Furuncle — the acute purulent inflammation of a hair follicle taking the soft fabrics surrounding it and an adjacent sebaceous gland. The furuncle begins with formation of dense infiltrate in which center the necrotic core which is coming to an end with pustuly is formed. Then there is an opening of a pustula, a core otkhozhdeniye together with purulent contents and healing of a furuncle after which on skin there is a hem. Diagnosis of a furuncle includes Dermoscopy, separated, blood test, a research of immune system, detection of associated diseases and complications. Treatment is carried out locally according to stages of development of a furuncle. According to indications antibiotic treatment, immunocorrection, treatment of complications is appointed.
The national name of a furuncle - "furuncle" is widespread. This disease meets more often at adults, and at men more often, than at women. Growth of incidence of furuncles is the share of fall and spring.
Together with ostiofollikulity, gidradenity, follikulity, sikozy and streptococcal impetigo the furuncle belongs to piodermiya — group of dermatological diseases of pyoinflammatory character. If ostiofollikulit and follikulit represent defeat of exclusively hair follicle, then the furuncle proceeds with involvement in purulent process of the fabrics surrounding a follicle and quite often is a complication of these diseases. Also development of a furuncle can complicate others stafilo-and streptodermiya.
Causes of a furuncle
The staphylococcal infection is the main reason for emergence of a furuncle. During the numerous researches which are conducted constantly by dermatology it was proved that staphylococcus normal are present at the surface of skin of the person. At the same time only 10% of total number of stafilokokk are pathogenic microorganisms. At patients with furuncles this ratio is changed and the number of pathogenic stafilokokk often reaches 90%. Similar violation of microflora of an integument can develop as a result of pollution of skin, its additional infection or at decrease in reactivity of immune system.
Decrease in immunity, in turn, can be caused by chronic diseases and infectious processes in an organism (tuberculosis, chronic pyelonephritis, bronchitis, hepatitis, sinusitis, tonsillitis, etc.); metabolic violations (diabetes, endocrine obesity); long therapy by glucocorticosteroids; application of the tsitostatik and other medicamentous medicines directed to suppression of immune system (at patients with a lymphoma, stomach cancer, a kidney adenocarcinoma, a breast cancer, sarcoma of a uterus and other oncological diseases).
Penetration of stafilokokk into a hair sack with formation of a furuncle can be promoted by maceration of skin at the increased sweating and its microtraumatizing: raschesa at dermatological diseases with the expressed itch (eczema, atopic dermatitis, itch, an inguinal epidermofitiya, a pochesukha), scratches, cuts and attritions. Furuncles in a nose and an auricle can develop as a result of continuous impact on skin mucopurulent separated from a nose or an ear at chronic rhinitis, adenoides, antritis, otitis.
Emergence of a furuncle is possible practically in any place on skin of the person. Most often it arises where there is a friction, perspiration or pollution of skin. This person, neck, axillary and inguinal areas, hips, buttocks, waist, breast. The furuncle passes 3 stages in the development: infiltration, suppuration and necrosis, healing. All process of its development usually takes no more than 10 days.
The stage of infiltration of a furuncle begins with emergence of bright red infiltration around the mouth of a hair follicle. Infiltrate increases in sizes (to 1-3 cm in the diameter), is condensed, to become more and more painful, is followed by hypostasis of the fabrics surrounding it and feeling of a pricking. The most expressed puffiness is observed at an arrangement of a furuncle in the person: in the field of a century, lips, cheeks.
The stage of suppuration and necrosis of a furuncle comes 3-4 days later from the moment of its emergence. It is characterized by formation typical for a furuncle is purulent - the necrotic core coming to the surface of skin in the form of a pustula. During this period rise in body temperature to 38 °C and sharply expressed morbidity in the field of a furuncle is noted. The general symptoms of intoxication are possible: indisposition, weakness, headache, deterioration in appetite. At peak of a clinical picture of a furuncle there is an opening of its tire. Through the formed opening pus streams and there is a necrotic core. After that infiltration, puffiness, morbidity and the general symptomatology quickly take place, healing process begins.
