Erysipelas (erysipelas): treatment, symptoms and diagnosis

Erysipelas, or simply erysipelas, is an infectious-allergic disease that affects the skin and subcutaneous tissue. The disease is quite common and prone to relapse. It ranks fourth among all infectious diseases and is also becoming more common over time. Thus, over the past twenty years, the number of relapses of this disease has increased by 25%. Moreover, a severe form of the disease is becoming more common - now it is about 80% of cases, although 50-60 years ago only 30 percent of patients were diagnosed with a severe form.

At-risk groups

Most often, women over 50 years of age are affected by this disease, but it can also occur in infants. In their case, infection occurs after streptococcus enters the wound of the umbilical region. There is no explanation for this fact, but people with blood group III suffer from erysipelas more often. There is also a connection with the place of residence. In South Asia, as well as in Africa, this disease is very rare.

People with a low level of immunity, weakened by illness, stress, treatment and other factors are at risk.

Symptoms

You can notice the first symptoms of erysipelas on different parts of the body: legs, arms, face, torso, perineum. Moreover, much will depend on how exactly the disease develops. For example, inflammation on the face can be localized around the eye socket, near the ear, on the scalp and neck. If the disease starts from the nose, a butterfly-type lesion may develop - extending to the cheeks. At the same time, swelling occurs, which distorts the size of the tissue. The same applies to all other organs - the localization of the disease is different and depends on the situation.

Symptoms of erysipelas are divided into general and local. General points include:

Chills, fever. Patients often shake violently.
High temperature, up to 40 degrees. It can last up to ten days.
Convulsions, clouding of consciousness, delirium.
Very strong weakness, dizziness.
Nausea, often vomiting.
Pain in muscles and joints.

In other words, symptoms of general poisoning of the body are observed.

Local symptoms of erysipelas look like this:

Redness of the skin at the site of the lesion. Usually changes are noticeable ten to twenty hours after the pathological processes begin.
Puffiness, swelling, pain in the place where the skin rises. Also, the area of skin becomes warmer to the touch, even hot. The patient may feel a burning sensation and a sensation as if something is bursting the skin from the inside.
Rapid growth of inflammation, since streptococci multiply quite actively. The edges of the lesions are uneven, they constantly change as they grow.
Enlargement of nearby lymph nodes as the pathogen spreads through the lymphatic system.
Bubbles with clear liquid. They are small at first, but then they grow and unite with each other. This sign is not always present.
Hemorrhages. If you do not help the patient at first, complications will occur, including damage to the blood vessels, the blood of which enters the intercellular space.
Bubbles with blood and pus surrounded by areas of hemorrhage. The classification of erysipelas suggests different degrees of development of the disease - and these manifestations are already characteristic of complicated forms.

The more advanced the situation, the higher the risks that even after successful treatment a relapse will occur. Often the disease occurs in the same place as the first time.

Erysipelas: CLINIC, DIAGNOSTICS, TREATMENT

• According to the nature of local manifestations: a) erythematous; b) erythematous-bullous; c) erythematous-hemorrhagic; d) bullous-hemorrhagic. • According to the degree of intoxication (severity): I - mild; II - moderate; III - heavy. • By flow rate: a) primary; b) recurrent (occurring after 2 years, different localization of the process) c) recurrent. If there are at least three relapses of erysipelas per year, the definition of “frequently recurrent erysipelas” is appropriate. • According to the prevalence of local manifestations: a) localized erysipelas; b) common (migratory) erysipelas; c) metastatic erysipelas with the appearance of distant foci of inflammation. • Complications of erysipelas: a) local b) general. • Consequences of erysipelas: a) persistent lymphostasis (lymphatic edema, lymphedema); b) secondary elephantiasis (fibredema). Primary, repeated erysipelas and the so-called late relapses of the disease (after 6 - 12 months and later) are an acute cyclic infectious process that occurs as a result of exogenous infection with group A b-hemolytic streptococcus. The source of infection in this case is both patients with a variety of streptococcal infections and and healthy streptococcus bacteria carriers. The main transmission mechanism is contact (microtraumas, abrasions, skin rash, etc.). The airborne transmission mechanism of streptococcus with primary damage to the nasopharynx and subsequent introduction of the microbe to the skin by hand, as well as by lymphogenous and hematogenous routes, is also of particular importance. Recurrent erysipelas, in which early and frequent relapses of the disease occur, is formed after a primary or recurrent erysipelas due to inadequate treatment, the presence of unfavorable background and concomitant diseases (varicose veins, mycoses, diabetes mellitus, chronic tonsillitis, sinusitis, etc.), the development of secondary immune deficiency, defects in nonspecific defense of the body. Foci of chronic endogenous infection form in the skin and regional lymph nodes. Along with the bacterial forms of group A streptococcus, when the process is chronic, the L-forms of the pathogen are also of great importance, persisting for a long time in the macrophages of the skin and organs of the mononuclear-phagocytic system. Reversion of L-forms of streptococcus into the original bacterial forms leads to another relapse of the disease. Erysipelas usually occurs against the background of pronounced sensitization to b-hemolytic streptococcus and is accompanied by the formation of fixed immune complexes in the dermis, including perivascularly. When infected with streptococcus, the disease develops only in individuals who have a congenital or acquired predisposition to it. Infectious-allergic and immunocomplex mechanisms of inflammation in erysipelas determine its serous or serous-hemorrhagic nature. The addition of purulent inflammation indicates a complicated course of the disease. Patients with erysipelas are less contagious. Women get erysipelas more often than men, especially the recurrent form of the disease. In more than 60% of cases, erysipelas occurs in people aged 40 years and older. Unlike other streptococcal infections, erysipelas is characterized by a distinct summer-autumn seasonality. In recent years, there has been an increase in the number of cases of hemorrhagic erysipelas, which is characterized by slow tissue repair at the site of inflammation, a tendency towards a protracted (chronic) course of the infectious process, and a high frequency of complications. Clinical picture of erysipelas

