhages, even in the absence of pronounced symptoms of intoxication and hyperthermia.

Laboratory research
· CBC: leukocytosis, neutrophilia with band shift, thrombocytopenia, increased ESR.
· OAM: proteinuria, cylindruria, microhematuria (in severe disease as a result of toxic kidney damage).
· C-reactive protein: increased content.
· biochemical blood test (according to indications): determination of total protein, albumin, electrolytes (potassium, sodium), glucose, creatinine, urea, residual nitrogen).
· coagulogram: for disorders in the vascular-platelet, procoagulant, fibrinolytic links in patients with severe hemorrhagic forms of erysipelas - determination of blood clotting time, activated partial thromboplastin time, prothrombin index or ratio, fibrinogen, thrombin time.
· blood sugar (according to indications);
· immunogram (according to indications).

· ECG (according to indications);
· X-ray of the chest organs (according to indications);
· Ultrasound of the abdominal organs, kidneys (according to indications).

Diagnostic algorithm

List of main diagnostic measures:
· UAC;
· OAM.

List of additional diagnostic measures:
· biochemical blood test: C-reactive protein, total protein, albumin.
With the development of acute renal failure - potassium, sodium, glucose, creatinine, urea, residual nitrogen;
For disorders in the vascular-platelet unit: coagulogram - blood clotting time, activated partial thromboplastin time, prothrombin index or ratio, fibrinogen, thrombin time.
blood sugar (according to indications);
Immunogram (according to indications).

Instrumental studies
·ECG (according to indications);
X-ray of the chest organs (according to indications);
· Ultrasound of the abdominal organs, kidneys (according to indications).

Differential diagnosis

Differential diagnosis and rationale for additional studies

Diagnosis		Surveys	Diagnosis exclusion criteria
Phlegmon	General symptoms: acute onset, severe symptoms of intoxication, fever, erythema with edema, changes in general blood count (neutrophilic leukocytosis, increased ESR)	Surgeon consultation	At the site of localization of the process, severe, sometimes throbbing pain and sharp pain on palpation occur. Hyperemia of the skin does not have clear boundaries, is brighter in the center, and develops against the background of an excessively dense infiltrate. Later, the infiltrate softens and fluctuation is detected. Characterized by hyperleukocytosis with a significant neutrophil shift to the left, significantly increased ESR.
Thrombophlebitis of the saphenous veins		consultation with a surgeon/vascular surgeon,	Pain, areas of hyperemia along the veins, palpated in the form of painful cords. Often there is a history of varicose veins. Body temperature is usually subfebrile, intoxication and symptoms of regional lymphadenitis are absent.
Shingles	Erythema, fever		The appearance of erythema and fever is preceded by neuralgia. Erythema is located on the face, torso, along the branches of one or another nerve, most often the branches of the trigeminal, intercostal, sciatic, which determines the size of the skin lesion, always one-sided, within 1-2 dermatomes. Edema is not expressed. On the 2-3rd day, against the background of erythema, numerous blisters appear filled with serous, hemorrhagic, and sometimes purulent contents. In place of the bubbles, yellow-brown or black crusts gradually form; The disease often takes a protracted course and is accompanied by persistent neuralgia.
Anthrax (skin form)	Fever, intoxication, erythema, edema	Consultation with an infectious disease specialist	The boundaries of hyperemia and edema are unclear, there is no local pain; in the center - a characteristic anthrax carbuncle, “jelly-like” swelling, its trembling (Stefansky’s symptom). Epid. medical history: working with carcasses of slaughter animals or with secondary raw materials.
Erysipeloid (pig mug)	Erythema	Consultation with an infectious disease specialist or dermatologist	No intoxication, fever, regional lymphadenitis. Erythema is localized in the area of ​​the fingers, hands, and is red, pinkish-red, or purplish-red in color. The edges of the erythema are brighter compared to the center, the swelling is insignificant. Vesicular elements sometimes appear against the background of erythema. Epidemiological data: skin microtraumas during processing of meat or fish, exposure to natural foci of erysipeloid.
Eczema, dermatitis	Erythema, skin infiltration	Consultation with a dermatologist	Itching, weeping, peeling of the skin, small blisters against the background of skin hyperemia. There is no regional lymphadenitis, fever, intoxication, or focal pain.
Erythema nodosum	Acute onset, fever, symptoms of intoxication, erythema, history of chronic tonsillitis	Consultation with a rheumatologist, dermatologist	Formation in the area of ​​the legs, less often the thighs and forearms, occasionally on the abdomen, limited, non-merging, dense, painful nodes, somewhat elevated above the surface of the skin, with local redness of the skin above them. The skin over the nodes is bright pink in color, later acquiring a bluish tint. Characterized by pain in the limbs, knee and ankle joints.

Differential diagnosis for localization of erysipelas on the face

Diagnosis	Rationale for differential diagnosis	Surveys	Diagnosis exclusion criteria
Quincke's edema	General symptoms: erythema, edema	Allergist consultation	Sudden onset, hyperemia and dense swelling, when pressed, a hole does not form. History: connection with the use of certain foods, medications, etc.
Periostitis of the upper jaw.	Erythema, swelling, local tenderness	Consultation with a dentist/oral and maxillofacial surgeon	Formation of a subperiosteal abscess, swelling of the perimaxillary soft tissues, pain in the area of ​​the affected tooth with irradiation to the ear, temple, and eye.
Abscessing furuncle of the nose	Erythema, edema, fever	Consultation with an ENT doctor	After 3-4 days, an abscess may appear at the top of the infiltrate, which is the core of a boil.

Treatment abroad

Get treatment in Korea, Israel, Germany, USA

Treatment abroad

Get advice on medical tourism

Treatment

Drugs (active ingredients) used in treatment

Azithromycin

Amoxicillin

Benzylpenicillin

Vancomycin

Warfarin

Gentamicin

Heparin sodium

Dextrose

Diclofenac

Ibuprofen

Imipenem

Indomethacin

Clavulanic acid

Clindamycin

Levofloxacin

Loratadine

Mebhydrolin

Meglumine

Meropenem

Sodium chloride

Nimesulide

Paracetamol

Pentoxifylline

Prednisolone

Roxithromycin

Spiramycin

Sulfamethoxazole

Teicoplanin

Trimethoprim

Quifenadine

Chloropyramine

Cetirizine

Cefazolin

Cefotaxime

Ceftriaxone

Cefuroxime

Ciprofloxacin

Enoxaparin sodium

Erythromycin

Groups of drugs according to ATC used in treatment

Treatment (outpatient clinic)

OUTPATIENT TREATMENT**

Treatment tactics.
Mild forms of erysipelas are treated on an outpatient basis.

Non-drug treatment

Bed rest
Diet: common table (No. 15), plenty of drink. If there is a concomitant pathology (diabetes mellitus, kidney disease, etc.), an appropriate diet is prescribed.

Drug treatment

Etiotropic therapy. When treating patients in a clinic, it is advisable to prescribe one of the following antibiotics:
· 1,000,000 units x 6 times/day, IM, 7-10 days [UD - A];
or
· amoxicillin/clavulanate orally 0.375-0.625 g 2-3 times a day for 7-10 days [UD - A];
or macrolides:
· erythromycin orally 250-500 mg 4 times a day for 7-10 days [UD - A];
· azithromycin orally - on the 1st day, 0.5 g, then for 4 days - 0.25 g once a day (or 0.5 g for 5 days) [UD - A],
or
· spiramycin orally - 3 million IU twice a day (course of treatment 7-10 days) [UD - A]
or
· roxithromycin orally - 0.15 g twice a day (course of treatment 7-10 days) [UD - A] or others.
or fluoroquinolones:
· levofloxacin orally - 0.5 g (0.25 g) 1-2 times a day (course of treatment 7-10 days) [UD - A].