The stage of healing of a furuncle proceeds with formation of granulyatsionny fabric in the crater which remained after its opening. Within 3-4 days on the place of a furuncle the hem is formed. In the beginning he has noticeable red-blue coloring, but gradually turns pale and can become almost imperceptible.
In some cases the course of a furuncle can be erased and not be followed by formation of a necrotic core. At formation of a furuncle in an auricle the intensive ear pain irradiating to the temporal area and jaws joins its symptoms. The diffusion headache is sometimes noted. The furuncle can block acoustical pass that is followed by deterioration in hearing.
Despite the seeming simplicity of a disease, even the single furuncle can be the cause of serious complications. Most often the furuncles located in the field of a nasolabial triangle and on mucous nose thresholds become complicated. Development of complications is quite often promoted by attempts of expression of a furuncle, its inadequate local treatment, traumatizing during shaving.
On process localization all complications of a furuncle divide on local (abscess, an anthrax, an ugly face, phlegmon), remote (lymphadenitis, limfangit, phlebitis) and the general (, damages of a brain, abscesses in internals, sepsis).
Local complications arise because separated a furuncle contains pathogenic staphylococcus and can become the reason of infection of other sites of skin. Merge of several furuncles leads to more extensive purulent damages of skin, such as anthrax, abscess, phlegmon of soft fabrics. The multiple nature of furuncles is regarded as .
Transition of an infection from a furuncle to lymphatic vessels and veins causes development of a limfangit, lymphadenitis, phlebitis and thrombophlebitis. The most dangerous is spread of a staphylococcal infection on arterial vessels with development of metastatic abscesses, pyelonephritis, sepsis. The furuncles which are localized on a face can become complicated arakhnoidity, meningitis, brain abscess.
Diagnosis of a furuncle
At detection of signs of an inflammation of skin the patient should address the dermatologist. The doctor will establish the diagnosis, based on survey and Dermoscopy of the struck area. For definition of an etiology of the activator it is made the separated furuncle. Recurrent and multiple furuncles are the indication for the general inspection of the patient with performing clinical blood test and urine, blood test on sugar, a bakposev of urine, faringo-and rinoskopiya, a X-ray analysis of additional bosoms of a nose, fluorography, ultrasonography of abdominal organs and kidneys. In need of the patient the endocrinologist, the gastroenterologist, the pulmonologist, the otolaryngologist and other experts in addition advise. Development of complications can demand carrying out crops of blood on sterility, KT of kidneys, MRT of a brain, a lyumbalny puncture.
Treatment of a furuncle
In most cases at a furuncle are limited to local treatment which is performed according to disease stages. In a stage of maturing of a furuncle apply ikhtiolovy bandages it, apply dry heat, UVCh-therapy. After its opening apply bandages with hypertensive solution of sodium of chloride, a turunda with the ointment containing chloramphenicol in combination with methyluracil. At a difficult otkhozhdeniye of a necrotic core proteolytic enzymes are shown: trypsin, chymotrypsin. Treatment to stages of healing of a furuncle is carried out by the antibacterial and healing means.
At multiple and recurrent furuncles treatment has to include the therapy directed to increase in immunity. The autogemoterapiya, laser and ultra-violet radiation of blood (VLOK and UFOK), introduction of gamma globulin, a staphylococcal anatoksin or vaccine is for this purpose applied. Medicamentous immunomodulatory therapy is appointed according to results of an immunogramma. System antibiotic treatment is carried out in case of the big, recidivous or complicated furuncle, and also at its localization on a face. Along with treatment of a furuncle correction of associated diseases and knocking over of complications is carried out.
Prevention of emergence of furuncles
Treat the preventive actions directed to the prevention of emergence of a furuncle: respect for hygiene of skin, the corresponding care of skin at a gipergidroza and the raised salootdeleniye, processing of injuries of skin by antiseptics, timely and adequate treatment of superficial forms of a piodermiya, correction of exchange violations and therapy of chronic diseases, the healthy lifestyle allowing to keep high immunity.
Prevention of complications consists first of all in the prevention of traumatizing a furuncle and spread of an infection. Self-treatment is not recommended. The timely address to the dermatologist and observance of its appointments is necessary.