The incubation period ranges from several hours to 3 - 5 days. In patients with recurrent erysipelas, the development of another attack of the disease is often preceded by hypothermia and stress. In the vast majority of cases, the disease begins acutely. Initial period

The disease is characterized by the rapid development of intoxication symptoms, which in more than half of patients (usually when erysipelas is localized on the lower extremities) precede the onset of local manifestations of the disease by several hours to 1–2 days.
Headache, general weakness, chills, and muscle pain are noted. Nausea and vomiting occur in 25–30% of patients. Already in the first hours of illness, the temperature rises to 38 - 40°C. In areas of the skin in the area of future local manifestations, a number of patients experience paresthesia, a feeling of fullness or burning, and mild pain. Often pain also occurs in the area of enlarged regional lymph nodes. The height of the disease
occurs within a period of several hours to 1 - 2 days after the first manifestations of the disease.
General toxic manifestations and fever reach their maximum. Characteristic local manifestations of erysipelas occur. Most often, the inflammatory process is localized on the lower extremities (60 - 70%), less often on the face (20 - 30%) and upper extremities (4 - 7%), very rarely only on the torso, in the area of the mammary gland, perineum, external genitalia . With timely treatment and uncomplicated course of erysipelas, the duration of fever usually does not exceed 5 days. In 10 - 15% of patients, fever persists for longer than 7 days, which is usually observed with a widespread process and insufficient adequate etiotropic therapy. The longest febrile period is observed with bullous hemorrhagic erysipelas. More than 70% of patients with erysipelas develop regional lymphadenitis, which develops in all forms of the disease. The period of convalescence.
Normalization of temperature and disappearance of symptoms of intoxication are observed with erysipelas earlier than the disappearance of local manifestations.
Acute local manifestations of the disease persist for up to 5 - 8 days, in hemorrhagic forms - up to 12 - 18 days or more. Residual effects of erysipelas that persist for several weeks and months include pasty and pigmented skin, congestive hyperemia at the site of faded erythema, dense dry crusts at the site of bullae, and edematous syndrome. Unfavorable prognostic significance (the likelihood of an early relapse) are persistent enlarged and painful lymph nodes, skin infiltrates in the area of the extinguished source of inflammation, and low-grade fever. Prognostically unfavorable is also the long-term persistence of lymphatic edema (lymphostasis), which should be considered as an early stage of secondary elephantiasis. Hyperpigmentation of skin areas on the lower extremities in patients who have suffered from bullous hemorrhagic erysipelas can persist for life. Erythematous erysipelas
can be either an independent clinical form of erysipelas or the initial stage of development of other forms of erysipelas.
A small red or pink spot appears on the skin, which within a few hours turns into the characteristic erythema erysipelas. Erythema is a clearly demarcated area of hyperemic skin with uneven boundaries in the form of teeth and tongues. The skin in the area of erythema is infiltrated, tense, hot to the touch, moderately painful on palpation (more along the periphery of the erythema). In some cases, a “peripheral ridge” can be detected in the form of infiltrated and raised edges of erythema. Along with hyperemia and infiltration of the skin, its edema develops, spreading beyond the erythema. Erythematous-bullous
erysipelas develops in a period of several hours to 2 - 5 days against the background of erythema erysipelas.
The development of blisters is associated with increased exudation at the site of inflammation and detachment of the epidermis from the dermis by accumulated fluid. When the surfaces of the blisters are damaged or they spontaneously rupture, exudate leaks out, and erosion often occurs in large quantities at the site of the blisters. While maintaining the integrity of the blisters, they gradually shrink to form yellow or brown crusts. Erythematous-hemorrhagic
erysipelas develops against the background of erythematous erysipelas within 1 to 3 days from the onset of the disease, sometimes later.
Hemorrhages of various sizes appear - from small petechiae to extensive confluent hemorrhages, sometimes throughout the entire erythema. Bullous-hemorrhagic
erysipelas transforms from the erythematous-bullous or erythematous-hemorrhagic form and occurs as a result of deep damage to the capillaries and blood vessels of the reticular and papillary layers of the dermis.
Bullous elements are filled with hemorrhagic and fibro-hemorrhagic exudate, and extensive hemorrhages occur in the skin in the area of erythema. The resulting blisters come in different sizes and are dark in color with translucent yellow inclusions of fibrin. The blisters may also contain predominantly fibrinous exudate. The appearance of extensive flattened blisters, dense on palpation due to significant deposition of fibrin in them, is possible. In patients with active repair in the lesion, brown crusts quickly form at the site of the blisters. In other cases, the covers of the blisters rupture and are rejected along with clots of fibrinous-hemorrhagic contents, exposing the eroded surface. In most patients, its gradual epithelization occurs. With significant hemorrhages in the bottom of the bladder and the thickness of the skin, necrosis may develop, sometimes with the addition of secondary suppuration and the formation of ulcers. According to the specialized erysipelas department of the 2nd Clinical Infectious Diseases Hospital (Moscow), in patients hospitalized in the department in 1997, the erythematous or erythematous-bullous form was diagnosed in 5.2% of cases, the erythematous-hemorrhagic form - in 48.8% , bullous-hemorrhagic - in 46%. The severity criteria