Pathogenetic therapy:
Non-steroidal anti-inflammatory drugs (contraindicated in hemorrhagic forms of erysipelas):
· indomethacin 0.025 g 2-3 times a day, orally, for 10-15 days [LE - B]
or
Diclofenac 0.025 g 2-3 times a day, orally, for 5-7 days [UD - B]
or
nimesulide 0.1 g 2-3 times a day, orally, for 7-10 days [UD - B]
or
· ibuprofen 0.2 g, 2-3 times a day, orally for 5-7 days [UD - B].

Symptomatic therapywith fever,

or
paracetamol 500 mg, orally [UD - B].

Desensitization therapy:
· mebhydrolin orally 0.1-0.2 g 1-2 times a day [UD - C];
or
hifenadine orally 0.025 g - 0.05 g 3-4 times a day [UD - D];
or

or

or
Loratadine 0.01 g orally once a day [EL-B].

Antibacterial therapy:
· benzylpenicillin sodium salt, powder for preparing a solution for intramuscular administration in a bottle of 1,000,000 units [UD - A];
or
· amoxicillin/clavulanate 375 mg, 625 mg, orally [UD - A];
or
· azithromycin 250 mg, orally [UD - A];
or
· erythromycin 250 mg, 500 mg, orally [UD - A];
or
· spiramycin 3 million IU, orally [UD - A];
or
· roxithromycin 150 mg, orally [UD - A];
or
Levofloxacin 250 mg, 500 mg, orally [UD - A].

or

or
nimesulide 100 mg orally [UD - B];
or
ibuprofen 200 mg, 400 mg, orally [UD - A];
or
· paracetamol 500 mg, orally [UD - A];
or

or

or

or

or
cetirizine 5-10 mg, orally [UD - B].

Drug comparison table

Class	INN	Advantages	Flaws	UD
Antibiotic,			Not resistant to beta-lactamases. "-" m/o.	A
Antibiotic, combined penicillin	amoxicillin/clavulanate	Has a wide spectrum of antibacterial action.	Side effects (very rare and mild): dysfunction of the gastrointestinal tract (nausea, diarrhea, vomiting), allergic reactions (erythema, urticaria)	A
Macrolides	erythromycin	Active against gram “+”, gram “-” m/o.	Low activity against Escherichia coli, Pseudomonas aeruginosa, Shigella spp., Salmonella spp., Bacteroides fragilis, Enterobacter spp. and etc.	A
	azithromycin	Active against gram “+”. It is quickly absorbed from the gastrointestinal tract, which is due to its stability in an acidic environment and lipophilicity.	Low activity against anaerobic pathogens	A
	spiramycin	Active against Streptococcus spp. (incl. Streptococcus pneumoniae)		A
	roxithromycin	Active against gram “+”, gram “-” m/o.	low activity against anaerobic pathogens	A
Fluoroquinolones	levofloxacin	Active against gram “+”, gram “-” m/o.	low activity against anaerobic pathogens.	A
Antihistamines	mebhydrolin		absolute contraindication - peptic ulcer of the stomach, duodenum, hyperacid gastritis, nonspecific ulcerative colitis.	WITH
	hifenadine	Antihistamine and antiallergic effect.		D
	chloropyramine			C
	loratadine			B
	cetirizine			IN
NSAIDs	indomethacin	Strong anti-inflammatory activity	Frequent development of adverse reactions can lead to the development of aspirin-induced bronchial asthma	IN
	diclofenac	Strong anti-inflammatory activity	Increased risk of developing cardiovascular complications.	IN
	nimesulide			IN
	Ibuprofen		Increased risk of toxic amblyopia.	IN
	Paracetamol		Hepatotoxic and nephrotoxic effects (with long-term use in large doses)	IN

· consultation with an endocrinologist: for concomitant diseases - diabetes, obesity;
· consultation with a rheumatologist: for differential diagnosis with erythema nodosum;
· consultation with an obstetrician-gynecologist: for erysipelas in pregnant women;
· consultation with a clinical pharmacologist for correction and justification of treatment;

Preventive actions:

At PHC: primary prevention:
· informing the patient on the prevention of microtraumas, diaper rash, hypothermia, careful adherence to personal hygiene, fungal and pustular skin diseases.

Secondary prevention (relapses and complications):
· timely and complete etiotropic and pathogenetic therapy of the primary disease and relapses;
· treatment of pronounced residual effects - erosion, persistent swelling in the local area, consequences of erysipelas (persistent lymphostasis, elephantiasis);
· treatment of long-term and persistent chronic skin diseases, leading to disruption of its trophism and the appearance of 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 as a result of primary and secondary lymphostasis and elephantiasis; chronic peripheral vascular diseases; treatment of obesity, diabetes mellitus (frequent decompensation of which is observed with erysipelas);
Bicillin prophylaxis.
Prophylactic administration of bicillin-5 is carried out in a dose of 1,500,000 units once every 3-4 weeks to convalescents after complete therapy for erysipelas in the acute period of the disease. Before its administration, 15-20 minutes before its administration, an injection of desensitizing drugs is recommended to prevent allergic complications.
The following methods of bicillin prophylaxis exist:
· year-round (with frequent relapses) for 2-3 years with an interval of drug administration of 3 weeks (in the first months the interval can be reduced to 2 weeks);
· seasonal (for 4 months, three seasons). The drug begins to be administered a month before the start of the morbidity season;
· one-course to prevent early relapses for 4-6 months after the illness.

Monitoring the patient's condition: carried out by KIZ doctors/general practitioners with the involvement of doctors of other specialties through medical examination.

The following are subject to medical examination:
· Group 1 - persons who experience frequent, at least 3 in the last year, relapses of erysipelas;
· Group 2 - persons with a pronounced seasonal nature of relapses;
· Group 3 - persons with prognostically unfavorable residual effects upon discharge from the hospital.

For 1st group:
· Regular, at least once every 3 months, medical examination of patients, which allows timely detection of deterioration of their condition, increase in lymphostasis, exacerbation of chronic concomitant skin diseases and foci of chronic streptococcal infection, which contribute to the development of relapses of erysipelas.
· Systematic laboratory examination of patients, including a clinical blood test, determination of the level of C-reactive protein. Preventive year-round (continuous) administration of Bicillin-5 for 2-3 years, 1.5 million units once every 3-4 weeks, intramuscularly (1 hour before the administration of Bicillin-5, antihistamines must be prescribed).
· Repeated physiotherapeutic treatment in the presence of persistent lymphostasis.
· Sanitation of foci of chronic ENT infection.
· Treatment of skin intertrigo, mycoses and other related skin diseases.
· Treatment in specialized medical institutions of chronic vascular diseases and endocrine diseases.
· Employment of patients under unfavorable working conditions. Clinical observation of patients in this group is advisable for 2-3 years (in the absence of relapses). The maximum period of observation (3 years) is required for patients with particularly aggravated concomitant diseases (trophic ulcers, other skin defects, lymphorrhea, deep skin cracks with hyperkeratosis, papillomatosis, who have undergone operations for elephantiasis).

For group 2:
· Regular medical examination at least once every 6 months.
· Annual laboratory examination before the relapse season (clinical blood test, determination of C-reactive protein level).
· Preventive seasonal administration of bicillin-5 (1.5 million units 1 time per day, intramuscularly (1 hour before the administration of bicillin-5, antihistamines must be prescribed) 1 month before the start of the morbidity season in the patient with a 3-week interval for 3-4 months annually 3 seasons.
· If there are appropriate indications - sanitation of foci of chronic ENT infections, treatment of concomitant chronic skin diseases, etc.

For the 3rd group:
· Medical examination 1-4 months later, if necessary, and 6 months after the illness.
· Laboratory examination at the beginning and end of clinical observation (clinical blood test, determination of C-reactive protein level).
· Physiotherapeutic treatment of prognostically unfavorable residual effects of erysipelas.
· Course prophylactic administration of bicillin-5 at intervals of 3 weeks for 4-6 months.