for erysipelas are the severity of intoxication and the prevalence of the local process.
The mild (I) form of erysipelas includes cases with minor intoxication, low-grade fever, and a localized (usually erythematous) local process. The moderate (II) form of the disease is characterized by severe intoxication. There is general weakness, headache, chills, muscle pain, sometimes nausea, vomiting, fever up to 38 - 40 ° C, tachycardia, and in almost half of the patients - hypotension. The local process can be either localized or widespread (involves two anatomical areas) in nature. Severe (III) form of erysipelas includes cases of illness with severe intoxication: intense headache, repeated vomiting, hyperthermia (above 40°C), sometimes blackout, symptoms of meningism, convulsions. Significant tachycardia and often hypotension are observed; in elderly and senile people, with late treatment, the development of acute cardiovascular failure is possible. Widespread bullous-hemorrhagic erysipelas with extensive blisters should be considered severe in the absence of pronounced toxicosis and hyperthermia. With different localization of erysipelas, the clinical course of the disease and its prognosis have their own characteristics. Erysipelas of the lower extremities is the most common localization of the disease (60 - 70%). Characteristic are hemorrhagic forms of the disease with the development of extensive hemorrhages, large blisters with subsequent formation of erosions and other skin defects. For this localization of the process, the most typical lesions of the lymphatic system are lymphangitis, periadenitis, and a chronically relapsing course of the disease. The latter is largely facilitated by background concomitant conditions - chronic venous insufficiency, primary disorders of lymph circulation, mycoses, etc. Erysipelas (20 - 30%) is usually observed in primary and recurrent forms of the disease. With it, it is relatively rare that the disease often recurs. With timely treatment, facial erysipelas is easier than erysipelas of other localizations. It is often preceded by tonsillitis, acute respiratory diseases, exacerbations of chronic sinusitis, otitis media, and caries. Erysipelas of the upper extremities (5 - 7%), as a rule, occurs against the background of postoperative lymphostasis (elephantiasis) in women operated on for a breast tumor. Erysipelas of this localization in women has a tendency to recur. One of the main aspects of the problem of erysipelas as a streptococcal infection is the tendency of the disease to have a chronically relapsing course (in 25 - 35% of all cases). Relapses of erysipelas can be late
(occur a year or more after the previous outbreak of erysipelas with the same localization of the local inflammatory process), seasonal (occur annually for many years, most often in the summer-autumn period).
Late and seasonal relapses of the disease, usually the result of reinfection, do not differ in clinical course from typical primary erysipelas, although they occur against the background of persistent lymphostasis and other consequences of previous outbreaks of the disease. Early
and
frequent
relapses (3 relapses per year or more) are exacerbations of a chronic disease.
In more than 70% of patients, often recurrent erysipelas occurs against the background of various concomitant conditions, accompanied by disturbances in skin trophism, a decrease in its barrier functions, and local immunodeficiency. These include primary lymphostasis and elephantiasis of various etiologies, chronic venous insufficiency (postthrombophlebitic syndrome, varicose veins), fungal skin lesions, diaper rash, etc. Chronic ENT infection, diabetes mellitus, and obesity are of particular importance for the formation of recurrent erysipelas. The combination of two or three of the listed background diseases significantly increases the possibility of frequent relapses of the disease, and those suffering from them constitute a risk group. Complications
of erysipelas, mainly of a local nature, are observed in 5 - 8% of patients.
Local complications of erysipelas include abscesses, phlegmons, skin necrosis, pustulization of bullae, phlebitis, thrombophlebitis, lymphangitis, and periadenitis. Complications most often occur in patients with bullous hemorrhagic erysipelas. With thrombophlebitis, the subcutaneous and less often the deep veins of the leg are affected. Treatment of these complications must be carried out in purulent surgical departments. Common complications that develop in patients with erysipelas quite rarely include sepsis, toxic-infectious shock, acute cardiovascular failure, pulmonary embolism, etc. The consequences
of erysipelas include persistent lymphostasis (lymphedema) and secondary elephantiasis itself (fibredema), which are two stages of one process. According to modern concepts, persistent lymphostasis and elephantiasis in most cases develop in patients with erysipelas against the background of already existing functional insufficiency of lymph circulation of the skin (congenital, post-traumatic, etc.). Recurrent erysipelas that occurs against this background significantly enhances existing (sometimes subclinical) lymph circulation disorders, leading to the formation of consequences of the disease. Successful anti-recurrence treatment of erysipelas (including repeated courses of physical therapy) can lead to a significant reduction in lymphedema. In case of already formed secondary elephantiasis, only surgical treatment is effective.