Criteria for the effectiveness of dispensary observation and treatment of persons who have had erysipelas:
· preventing relapses of the disease, reducing their number;
· relief of edema syndrome, persistent lymphostasis, other residual effects and consequences of the disease.

Treatment (ambulance)

DIAGNOSIS AND TREATMENT AT THE EMERGENCY CARE STAGE

If outpatient treatment is possible, transfer the asset to the clinic at the patient’s place of residence.

Hospitalization in a hospital according to indications.

Transport the patient by ambulance in a prone position, taking into account pain and signs of intoxication.
To reduce body temperature and relieve pain, administer 2.0 ml of a 50% analgin solution (can be combined with a 1% solution of diphenhydramine 2.0).

Treatment (inpatient)

INPATIENT TREATMENT**

Treatment tactics

Non-drug treatment

Bed rest- until the temperature normalizes, if the lower extremities are affected - during the entire period of the disease.
Diet No. 15 - complete, easily digestible food, drink plenty of fluids. If there is a concomitant pathology (diabetes mellitus, kidney disease, etc.), an appropriate diet is prescribed.

Drug treatment

Etiotropic therapy

Standard treatment regimen for moderate forms	Standard treatment regimen for severe forms	Standard treatment regimen for recurrent erysipelas, severe form and complications	Alternatives	Alternatives treatment regimen for severe forms and complications №2
Benzylpenicillin sodium salt 1,000,000 units x 6 times/day. IM, 10 days Reserve drug: Ceftriaxone 1.0 - 2.0g x 2 times/day, IM, IV, 7-10 days or cefazolin 2-4 g/day, IM, 7-10 days or cefuroxime 2.25-4.5 g/day in 3 doses IM, IV, 7-10 days or cefotaxime 2-8 g/day in 2-4 doses IV or IM, 7- 10 days.	Benzylpenicillin sodium salt 1,000,000 units x 6-8 times/day. IM, IV, 10 days + Ciprofloxacin 200 mg x 2 times/day. IV drop, 10 days (single dose may be increased to 400 mg); or cefazolin 1.0 g 3-4 times a day, 10 days; ilaceftriaxone 2.0 - 4.0 g/day, IM, IV, 10 days or cefuroxime 0.75-1.5 g 3 times a day IM, IV, 10 days or cefotaxime 1-2 g 2-4 times a day IV or IM, 10 days	Ceftriaxone 2.0 x 2 times/day, IM, IV, 10 days + Clindamycin 300 mg x 4 times a day. i/m, i/v 10 days	1.Benzylpenicillin sodium salt 1,000,000 units x 6-8 times/day. IM, 10 days + Gentamicin sulfate 80 mg x 3 times a day IM, 10 days.	Benzylpenicillin sodium salt 1,000,000 units x6-8 times/day. IM, 10 days + Clindamycin 300 mg x 4 times a day. i/m, i/v (single dose may be increased to 600 mg), 10 days

In case of intolerance to antibiotics of the penicillin and cephalosporin classes, one of the antibiotics of other classes (macrolides, tetracyclines, sulfonamides and co-trimoxazole, rifimycins) is used.
Reserve drugs for the treatment of severe forms of erysipelas - carbapenems (imipenem, meropenem), glycopeptides (vancomycin, teicoplanin).

Treatment of recurrent erysipelas carried out in a hospital setting. Mandatory prescription of reserve antibiotics that were not used in the treatment of previous relapses - cephalosporins:
· cefazolin 1.0 g 3-4 times a day, 10 days;
or
· ceftriaxone 1.0 - 2.0g x 2 times/day, IM, IV, 10 days;
or
· Cefuroxime 0.75-1.5 g 3 times a day IM, IV, 10 days;
or
· Cefotaxime 1-2 g 2-4 times a day, IV, IM, 10 days.
For frequently recurrent erysipelas, 2 courses of treatment:
1 course: cephalosporins (10 days), break 3-5 days,
2 course: bacteriostatic antibiotics (the drug of choice is antibiotics of the lincosamide series: lincomycin 0.6-1.2 g 1 - 2 times a day intramuscularly or 0.5 g orally three times a day or others), 7 days.

Pathogenetic therapy:

Detoxification therapy(the amount of fluid should be strictly controlled based on daily diuresis, the volume of fluid administered taking into account the degree of severity) :
With an average severity of the infectious process, patients should drink plenty of fluids at the rate of 20-40 ml/kg.
In case of severe infection, parenteral administration of isotonic (0.9% sodium chloride solution, 400; 0.5% dextrose solution, 400.0, etc.) and colloidal (meglumine sodium succinate, 400.0) solutions in a ratio of 3- 4:1 in a total volume of 1200-1500 ml for 3-5 days.

Nonsteroidal anti-inflammatory drugs(simultaneously with antibiotic therapy, taking into account contraindications, course 7-10 days):
· indomethacin 0.025 g 2-3 times a day, orally [UD - B];
or
Diclofenac 0.025 g 2-3 times a day, orally, for 5-7 days [UD - B];
or
nimesulide 0.1 g 2-3 times a day, orally, for 7-10 days [UD - B];
or
ibuprofen 0.2 g, 2-3 times a day, orally for 5-7 days [UD - B].

Desensitization therapy:
· mebhydrolin orally 0.1-0.2 g 1-2 times a day [UD - C];
or
hifenadine orally 0.025 g - 0.05 g 3-4 times a day [UD - D];
or
· chloropyramine orally 0.025 g 3-4 times a day [UD - C];
or
cetirizine orally 0.005-0.01 g 1 time per day, 5-7 days [UD-B];
or
Loratadine 0.01 g orally once a day [EL-B].

Glucocorticosteroids prescribed for persistently recurrent erysipelas, with the development of lymphostasis: prednisolone orally, 30 mg per day with a gradual reduction in the daily dose (course dose 350-400 mg) [UD - B].

To improve microcirculation and rheological properties of blood, for antiplatelet purposes(taking into account coagulogram indicators):
· pentoxifylline 2% solution 100 mg/5 ml, 100 mg in 20-50 ml of 0.9% sodium chloride, intravenous course from 10 days to 1 month [UD - B];
or
· heparin subcutaneously (every 6 hours) 50-100 IU/kg/day for 5-7 days [UD - A];
or
Warfarin 2.5-5 mg/day, orally;
or
· enoxaparin sodium 20-40 mg 1 time/day s.c.

Symptomatic therapy

For fever:
one of the following drugs:
ibuprofen 200 mg, 400 mg, 3-4 times a day [UD - B];
or
Diclofenac 75 mg/2 ml, IM [UD - B];
or
· paracetamol 500 mg, orally, with an interval of at least 4 hours [UD - B];
or
· paracetamol (1g/6.7ml) 1.5g-3g per day IV [UD - B].

List of essential medicines
· benzylpenicillin sodium salt, for intramuscular administration 1,000,000 units;
· or ceftriaxone, for injection for intramuscular and intravenous administration 1g.
· or ciprofloxacin, for infusion 0.2%, 200 mg/100 ml; 1% solution, 10 ml (concentrate to be diluted);
· or gentamicin sulfate, 4% for injection 40 mg/1 ml in 2 ml ampoules;
· clindamycin, for intramuscular and intravenous administration 150 mg/ml, in 2 ml.
· or cefazolin, for intramuscular and intravenous administration, 0.5 g, 1.0 g, 2.0 g.
· or lincomycin, for intramuscular and intravenous administration, 300 mg, 600 mg.
· or cefuroxime, IV and IM administration, 750 mg, 1.5 g.
· or cefotaxime, IV and IM administration, 1.0 g.

List of additional medicines
sodium chloride 0.9% - 100, 200, 400 ml
· dextrose 5% - 400 ml;
meglumine succinate for infusion 400.0
· indomethacin 25 mg, orally [UD - B];
or
Diclofenac 25 mg, 100 mg, orally [UD - B];
or
nimesulide 100 mg orally [UD - B];
or
ibuprofen 200 mg, 400 mg, orally [UD - B];
or
· paracetamol 500 mg, orally [UD - B];
· mebhydrolin, 100 mg, orally [UD-S];
or
· quifenadine, 25 mg, orally [UD-D];
or
· chloropyramine 25 mg, orally [UD - C];
or
Loratadine 10 mg, orally [LE - B];
or
cetirizine 5-10 mg, orally [UD - B];
Prednisolone 5 mg, orally [UD - A];
· pentoxifylline 2% solution 100 mg/5 ml, 100 mg in 20-50 ml 0.9% sodium chloride, ampoules.
· heparin, 1 ml/5000 units, ampoules 1.0 ml, 5.0 ml, 5.0 ml each.
or
Warfarin 2.5 mg, orally;
or
· enoxaparin sodium 20-40 mg, syringes for subcutaneous injection.

Drug comparison table:

Class	INN	Advantages	Flaws	UD
Antibiotic, biosynthetic penicillins	benzylpenicillin sodium salt	Active against gram “+” cocci (streptococci)	Not resistant to beta-lactamases. Low activity for most grams "-" m/o.	A
Antibiotic, third generation cephalosporin	ceftriaxone	Active against gram “+”, gram “-” m/o. Resistant to beta-lactamase enzymes. Penetrates well into tissues and liquids. The half-life is 8-24 hours.	Low activity against anaerobic pathogens.	A
Antibiotic, 1st generation cephalosporin	cefazolin	Active against gram “+” and some gram “-” m/o., Spirochaetaceae and Leptospiraceae.	Ineffective in relation to P. aeruginosa, indole-positive strains of Proteus spp., M. tuberculosis, anaerobic microorganisms	A
Antibiotic, II generation cephalosporin	cefuroxime	Has a bactericidal effect. Highly active against grams “+” and some grams “-” m/o.	Inactive against Clostridium difficile, Pseudomonas spp., Campylobacter spp., Acinetobacter calcoaceticus, Listeria monocytogenes, methicillin-resistant strains of Staphylococcus aureus, Staphylococcus epidermidis, Legionella spp., Streptococcus (Enterococcus) faecalis, Morganella morganii, Proteus vulgaris, Enterobacter spp. ., Citrobacter spp., Serratia spp., Bacteroides fragilis.	A
Antibiotic, III generation cephalosporin	cefotaxime	Broad-spectrum antibiotic. Has a bactericidal effect. Highly active against gram “+”, gram “-” m/o.	Resistant to most beta-lactamases of gram-positive and gram-negative microorganisms.
Fluoroquinolones	ciprofloxacin	Active against some grams “+”, grams “-” m/o. antipseudomonas drug	Moderate activity to Str.pn. If you suspect or have an infection caused by Pseudomonas aeruginosa	A
Antibiotic, aminoglycoside	gentamicin sulfate	Potentiates the effect of b-lactam antibiotics	Low activity against anaerobic pathogens. Oto-nephrotoxic effect	A
Antibiotic, lincosamide	clindamycin	Bacteriostatic, active against gram “+”, gram “-” m/o (Strept., Staph.)	Low activity to Clostridium sporogenes and Clostridium tertium	A
Antibiotic, lincosamide	lincomycin	Bacteriostatic, active against gram “+”, gram “-” m/o (Strept., Staph.), Corynebacteriumdiphtheriae, anaerobic bacteria Clostridium spp., Bacteroidesspp., Mycoplasmaspp.	Low activity to most gram-negative bacteria, fungi, viruses, protozoa.	A
Antihistamines	mebhydrolin	Antihistamine and antiallergic effect	Side effects: increased fatigue, dizziness, paresthesia; when using high doses - slower reactions, drowsiness, blurred visual perception; rarely - dry mouth, nausea, heartburn, irritation of the gastric mucosa, pain in the epigastric region, vomiting, constipation, difficulty urinating. granulocytopenia, agranulocytosis.	WITH
	hifenadine	Antihistamine and antiallergic action.	Has a moderate antiserotonin effect.	D
	chloropyramine	It does not accumulate in the blood serum, therefore, even with prolonged use it does not cause an overdose. Due to its high antihistamine activity, a rapid therapeutic effect is observed.	Side effects - drowsiness, dizziness, inhibition of reactions, etc. - are present, although less pronounced. The therapeutic effect is short-term; in order to prolong it, chloropyramine is combined with H1-blockers that do not have sedative properties.	C
	loratadine	Highly effective in the treatment of allergic diseases, does not cause addiction or drowsiness.	Cases of side effects are rare; they include nausea, headache, gastritis, agitation, allergic reactions, and drowsiness.	B
	cetirizine	Effectively prevents the occurrence of edema, reduces capillary permeability, relieves spasm of smooth muscles, and does not have anticholinergic or antiserotonin effects.	Improper use of the drug can lead to dizziness, migraines, drowsiness, and allergic reactions.	IN
NSAIDs	indomethacin		Frequent development of adverse reactions. may lead to the development of aspirin-induced bronchial asthma	IN
	diclofenac	Strong pronounced anti-inflammatory activity	Increased risk of developing cardiovascular complications.	IN
	nimesulide	It has anti-inflammatory, analgesic, antipyretic and antiplatelet effects.	In case of an overdose, life-threatening conditions can develop: a drop in blood pressure, disturbances in heart rhythm, breathing, and acute renal failure.	IN
	ibuprofen	Analgesic and antipyretic effects predominate	Increased risk of toxic amblyopia.	IN
	paracetamol	Mainly “central” analgesic and antipyretic effect	Hepatotoxic and nephrotoxic effects (with long-term use in large doses)	IN

Surgical intervention

In the acute period with the erythematous-bullous form of erysipelas:
· opening intact blisters, removing exudate, applying a bandage with liquid antiseptics (0.02% furatsilin solution, 0.05% chlorhexidine solution, 3% hydrogen peroxide solution).

For extensive weeping erosions:
· local treatment - manganese baths for the extremities, then applying a bandage with liquid antiseptics.

For purulent-necrotic complications of erysipelas:
· surgical treatment of the wound - excision of necrotic tissue, application of a bandage with liquid antiseptics.
Ointment dressings (ichthyol ointment, Vishnevsky balm, antibiotic ointments) are strictly contraindicated during the acute period of the disease.

Other treatments

Physiotherapy
Suberythemal doses of ultraviolet radiation to the area of ​​inflammation and ultrasonic frequency currents to the area of ​​regional lymph nodes (5-10 procedures);
A method of low-intensity laser therapy for anti-inflammatory purposes, to normalize microcirculation in the source of inflammation, restore the rheological properties of blood, enhance reparative processes from 2 to 12 sessions, at intervals of 1-2 days.

Indications for consultation with specialists:
· consultation with a surgeon: for differential diagnosis with abscess, phlegmon; in severe forms of erysipelas (erythematous-bullous, bullous-hemorrhagic), surgical complications (phlegmon, necrosis);
· consultation with an angiosurgeon: with the development of chronic venous insufficiency, thrombophlebitis, trophic ulcers;
· consultation with a dermatovenerologist: for differential diagnosis with contact dermatitis, mycoses of the feet;
· consultation with a resuscitator: determination of indications for transfer to the ICU;
· consultation with an endocrinologist: for concomitant diseases - diabetes, obesity.
· consultation with an otorhinolaryngologist: for diseases of the ENT organs;
· consultation with a clinical pharmacologist for correction and justification of therapy;
· consultation with a physiotherapist: to prescribe physiotherapy;
· consultation with an allergist for differential diagnosis with Quincke's edema.