Laboratory diagnostics

Due to the rare isolation of b-hemolytic streptococcus from the blood of patients and from the source of inflammation, conducting routine bacteriological studies is impractical. Elevated titers of antistreptolysin-O and other antistreptococcal antibodies, identification of bacterial and L-forms of streptococcus in the blood of patients have a certain diagnostic significance, which is especially important when predicting relapses in convalescents. Recently, polymerase chain reaction has begun to be used to diagnose streptococcal infections. In most patients with erysipelas, at the height of the disease, moderate neutrophilic leukocytosis with a shift to the left, aneosinophilia, and moderately increased ESR are usually observed. In patients with frequent relapses of the disease, leukopenia may occur. In severe cases of erysipelas and its purulent complications, hyperleukocytosis may be detected, sometimes with the development of a leukemoid reaction and toxic granularity of neutrophils. Changed hemogram parameters usually normalize during the period of convalescence. Changes in the T- and B-immune systems are most typical for the recurrent form of the disease. They reflect signs of secondary immune deficiency, usually occurring in the hypersuppressor mode. For patients with hemorrhagic erysipelas, pronounced disturbances of hemostasis and fibrinolysis are typical, manifested by an increase in the blood level of fibrinogen, PDP, RKMP, an increase or decrease in the amount of plasminogen, plasmin, antithrombin III, an increase in the level of platelet factor 4, and a decrease in their number. Moreover, the activity of various components of hemostasis and fibrinolysis varies significantly in individual patients.

Diagnostic criteria and differential diagnosis

Diagnostic criteria for erysipelas in typical cases are: • acute onset of the disease with severe symptoms of intoxication, increased body temperature to 38-39°C and above; • predominant localization of the local inflammatory process on the lower extremities and face; • development of typical local manifestations with characteristic erythema, possible local hemorrhagic syndrome; • development of regional lymphadenitis; • absence of severe pain in the area of inflammation at rest. Differential diagnosis for erysipelas should be carried out with more than 50 diseases related to the clinic of surgical, skin, infectious and internal diseases. First of all, it is necessary to exclude abscess, phlegmon, suppurating hematoma, thrombophlebitis (phlebitis), dermatitis, eczema, herpes zoster, erysipeloid, erythema nodosum.

Treatment

Treatment of patients with erysipelas should be carried out taking into account the form of the disease, primarily its frequency (primary, repeated, recurrent, often recurrent erysipelas), as well as the degree of intoxication, the nature of local lesions, the presence of complications and consequences. Currently, most patients with mild erysipelas and many patients with moderate forms of the disease are treated in a clinic. Indications for compulsory hospitalization in infectious diseases hospitals (departments) are: • severe erysipelas with severe intoxication or widespread skin lesions (especially in the bullous-hemorrhagic form of erysipelas); • frequent relapses of erysipelas, regardless of the degree of intoxication, the nature of the local process; • presence of severe common concomitant diseases; • old age or childhood. Antibacterial therapy occupies the most important place in the complex treatment of patients with erysipelas (as well as other streptococcal infections). When treating patients in a clinic and at home, it is advisable to prescribe antibiotics orally: erythromycin 0.3 g 4 times a day, oletethrin 0.25 g 4 - 5 times a day, doxycycline 0.1 g 2 times a day, spiramycin 3 million IU 2 times a day (course of treatment 7 - 10 days); azithromycin - on the 1st day 0.5 g, then for 4 days 0.25 g 1 time per day (or 0.5 g for 5 days); ciprofloxacin - 0.5 g 2 - 3 times a day (5 - 7 days); biseptol (sulfatone) - 0.96 g 2 - 3 times a day for 7 - 10 days; rifampicin - 0.3 - 0.45 g 2 times a day (7 - 10 days). In case of intolerance to antibiotics, furazolidone is indicated - 0.1 g 4 times a day (10 days); delagil 0.25 g 2 times a day (10 days). It is advisable to treat erysipelas in a hospital setting with benzylpenicillin in a daily dose of 6 - 12 million units, a course of 7 - 10 days. In severe cases of the disease, the development of complications (abscess, phlegmon, etc.), a combination of benzylpenicillin and gentamicin (240 mg once a day) and the prescription of cephalosporins are possible. For severe skin infiltration at the site of inflammation, non-steroidal anti-inflammatory drugs are indicated: chlotazol 0.1 - 0.2 g 3 times or butadione 0.15 g 3 times a day for 10 - 15 days. Patients with erysipelas need to be prescribed a complex of B vitamins, vitamin A, rutin, ascorbic acid, a course of treatment of 2 - 4 weeks. In case of severe erysipelas, parenteral detoxification therapy is carried out (hemodez, rheopolyglucin, 5% glucose solution, saline solution) with the addition of 5 - 10 ml of 5% ascorbic acid solution, 60 - 90 mg of prednisolone. Cardiovascular, diuretic, and antipyretic drugs are prescribed. Pathogenetic therapy of local hemorrhagic syndrome is effective with earlier treatment (in the first 3-4 days), when it prevents the development of extensive hemorrhages and bullae. The choice of drug is carried out taking into account the initial state of hemostasis and fibrinolysis (according to coagulogram data). In case of clearly expressed hypercoagulation phenomena, treatment with a direct-acting anticoagulant heparin (subcutaneous administration or by electrophoresis) and the antiplatelet agent trental at a dose of 0.2 g 3 times a day for 7 - 10 days is indicated. In the presence of pronounced activation of fibrinolysis in the early stages of the disease, it is advisable to treat with the fibrinolysis inhibitor Ambien at a dose of 0.25 g 3 times a day for 5 - 6 days. In the absence of pronounced hypercoagulation, it is also recommended to administer protease inhibitors - Contrical and Gordox - directly into the inflammation site by electrophoresis, for a course of treatment of 5 - 6 days.

Treatment of patients with recurrent erysipelas

Treatment of this form of the disease should be carried out in a hospital setting. It is mandatory to prescribe reserve antibiotics that were not used in the treatment of previous relapses. Cephalosporins (I or II generation) are prescribed intramuscularly at 0.5 - 1.0 g 3 - 4 times a day or lincomycin intramuscularly 0.6 g 3 times a day, rifampicin intramuscularly 0.25 g 3 times a day. The course of antibacterial therapy is 8 - 10 days. For particularly persistent relapses of erysipelas, two-course treatment is advisable. Antibiotics are consistently prescribed that have an optimal effect on bacterial and L-forms of streptococcus. The first course of antibiotic therapy is carried out with cephalosporins (7 - 8 days). After a 5-7 day break, a second course of treatment with lincomycin is carried out (6-7 days). For recurrent erysipelas, immunocorrective therapy (methyluracil, sodium nucleinate, prodigiosan, T-activin) is indicated.

Local therapy

Treatment of local manifestations of the disease is carried out only in its bullous forms with localization of the process on the extremities. The erythematous form of erysipelas does not require the use of local treatments, and many of them (ichthyol ointment, Vishnevsky balm, antibiotic ointments) are generally contraindicated. In the acute period of erysipelas, if there are intact blisters, they are carefully incised at one of the edges and after the exudate is released, bandages with a 0.1% solution of rivanol or a 0.02% solution of furatsilin are applied to the site of inflammation, changing them several times during the day. Tight bandaging is unacceptable. In the presence of extensive weeping erosions at the site of the opened blisters, local treatment begins with manganese baths for the extremities, followed by the application of the bandages listed above. For the treatment of local hemorrhagic syndrome with erythematous-hemorrhagic erysipelas, 5-10% dibunol liniment is prescribed in the form of applications in the area of inflammation 2 times a day for 5-7 days. Timely treatment of hemorrhagic syndrome significantly reduces the duration of the acute period of the disease, prevents the transformation of erythematous-hemorrhagic erysipelas into bullous-hemorrhagic, accelerates reparative processes, and prevents complications characteristic of hemorrhagic erysipelas.

Physiotherapy

Traditionally, in the acute period of erysipelas, ultraviolet radiation is prescribed to the area of inflammation in the area of regional lymph nodes. If skin infiltration, edematous syndrome, regional lymphadenitis persist during the convalescence period, ozokerite applications or dressings with heated naphthalan ointment (on the lower extremities), paraffin applications (on the face), lidase electrophoresis (especially in the initial stages of elephantiasis formation), calcium chloride, radon baths. Recent studies have shown the high effectiveness of low-intensity laser therapy for local inflammation, especially in hemorrhagic forms of erysipelas. Laser radiation is used in both the red and infrared ranges. The applied dose of laser radiation varies depending on the condition of the local hemorrhagic lesion and the presence of concomitant diseases.

Bicillin prevention of recurrent erysipelas

Bicillin prophylaxis is an integral part of complex dispensary treatment of patients suffering from a recurrent form of the disease. Prophylactic intramuscular administration of bicillin (5 - 1.5 million units) or retarpen (2.4 million units) prevents relapses of the disease associated with reinfection with streptococcus. While foci of endogenous infection persist, these drugs prevent the reversion of L-forms of streptococcus into the original bacterial forms, which helps prevent relapses. In case of frequent relapses (at least 3 in the last year) of erysipelas, continuous (year-round) bicillin prophylaxis is advisable for 2 - 3 years with an interval of drug administration of 3 - 4 weeks (in the first months the interval can be reduced to 2 weeks). In case of seasonal relapses, the drug is started to be administered a month before the start of the morbidity season in a given patient with an interval of 4 weeks for 3 to 4 months annually. If there are significant residual effects after erysipelas, the drug is administered at intervals of 4 weeks for 4 to 6 months. Clinical examination of patients with erysipelas should be carried out by doctors in the infectious diseases departments of polyclinics, with the involvement, if necessary, of doctors of other specialties.