Indications for transfer to the intensive care unit:
If complications develop:
· infectious-toxic encephalopathy;
· infectious-toxic shock;
· secondary pneumonia and sepsis (in persons suffering from immunodeficiency).

Indicators of treatment effectiveness:

Clinical indicators:

With primary erysipelas:

· relief of local inflammatory process;
· restoration of working capacity.
For recurrent erysipelas:
· relief of general toxic syndrome (normalization of body temperature);
· elimination or reduction of edematous syndrome, persistent lymphostasis, other residual effects and consequences of the disease;
· reducing the number of relapses.

Laboratory indicators:
· Normalization of UAC indicators.

Hospitalization

Indications for planned hospitalization: none.

Indications for emergency hospitalization(infectious diseases hospital/department or surgical department):
- moderate and severe erysipelas, regardless of the localization of the process (especially the bullous-hemorrhagic form of erysipelas);
- the presence of severe concomitant diseases, regardless of the degree of intoxication, the nature of the local process and its localization;
- age of patients over 70 years of age, regardless of the degree of intoxication, the nature of the local process and its location;
- the course of erysipelas against the background of persistent lymph circulation disorders and diseases of the peripheral vessels of the extremities, pronounced skin defects (scars, ulcers, etc.) regardless of the degree of intoxication, the nature of the local process and its localization;
- frequent relapses of erysipelas and early relapses, regardless of the degree of intoxication, the nature of the local process and its location;
- complications of erysipelas.

Information

Sources and literature

1. Minutes of meetings of the Joint Commission on the Quality of Medical Services of the Ministry of Health of the Republic of Kazakhstan, 2016
   1. 1) Infectious diseases: national guidelines / Ed. N.D. Yushchuka, Yu.Ya. Vengerova. M.: GEOTAR-Media, 2009, pp. 441–53. 2) Cherkasov V.L. Erysipelas. Guide to Internal Medicine: Volume Infectious Diseases / Ed. IN AND. Pokrovsky. M., 1996. pp. 135–150. 3) Amireev S.A., Bekshin Zh.M., Muminov T.A. and others. Standard definitions of cases and algorithms of measures for infectious diseases. Practical Guide, 2nd edition, updated. - Almaty, 2014 - 638 p. 4) Erovichenkov A.A. Erysipelas. Streptococci and streptococcosis /Ed. IN AND. Pokrovsky, N.I. Brico, L.A. Ryapis. M., 2006. P.195–213. 5) Ryapis L.A., Briko N.I., Eshchina A.S., Dmitrieva N.F. Streptococci: general characteristics and methods of laboratory diagnostics / Ed. N.I. Briko. M., 2009. 196s. 6) Erysipelas, a large retrospective study of aetiology and clinical presentation/Anna Bläckberg, Kristina Trell, and Magnus Rasmussen. BMC Infectious Disease. 2015. 7) A systematic review of bacteremias in cellulitis and erysipelas/ Gunderson CG1, Martinello RA. Journal of Infection 2012 Feb.4. 8) Glukhov A.A. Modern approach to the complex treatment of erysipelas/Basic research.-No.10.-2014.P. 411-415.

Information

Abbreviations used in the protocol:

ITS	infectious-toxic shock
KIZ	office of infectious diseases
INR	international normalized ratio
UAC	general blood analysis
OAM	general urine analysis
surge arrester	acute renal failure
ESR	erythrocyte sedimentation rate
SRB	C-reactive protein
Ultrasound	ultrasonography
Ural Federal District	ultraviolet irradiation
ECG	electrocardiogram

List of developers:
1) Kosherova Bakhyt Nurgalievna - Doctor of Medical Sciences, Professor, RSE at the Karaganda State Medical University, Vice-Rector for Clinical Work and Continuing Professional Development, Chief Freelance Adult Infectious Diseases Specialist of the Ministry of Health of the Republic of Kazakhstan.
2) Kulzhanova Sholpan Adlgazyevna - Doctor of Medical Sciences, Astana Medical University JSC, head of the department of infectious diseases and epidemiology.
3) Kim Antonina Arkadyevna - Candidate of Medical Sciences, RSE at Karaganda State Medical University, Associate Professor, Head of the Department of Infectious Diseases and Dermatovenereology.
4) Mukovozova Lidiya Alekseevna - Doctor of Medical Sciences, RSE at the State Medical University of Semey, Professor of the Department of Neurology and Infectious Diseases.
5) Nurpeisova Aiman ​​Zhenaevna - Municipal State Enterprise “Polyclinic No. 1” Health Department of the Kostanay region, head of the department, infectious disease doctor, chief freelance infectious disease specialist of the Kostanay region.
6) Khudaibergenova Mahira Seidualievna - JSC "National Scientific Center of Oncology and Transplantology", doctor - clinical pharmacologist.

Conflict of interest: absent.

List of reviewers: Duysenova Amangul Kuandykovna - Doctor of Medical Sciences, Professor, RSE at the PVC “Kazakh National Medical University named after S.D. Asfendiyarova”, Head of the Department of Infectious and Tropical Diseases.

Conditions for reviewing the protocol: review of the protocol 3 years after its publication and from the date of its entry into force or if new methods with a level of evidence are available.

Attached files

Attention!

• By self-medicating, you can cause irreparable harm to your health.
• The information posted on the MedElement website cannot and should not replace a face-to-face consultation with a doctor. Be sure to contact a medical facility if you have any illnesses or symptoms that concern you.
• The choice of medications and their dosage must be discussed with a specialist. Only a doctor can prescribe the right medicine and its dosage, taking into account the disease and condition of the patient’s body.
• The MedElement website is solely an information and reference resource. The information posted on this site should not be used to unauthorizedly change doctor's orders.
• The editors of MedElement are not responsible for any personal injury or property damage resulting from the use of this site.

Erysipelas– an acute anthroponotic infectious disease caused by hemolytic streptococci, characterized by fever, intoxication, the presence of a local focus of serous-hemorrhagic skin lesions with a tendency to recur.

Etiology: group A b-hemolytic streptococcus.

Epidemiology: with an exogenous variant of infection, the source is patients with any streptococcal disease (tonsillitis, pharyngitis, scarlet fever, streptoderma, etc.) or healthy carriers of streptococcus, transmission routes are airborne, contact; with autoinfection, the pathogen enters the lesion from endogenous foci of streptococcal infection.

Pathogenesis: penetration of MB into the lesion by contact (through skin microtraumas) or hematogenously-lymphogenously (in case of autoinfection) -> activation of mediators of the allergic inflammatory reaction (in the presence of sensitization of certain areas of the skin to streptococcal Ag) -> development of serous or serous-hemorrhagic inflammation with hyperemia , swelling and infiltration of affected areas of the skin and subcutaneous tissue -> involvement of microvasculature, lymphatic capillaries in the process, damage to vascular walls -> elimination of streptococcus due to activation of phagocytosis and the humoral immune system while maintaining skin sensitization -> re-entry of streptococcus -> sclerosis and desolation repeatedly damaged vessels, chronic lymphostasis up to elephantiasis; In addition to local ones, general manifestations of the disease caused by MB enzymes are also characteristic.

Erysipelas clinic:

– incubation period from several hours to 5 days

– acute onset of the disease with the dominance of symptoms of general intoxication (fever up to 39-40 ° C of a remitting type, chills, general weakness, headache, pain in the lower back, muscles and joints, often nausea and vomiting, in some – convulsions, meningism symptoms), especially pronounced in the first days of the disease

– 12-24 hours after the disease occurs Local manifestations: pain, hyperemia and swelling of the affected skin area; the local process is more often located on the lower extremities, less often on the face and upper extremities, depending on its nature it is distinguished Clinical forms of erysipelas:

A) erythematous– the affected area of ​​the skin is characterized by erythema of uniformly bright color rising above the skin, with clear boundaries, a tendency to peripheral distribution, irregularly shaped edges (in the form of notches, “tongues of flame”), swelling and pain; subsequently, peeling of the skin may appear at the site of erythema

B) Erythematous-bullous– begins as erythematous, but after 1-3 days from the moment of illness, epidermal detachment occurs at the site of erythema and blisters of various sizes are formed filled with serous contents; later the blisters burst, and in their place brown crusts form, after which, when rejected, young, delicate skin is visible; in some cases, erosions appear in place of the blisters, which can transform into trophic ulcers.