Causes

Erysipelas is caused by streptococci - or rather, one of the varieties of bacteria of this group. In an organism with a weakened immune system, streptococcus can cause other diseases - for example, scarlet fever, myocarditis, and sore throat.

About 15% of the world's people are carriers of streptococcus. That is, their immunity is quite strong so as not to get sick, but at the same time they spread the infection. It is transmitted through personal contacts, household objects, airborne droplets, etc.

Predisposing factors for infection:

Various skin injuries, including insect bites, animal bites, bedsores and ulcers. Even venous catheters can be dangerous in this sense.
Harmful working conditions - when the skin is constantly exposed to chemicals, it often becomes dirty. People who constantly wear rubber clothing and shoes are also at risk.
Viral skin lesions - chickenpox, shingles, herpes. They not only violate the integrity of the integument, but also greatly reduce immunity.
Chronic skin lesions such as eczema, atopic dermatitis, psoriasis, etc.
Purulent lesions of the skin: boil, carbuncle and similar formations.
Disturbances in the circulatory system - varicose veins, thrombophlebitis. If the skin is deprived of oxygen, it becomes damaged and becomes more susceptible to infection.
Various scars, the cells of which the body itself can attack, which is why erysipelas develops.
Fungal diseases of the scalp and feet.
Serious complications with rhinitis, otitis media, conjunctivitis.
Injuries to the skin caused by wearing tight clothing that rubs and disrupts blood circulation in the tissues.
Any reasons that suppress the immune system: taking certain medications, serious illnesses, exhaustion as a result of malnutrition, hypothermia, bad habits, chronic or severe stress and much more.

To summarize, the disease develops against a background of weakened immunity and streptococcal infection, which can occur in different ways.

Erysipelas is a contagious infectious skin disease caused by streptococcus (beta-hemolytic, from group A). With this disease, complications may occur, such as local ones - the development of a localized or widespread purulent focus (abscess, phlegmon), necrotic skin changes, inflammation of the lymph nodes, as well as general ones - a septic condition, infectious-toxic shock, damage to internal organs. The consequences of an erysipelas infection can be the development of persistent lymphatic edema of the affected area, up to secondary elephantiasis.

Erysipelas can occur acutely in the form of primary, repeated and recurrent, as well as chronically (which is associated with the slow restoration of affected tissues for various reasons). The causative agent of the disease (beta-hemolytic streptococcus group A) is transmitted from a sick person or bacteria carrier by contact or airborne droplets. The first route ensures direct contact of the pathogen on the skin with compromised integrity (microtraumas, abrasions, primary inflammatory changes, diaper rash). In the second case, the pathogen initially enters the mucous membranes of the oropharynx and is subsequently transferred by hand to the skin. Predisposing factors include background inflammatory diseases of the skin and mucous membranes, the presence of chronic venous insufficiency against the background of varicose veins, heart failure, lymphatic insufficiency; endocrine disorders (obesity, impaired carbohydrate tolerance, diabetes), trauma to the skin, foci of chronic infection in the body, immunodeficiency states, hereditary predisposition, increased sensitization (sensitivity) to streptococcal antigens and others. The actual provoking (initiating) factors include external influences - violation of the integrity of the skin, trauma, exposure to high or low temperatures, excessive insolation. The mechanism for the development of relapses in erysipelas is associated with the chronic persistence of streptococcus in the skin and lymphatic formations. In rare cases, erysipelas can be transmitted to other people, but only if there is a predisposition (after all, inflammation in erysipelas is allergic and immunocomplex in nature).

The classification of erysipelas includes three forms of course - primary, repeated and recurrent erysipelas; depending on the clinical manifestations - erythematous, erythematous-bullous, erythematous-hemorrhagic and bullous-hemorrhagic. From the moment of infection, the clinical picture usually develops quite quickly (after several hours or days). At the beginning, symptoms of general intoxication appear - fever, chills, headaches, nausea, weakness. Against the background of increasing intoxication, local manifestations appear after a couple of days - most often the lower extremities, face and upper extremities are involved. Initially, an area of redness appears with unclear, “flame-shaped” boundaries, hot to the touch, as well as swelling of the surrounding tissues (erythematous form). In the future, other symptoms characteristic of the bullous or hemorrhagic form may appear: areas of hemorrhage appear in the area of the pathological focus or blisters, followed by transformation into erosion. The most severe form is considered to be bullous-hemorrhagic, in which inflammation affects deep areas of the skin and blisters with bloody contents form, in place of which large erosions and crusts remain. The severity of erysipelas depends on the severity of local and general symptoms and is defined as mild, moderate or severe. This disease often recurs and can lead to complications, which necessitates timely consultation with a specialist and treatment.

Diagnosis and treatment of erysipelas can be carried out by doctors of various specialties - dermatovenerologists, therapists, infectious disease specialists.

Diagnostics includes identifying complaints, physical examination, prescribing laboratory and instrumental methods according to indications - general analysis of urine, blood, biochemical blood test, coagulogram, glycemic profile, immunogram, ECG. There are no specific examination methods at the moment, but sometimes an increase in the titer of antistreptococcal antibodies is determined.

Treatment includes etiotropic antibacterial therapy - penicillin preparations, macrolide or fluoroquinolone antibiotics for a course of up to 10 days; pathogenetic therapy - drugs that reduce inflammatory manifestations (NSAIDs), symptomatic prescription of temperature-reducing drugs and desensitizing therapy (antihistamines). It is also important to prevent relapses of the disease: prophylactic administration of bicillin-5, sanitation of chronic foci of infection, exclusion of hypothermia, full treatment of primary erysipelas until all manifestations completely disappear, treatment of concomitant somatic diseases.

Diagnostics

If the first signs of erysipelas occur, you should consult a dermatologist or therapist. Depending on the extent of the problem, assistance from specialists such as an immunologist, surgeon, or infectious disease specialist may be required.

Diagnosis of the disease includes interviewing the patient, as well as a thorough examination. Then tests are prescribed for the level of T-lymphocytes, ESR, and the number of neutrophils (all this is determined through a blood test).

An optional bacteriological examination is prescribed to determine the causative agent - doctors do not agree on the advisability of such an examination.

Treatment

If erysipelas develops on a leg, arm or other part of the body, the approach will always be comprehensive - local treatment alone is simply not enough. Moreover, the emphasis is largely on increasing immunity, otherwise the risks that the disease will recur are very high. Special medications are used to work with the immune system, but it is important for the patient to change their lifestyle: rest well, carefully monitor their health, eat right, and eliminate negative factors.

In the treatment of erysipelas, antibiotics are used, as well as antibacterial drugs from other groups. Drug therapy is selected individually - you should not prescribe medications yourself under any circumstances.

Along with taking medications, it is necessary to treat the affected skin: with special solutions, powders, aerosols. And the ointments that people love to prescribe for themselves - synthomycin, ichthyol, Vishnevsky - are strictly prohibited in this case, since they can provoke complications and cause the development of an abscess. The use of traditional medicine in any form is not allowed - in the treatment of erysipelas it is extremely dangerous!

Patients must have a preventive conversation regarding the nuances of hygiene during treatment. So, you need to change bed linen every day, take care of air access to the affected area, and regularly take a shower in warm, very comfortable water. Do not wipe the skin - only soak it with paper towels.

Physiotherapeutic methods are also used for erysipelas: ultraviolet irradiation, magnetic therapy, UHF, electrophoresis, certain types of laser therapy, applications with warm paraffin. At each stage of treatment, specific procedures are prescribed, and they are selected individually - for each patient and his condition. Any amateur activity is also inappropriate here, otherwise you can harm your health.

Very serious complications require surgical treatment.

If you encounter such a problem, we recommend immediately contacting the JSC Medicine clinic. We are located in Moscow and have a large staff of professional dermatologists, therapists and other specialists who can help you. And modern conditions for diagnosis and treatment will help achieve results much faster.

If doctors begin treatment in a timely manner and the patient follows all recommendations, the disease can be cured within 10-14 days.

Erysipelas

The modern clinical classification of erysipelas includes the following forms of the disease. 1. According to the nature of local lesions: - erythematous; - erythematous-bullous; - erythematous-hemorrhagic; - bullous-hemorrhagic. 2. According to the degree of intoxication (severity): - mild; - moderate severity; - heavy. 3. By flow rate: - primary; - repeated; - recurrent (often and rarely, early and late). 4. According to the prevalence of local manifestations: - localized; - widespread; - wandering (creeping, migrating); - metastatic. Explanations for classification. 1. Recurrent erysipelas includes cases that occur in the period from several days to 2 years after the previous disease, usually with the same localization of the local process, as well as later ones, but with the same localization with frequent relapses. 2. Recurrent erysipelas includes cases that occur no earlier than 2 years after the previous illness, in persons who have not previously suffered from recurrent erysipelas, as well as cases that developed at an earlier date, but with a different localization. 3. Localized are the forms of the disease with a local focus of inflammation localized within one anatomical area, widespread - when the focus covers more than one anatomical area. 4. Cases of the disease with the addition of phlegmon or necrosis (phlegmonous and necrotic forms of erysipelas) are considered as complications of the disease.

The incubation period can only be established for post-traumatic erysipelas; in these cases it lasts from several hours to 3-5 days. In more than 90% of cases, erysipelas begins acutely; patients indicate not only the day, but also the hour of its occurrence.

The initial period is characterized by a rapid rise in body temperature to high numbers, chills, headache, aches in muscles and joints, and weakness. In severe cases of the disease, vomiting, convulsions and delirium are possible. After a few hours, and sometimes on the 2nd day of illness, in a limited area of the skin there is a feeling of fullness, burning, itching, moderate pain, weakening or disappearing with rest. The pain is most pronounced with erysipelas of the scalp. Quite often, pain occurs in the area of the regional lymph nodes, which intensifies with movement. Then redness of the skin (erythema) with swelling appears.