V) Erythematous-hemorrhagic- occurs with the same symptoms as erythematous, however, against the background of erythema, hemorrhages appear in the affected areas of the skin.

D) bullous-hemorrhagic– has almost the same manifestations as the erythematous-bullous form of the disease, but the blisters that form at the site of erythema are filled not with serous, but with hemorrhagic exudate

Inflammatory skin changes in the erythematous form of erysipelas persist for 5-8 days, and in other forms - 10-15 days or more.

– characterized by a moderate increase and sharp pain regionally in relation to the affected area of ​​the skin. u. (regional lymphadenitis), hyperemia, compaction and soreness of the lymphatic vessels between the source of inflammation and the affected lymph nodes. u. (regional lymphangitis)

Complications of erysipelas (in 5-10% of patients with severe forms of the disease): phlegmon, abscesses (phlegmonous and abscessive erysipelas), necrosis of tissues of the affected area (gangrenous erysipelas), thrombophlebitis, chronic disturbance of lymph flow and lymphostasis (with the development of elephantiasis during repeated diseases), infectious-toxic encephalopathy and infectious-toxic shock, secondary pneumonia, sepsis

Diagnosis of erysipelas:

1) clinical and anamnestic data (acute onset of the disease, characteristic appearance of the lesion, history of erysipelas, identification of predisposing factors)

2) changes in the CBC: leukocytosis, neutrophilia with band shift, increased ESR

Differential diagnosis of erysipelas is carried out with:

1) with phlegmon, abscess– with phlegmon, the lesion is not clearly demarcated from healthy tissue, the greatest pain is in the center of the lesion, intoxication appears later than local changes, with an abscess fluctuation is determined

2) with thrombophlebitis– soreness and hyperemia of the skin spread along the vascular bundle, dense painful cords are often palpated along the veins

3) with erythema nodosum– characterized by delimited multiple low-painful elements located symmetrically on the extensor surface of the legs, thighs, forearms, no lymphadenitis

4) with dermatitis, eczema– intoxication and fever are not typical, there is itching, weeping, infiltration and peeling of the skin

5) with ring-shaped erythema in Lyme disease– localized more often on the legs, has a ring-shaped shape with a pale center, in which you can see a mark from the tick’s suction; rapid onset and sudden intoxication are not typical

6) with erysipeloid– bacterial zoonosis caused by Erysipelothrix rhusiopathiae, which enters the body through damaged skin (usually the hands); The professional nature of the disease is typical (butchers, fish sellers, cooks), the appearance of swelling and erythema in the area of ​​the hands, accompanied by burning and itching without fever and symptoms of general intoxication

Treatment of erysipelas:

1. Patients with a severe course of the disease, repeatedly recurrent erysipelas, in the presence of a severe premorbid background (diabetes, obesity, CHF) are subject to hospitalization; the rest are treated on an outpatient basis

2. Bed rest in the first 5 days, and in case of damage to the lower extremities, during the entire period of the disease.

3. Etiotropic therapy - drugs of choice: phenoxymethylpenicillin orally 0.5 g 4 times a day for 10-14 days, benzathine penicillin 2.4 million units intramuscularly once, alternative drugs - for allergies to beta-lactams: orally azithromycin 250 mg 1 once a day for 10-14 days, clarithromycin 250 mg 2 times a day for 10-14 days, clindamycin 300 mg 3 times a day for 10-14 days. At the end of the course of treatment, in order to prevent relapses, 1.5 million units of bicillin-5 or 1.2 million units of bicillin-3 are administered intramuscularly.

4. Vitamin therapy: multivitamins 2 tablets 3 times a day orally

5. After normalization of temperature - FTL (suberythemal doses of ultraviolet irradiation to the affected area, UHF to the area of ​​infiltration and regional lymph nodes)

6. For prolonged and recurrent erysipelas, hospitalization is indicated, followed by 2 courses of ABT with drugs of different pharmacological groups, immunomodulatory therapy (pentoxyl, methyluracil, prodigiosan), the use of corticosteroids (prednisolone 30-40 mg/day for 5-10 days), etc. .

7. In case of persistent relapses of erysipelas, bicillin prophylaxis is indicated: 1.5 million units of bicillin-5 IM 1 time per month for 3-5 years.

– This is a fairly common disease, which is one of the most pressing problems of modern medicine. Currently, in Russia, this pathology in the form of sporadic cases occurs everywhere, characterized by an increase in the proportion of severe erysipelas, accompanied by the development of hemorrhagic and infectious-toxic syndromes.

Clinical classification

is a disease of an infectious nature that affects the skin and mucous membranes and is characterized by the formation of sharply limited serous or serous-hemorrhagic inflammation.

In clinical practice, this pathology is classified according to the following criteria:

Flow rate;
The nature of local manifestations;
Severity;
Prevalence of the pathological process.

Classification of the disease by flow rate. If the disease occurs for the first time, it is diagnosed primary erysipelas. As a rule, the skin of the face is most often affected by this form of pathology. Erysipelas that develops two years after the first case of the disease (or earlier, but with a different localization) is repeated. If the inflammatory process periodically occurs in the same place, we are talking about recurrent erysipelas. The disease can occur in mild, moderate and severe form.

Forms of erysipelas:

1. Erythematous.
2. Erythematous-bullous.
3. Erythematous-hemorrhagic.
4. Bullous-hemorrhagic.

Prevalence of the inflammatory process:

Localized form(the source of inflammation does not extend beyond one area, that is, it appears only on the leg, or on the face, arm or torso).
Common form(simultaneously combining several areas).
Creeping (migratory) form.
Metastatic form(damage to areas distant from each other).
Erysipeloid (pig erysipelas). This form of erysipelas is considered an occupational disease caused by swine erysipelas. As a rule, it occurs in residents of rural areas, and also develops in workers in the meat and fishing industries after punctures with bones and injuries from cans or various tools. Most often, the inflammation is localized on the finger or hand.

Note: Under natural conditions, pig erysipelas affects piglets 3-12 months old. In animals, the disease can occur in several forms: fulminant (white erysipelas), septic (acute), cutaneous (subacute) and chronic. In order to prevent the inevitable death of animals, they require a special aluminum hydroxy vaccine, which helps to form active immunity and makes them unacceptable to infection.

Clinical signs of erysipelas

In the early stages of the development of the infectious process, patients complain of malaise, headache, nausea (sometimes vomiting) and insomnia. Next, redness of the skin occurs in a certain area of ​​the body. Over the course of several days, the inflamed area increases, then its size remains at a certain level for some time, after which the disease subsides.

During development erythematous form erysipelas, 5-10 hours after the onset of infection, a burning and bloating sensation occurs in a limited area of ​​the body, as well as itching and pain, which intensifies when touched. Then the affected area swells, thickens, turns red and takes on the appearance of a spot with uneven borders that looks like flames. The edges of the spot rise, forming an infiltration ridge. Patients with this form of erysipelas experience a feverish state for a week and symptoms of intoxication varying in severity, as well as enlargement, hardening and soreness of regional lymph nodes. It should be noted that in this form, erysipelas is not contagious.

Erythematous-bullous form characterized by the development of redness and the formation of bubbles of various sizes filled with colorless contents. After some time, they spontaneously open, after which necrosis and peeling of the top layer of skin occurs. At this place, crusts form that do not leave scars. In this case, a feverish state and enlarged lymph nodes are also observed.

Erythematous-hemorrhagic form erysipelas occurs most often in clinical practice. It is accompanied by hemorrhages of varying sizes (from 1-2 mm to several cm) that occur against the background of redness, a prolonged (up to two weeks) feverish state, and necrotic changes on the skin.

Considered the heaviest bullous-hemorrhagic form. In this case, inflammation occurs with damage to small blood vessels of the skin, and is accompanied by the formation of blisters filled with serous-hemorrhagic contents. After opening them, necrotic areas and scars remain on the body.

Most often, the disease affects the skin of the lower extremities, less often – the face and hands. Sometimes erysipelas can occur on the skin of the torso. Infectious lesions of the upper extremities are more common in women after breast surgery (as a consequence of postoperative lymphostasis). In the case when erysipelas is localized on the face, the inflammatory process can spread to the retina of the eyes, provoking the development of neuritis. In men, erysipelas develops less frequently (as a rule, it appears in representatives of certain professions at the age of 20-30 years and is associated with harmful production factors).

It should be noted that the child’s erysipelas is very mild. At the same time, older people and patients with diagnosed immunodeficiency usually experience more complex disorders.

Complications

Currently, complications with erysipelas occur in 5-10% of the total number of patients. As a rule, they occur in the acute form of the disease. In such patients, along with toxic damage to internal organs, abscesses or phlegmons (abscess and phlegmonous erysipelas), thrombophlebitis, chronic impaired lymph circulation, lymphostasis, necrosis of affected tissues (gangrenous erysipelas), infectious-toxic encephalopathy and a state of shock caused by toxins of hemolytic streptococcus may develop. . For recurrent erysipelas, a characteristic complication is wuchereriosis (elephantiasis). Elderly people and patients diagnosed with AIDS may develop secondary pneumonia and sepsis.

Causes of erysipelas and predisposition factors

The causative agent of erysipelas is group A hemolytic streptococcus. This is a facultative anaerobic bacterium, capable of existing only with access to oxygen.

This microorganism, quite stable in the external environment, produces enzymes and antigens that have a detrimental effect on the human body and releases toxins. Under the influence of unfavorable factors (antibodies, natural antibacterial agents and antibiotics), it is capable of transforming into L-forms, which can persist for a long time in the lymph nodes and phagocytic system of the bone marrow, and when the body’s immune forces weaken, it can again transform into its original bacterial form.

The source of infection can be a sick person or a carrier of various forms of streptococcal infection. The main route of transmission of infection is airborne, but at the same time, sometimes erysipelas is transmitted by contact, penetrating through various damage to the skin and mucous membranes. Due to the fact that very often hemolytic streptococcus is able to “settle” on the skin and mucous membranes of absolutely healthy people, failure to comply with basic rules of personal hygiene can cause erysipelas.

According to experts, erysipelas is a skin infection characterized by a hereditary predisposition. Most often, this disease develops in people over 50 years of age, suffering from certain pathological conditions associated with the aging process, and in HIV-infected patients. Erysipelas is very rare in children.

Predisposing factors:

Associated pathologies (diabetes mellitus, foot mycoses, osteomyelitis, eczema, trophic ulcers, thrombophlebitis, obesity, chronic lymphovenous insufficiency, etc.)
Occupational hazards (skin contamination, increased trauma)
Presence of foci of chronic streptococcal infection
Weakening of the immune system after an infectious disease (especially in old age)
Impaired integrity of the skin and mucous membranes
Insolation
Overheating or hypothermia
Development of inflammation at the site of injuries or bruises.

Diagnostics

The diagnosis is made on the basis of the following clinical symptoms: acute onset of the disease, feverish state, signs of severe intoxication and peculiar local manifestations (red skin, or the presence of an erythematous spot on the lower leg or other parts of the body). Laboratory diagnostic methods that make it possible to determine the presence of a persistent and bacterial infection in the patient’s blood using immune complexes with anti-streptococcal antibodies include PCR. At the same time, the patient is required to undergo a comprehensive clinical blood test and coagulogram

Treatment

Treatment of erysipelas is carried out in a complex manner. In case of a mild course of the disease, it can be carried out at home, but, at the same time, in case of severe and recurrent forms of erysipelas, medical care should be provided only in a hospital setting.

The main method of treatment is antibacterial therapy (it is prescribed after an allergy test to antibiotics).

Interesting data
As paradoxical as it sounds, erysipelas can lead to the complete disappearance of malignant tumors and chronic inflammatory processes, and it also prevents the development of skin diseases and lymphadenopathy and has a beneficial effect on severe psychoses observed in mentally ill people.

In parallel, patients are given anti-inflammatory and detoxification therapy, and are also prescribed antihistamines and vitamins.

For erysipelas complicated by the development of fungus, patients are recommended to take antifungal agents.

Antiseptic solutions are used as drugs for local treatment (ointments for erysipelas are prescribed very rarely, as they slow down reparative processes and increase exudation).

Physiotherapeutic treatment (UV irradiation, paraffin, ozokerite, UHF, etc.) is prescribed to eliminate residual effects.

As for non-traditional methods of treatment, they can only be used with the permission of a doctor as an aid. Unfortunately, it is impossible to cure erysipelas with herbal infusions and ointments from traditional healers alone, without the use of antibacterial drugs. Therefore, traditional medicine does not recommend using folk remedies as the main treatment.

Prevention of erysipelas

In order to prevent the development of a pathological process, you should carefully monitor the cleanliness of the skin, even with minor injuries, perform initial treatment of wounds with antiseptic agents and carry out timely treatment of fungal and pustular skin diseases.

Patients suffering from a recurrent form of erysipelas require regular prophylaxis with medications (anti-relapse treatment), and they are also strongly recommended to reconsider the hygienic aspects of work and life. Such measures will not only remove the cause of infection, but will also help completely get rid of the disease.

In recent years, doctors have noted an increase in erysipelas, which appears on the skin as red areas with raised edges or separated from the dermis layer. More often, the disease is diagnosed in women after 50 years of age or in infants when the infection penetrates into the umbilical region.

Erysipelas on the hand is dangerous due to complications, if not treated, then can lead to sepsis, blood poisoning and death. This is a rather rare phenomenon in civilized countries, but today there is a tendency towards a constant increase in the number of cases. When the first symptoms appear, you should not hesitate to consult a doctor.

What kind of disease is erysipelas on the hand?

Erysipelas– this is a manifestation of an infectious focus on the skin caused by a streptococcal infection, in the form of redness of the area, accompanied by an increase in temperature and signs of intoxication. Streptococcus is a bacterium that can quickly penetrate the pores of the skin through cuts, abrasions, and insect bites.

However, erysipelas is contagious. Streptococcal infection can spread quickly from one person to another. To avoid infection when in contact with a sick person, you must wear gloves, use antibacterial soap to wash your hands, and immediately treat cut sites with antiseptics to avoid introducing streptococcus under the skin after contact with sick people.

Causes of the disease

Streptococcus lives in the body of almost every person, and many people are its carriers. But the development of erysipelas and other streptococcal diseases does not occur if provoking factors are absent.

The occurrence of pathology is possible as a result of:

• damage to the dermis due to purulent, viral infection;
• circulatory disorders due to post-traumatic scars after surgery;
• decreased immunity;
• taking a number of drugs - cytostatics, steroids;
• the presence of pathology in metabolic processes;
• diseases of the immune system;
• AIDS;
• presence of bad habits.

Erysipelas is transmitted by airborne droplets or through direct contact with patients. It quickly begins to develop against the background of diabetes mellitus, sudden changes in temperature, poor nutrition, viral infectious diseases, and chronic ailments in the body.

Provoking factors

Inflammation in the hand can be caused by:

• surgery to remove mammary glands in women;
• excessive insolation;
• overheating or hypothermia;
• infection of abrasions, scratches, bruises, cuts with sharp objects.

In addition, the risk group includes people with pathologies such as:

• diabetes;
• alcoholism;
• obesity;
• varicose veins;
• lymphostasis;
• tonsillitis;
• caries;
• periodontitis;
• fungal infection of the feet;
• thrombophlebitis.

The cream is definitely an effective remedy for combating all types of fungal infections on both the skin and nails.

It not only eliminates pathogenic dermatophytes, causative agents of epidermycosis and trichomycosis, but also restores the protective functions of the skin. Effectively eliminates itching, flaking and irritation from the first use.

Characteristic symptoms of erysipelas on the hand

Microorganisms, penetrating into the pores of the skin on the hand, first remain for some time in the incubation period until 2-3 days. Infection may not occur if you immediately treat the area with an antiseptic in the event of an unexpected cut or if your immune system is fairly stable.

Otherwise, the primary and characteristic signs of the development of erysipelas are as follows:

• a sharp increase in body temperature;
• nausea;
• dizziness;
• increased fatigue;
• body aches;
• chills;
• loss of appetite;
• redness appears on the hand in the form of a pink-red spot or a roller with uneven edges with tongues of flame;
• further – peeling, burning sensation, swelling at the site of the lesion;
• in some cases, hemorrhages or blisters with serous or bloody fluid appear within the lesion.

Sometimes the first symptoms are similar to ordinary dermatitis. That is why, when the first dangerous signs appear, you should not postpone going to the doctor. If similar symptoms suddenly appear, you should not hesitate to call an ambulance or go to the nearest clinic. By the way, the disease occurs in older people when carrying out gardening work, so you need to be vigilant.

initial stage

The appearance of a pink spot when streptococcus penetrates the skin occurs within a few hours. The place begins to burn, burn, turn red, resembling tongues of flame. The skin becomes swollen and hot to the touch. The infection quickly spreads further.

Inflammation begins with:

• pain, aches in joints and muscles;
• increased temperature, fever;
• deterioration of general health;
• the appearance of nausea and vomiting;
• headache, dizziness;
• increased heart rate.

At first, erysipelas has an acute course and the symptoms are not specific. Through 1-2 days severe intoxication of the body occurs, some even experience hallucinations and delusions. Toxic damage to the kidneys and heart may occur. The patient feels nauseous, shivering, and sleepy. At the initial stage, erysipelas is similar to the flu.

Features of erysipelas on the hand

Features of the face on the hand the fact that when it gets under the skin, the microorganism quickly penetrates into the deep layers of the dermis, leading to a sharp increase in temperature, chills, and even loss of consciousness. This unpleasant disease, which can greatly worsen the quality of life, interferes with ordinary household activities.

If the disease is not treated, the outcome of such a disease is extremely unfavorable. A minor lesion on the skin can lead to disruption of tissue trophism and gangrene.

In children, the disease is usually mild, but in older people it is more severe. The febrile state can last about 2 months, and all chronic diseases in the body often worsen. Erysipelas tends to recur and is difficult to treat. Those who become ill if they suspect an illness should not delay contacting a dermatologist, immunologist or infectious disease specialist.

Features of erysipelas on the leg

It has the following properties:

• Penetrates freely under the nail and inter-nail spaces
• Has an antibacterial effect. Relieves itching and inflammation in 1 application
• Removes cracks and itching between fingers thanks to propolis
• Destroys spores due to poultry alkaloids
• Golden mustache restores healthy nails

Complications

With proper treatment, erysipelas on the arm can go away on its own after 2-3 weeks. Redness and swelling will subside and will soon disappear altogether. But pigmentation may remain. Relapses are possible.

New erysipelas can subsequently lead to:

• stagnation of lymph;
• lymph circulation insufficiency;
• pulmonary embolism;
• sepsis;
• dead skin;
• thrombophlebitis.

All this indicates untimely treatment and progression of the disease.

Complications, as a rule, result from untimely consultation with doctors, self-medication, or the addition of a secondary infection. The risk group includes people with diabetes, HIV-infected people, and those who have had meningitis or pneumonia.

Erysipelas with complications can lead to the formation of trophic ulcers on the arm, lymphostasis, abscess, suppuration and thickening of the skin, which will significantly complicate treatment, and even may endanger the life of the patient himself.

Treatment

When visiting the clinic, the doctor will first examine the skin, identify the nature, location, degree of damage and shape of the erysipelas. Most likely, the patient with obvious clinical signs will be sent to hospitalization in the infectious diseases department.

For the treatment of erysipelas the following is prescribed:

• antiallergic drugs(Suprastin, Diazolin, Tavegil);
• sulfonamides(Biseptol, Streptocide);
• nitrofurans(Furadonin, Furazolidone) to destroy bacteria;
• corticosteroids(Prednisolone) to eliminate infection;
• biostimulants(Pentoxyl, Methyluracil) to stimulate the formation of new healthy immune cells and skin regeneration;
• vitamins(ascorbic acid, Ascorutin) to strengthen vascular walls damaged by bacteria, increase proteolytic enzymes (trypsin, lidase, tactivin).

Left untreated, it can lead to serious complications and death. Self-medication for erysipelas is excluded. Only a qualified specialist can direct treatment in the right direction.

In addition, treatment is carried out in a hospital with the appointment of:

• benzylpenicillin, as the main antibiotic for streptococcal infections;
• cephalosporins to suppress pathogenic flora in the event of an abscess or phlegmon. The course of treatment is up to 10 days.

Treatment also includes the following:

• Detoxification therapy is carried out in severe cases of the disease by intravenous administration of hemodez or saline solution with glucose.
• It is possible to prescribe cardiovascular, antipyretic, diuretic drugs, also treating the affected area by applying applications of dimexide solution, enteroseptol powders to kill bacteria in the affected areas and prevent the addition of another infection.
• Patients are advised to wash their wounds with furatsilin themselves., other solutions with antimicrobial action to kill bacteria. An oxycyclosol aerosol will help, applying bandages with syntomycin ointment, Vishnevsky's liniment, to relieve inflammation and heal wounds.

You can't warm up places- will only accelerate the movement of streptococci through the blood and the spread of bacteria throughout the body. The main treatment is antibiotics, and in no case should you resort to homemade formulations and prescriptions without the knowledge of your doctor.

Those who are sick must strengthen their immune system, take vitamins, multivitamins, and antiallergic medications. Electrophoresis, laser therapy, ultraviolet irradiation, high-frequency magnetic therapy, and physical therapy are indicated for complete suppression of pathogenic microflora.

Stories from our readers!
"I used the cream in complex therapy for nail and toe fungus. The debilitating itching went away and stopped bothering me altogether. It rubs into the toes easily. The main thing is that the skin is dry.

After a month of use, the nails became lighter, the yellow color disappeared and the delamination that had already begun went away. I am very pleased with the result. It was as if there was no fungus."

Prevention

There are no specific specifics and prevention for erysipelas.

Development can be prevented if:

• do not neglect the rules of personal hygiene, wearing loose clothing and shoes made of natural fabrics;
• use soap containing lactic acid when showering to create a protective layer on the skin;
• immediately treat any damage or abrasions on the skin with antiseptics;
• Avoid ultraviolet irradiation, chapping, frostbite of extremities.

Erysipelas is a common ailment, and it can be treated fairly quickly with timely medication. An advanced disease will ultimately lead to a chronic relapsing course, scarring on the arm, swelling, and lymph stagnation.

Symptoms will recur from time to time, up to the appearance of stiffness in the joints, constant pain, limited mobility and disability. The appearance of a red, itchy and flaky spot on your hand cannot be ignored. It is possible that a streptococcal infection has occurred. The sooner, the better to seek advice from a dermatologist.