At the height of the disease, subjective sensations, high fever and other general toxic manifestations persist. Due to toxic damage to the nervous system against the background of high body temperature, apathy, insomnia, vomiting can develop, and with hyperpyrexia - loss of consciousness and delirium. A spot of bright hyperemia with clear, uneven boundaries in the form of “tongues of flame” or “geographic map”, swelling, and thickening of the skin forms on the affected area. The lesion is hot and slightly painful to the touch. In case of lymph circulation disorders, hyperemia has a cyanotic tint; in case of trophic disorders of the dermis with lymphovenous insufficiency, it is brownish. After pressing with your fingers on the area of erythema, the redness underneath disappears within 1-2 seconds. Due to the stretching of the epidermis, the erythema is shiny, and at its edges the skin is slightly raised in the form of a peripheral infiltration ridge. At the same time, in most cases, especially with primary or recurrent erysipelas, the phenomena of regional lymphadenitis are observed: compaction of the lymph nodes, their pain on palpation, limited mobility. In many patients, concomitant lymphangitis appears in the form of a narrow pale pink stripe on the skin connecting the erythema with the regional group of lymph nodes.

From the internal organs, muffled heart sounds, tachycardia, and arterial hypotension can be observed. In rare cases, meningeal symptoms appear.

Fever, varying in height and nature of the temperature curve, and other manifestations of toxicosis usually persist for 5-7 days, and sometimes a little longer. As body temperature decreases, a period of convalescence begins. The reverse development of local inflammatory reactions occurs after the body temperature normalizes: the erythema turns pale, its boundaries become unclear, and the marginal infiltration ridge disappears. The swelling subsides, the symptoms of regional lymphadenitis decrease and disappear. After the hyperemia disappears, fine scaly peeling of the skin is observed, and pigmentation is possible. In some cases, regional lymphadenitis and skin infiltration persist for a long time, which indicates the risk of early recurrence of erysipelas. Long-term persistence of persistent edema is a sign of the formation of lymphostasis. The given clinical characteristics are characteristic of erythematous erysipelas.

Erythematous-hemorrhagic erysipelas. In recent years, the condition has been encountered much more frequently; in some regions, in terms of the number of cases, it comes out on top among all forms of the disease. The main difference between local manifestations of this form and erythematous is the presence of hemorrhages - from petechiae to extensive confluent hemorrhages against the background of erythema. The disease is accompanied by a longer fever (10-14 days or more) and a slow reverse development of local inflammatory changes. Complications such as skin necrosis often occur.

Erythematous bullous erysipelas. Characteristic is the formation of small blisters against the background of erythema (phlyctenas, visible in side lighting) or large blisters filled with transparent serous contents. Bubbles form several hours or even 2-3 days after the onset of erythema (due to epidermal detachment). As the disease progresses, they spontaneously rupture (or are opened with sterile scissors), the serous contents drain, and the dead epidermis exfoliates. The macerated surface slowly epithelializes. Crusts form, after which no scars remain. Infectious-toxic syndrome and regional lymphadenitis are not fundamentally different from their manifestations in erythematous erysipelas.

Bullous-hemorrhagic erysipelas. The fundamental difference from erythematous-bullous erysipelas is the formation of blisters with serous-hemorrhagic contents, caused by deep damage to the capillaries. When the blisters are opened, erosions and ulcerations often form on the macerated surface. This form is often complicated by deep necrosis and phlegmon; After recovery, scars and skin pigmentation remain.

The most common localization of the local inflammatory focus in erysipelas is the lower limbs, less often the face, even less often the upper limbs, chest (usually with lymphostasis in the area of postoperative scars), etc.

Erysipelas, regardless of the form of the disease, has some age-related characteristics. • Children get sick rarely and easily. • In elderly people, primary and recurrent erysipelas usually have a more severe course with a prolongation of the febrile period (sometimes up to 4 weeks) and exacerbation of various concomitant chronic diseases. Regional lymphadenitis is absent in most patients. Regression of local manifestations in elderly people is slow.

The disease is prone to relapsing. There are early (in the first 6 months) and late, frequent (3 times a year or more) and rare relapses. With frequent recurrence of the disease (3-5 times a year or more), they speak of a chronic course of the disease. In these cases, quite often the symptoms of intoxication are moderate, the fever is short, the erythema is faint and without clear boundaries, and there is no regional lymphadenitis.

Complications The disease is often complicated by abscesses, cellulitis, deep skin necrosis, ulcers, pustulization, phlebitis and thrombophlebitis, and in rare cases, pneumonia and sepsis. Due to lymphovenous insufficiency, which progresses with each new relapse of the disease (especially in patients with frequently recurrent erysipelas), in 10-15% of cases the consequences of erysipelas develop in the form of lymphostasis (lymphedema) and elephantiasis (fibredema). With a long course of elephantiasis, hyperkeratosis, skin pigmentation, papillomas, ulcers, eczema, and lymphorrhea develop.

Prevention

Since the disease can affect anyone, prevention of erysipelas is important both for those who have already had the disease once, and for those who have only heard about such a disease.

Prevention consists of following the following tips:

Treat any inflammation on the skin or mucous membranes in a timely manner.
Maintain personal hygiene. In the event that work or lifestyle is associated with additional pollution, hygiene should be even more thorough, but not excessive, so that the skin does not suffer - otherwise the effect will be the opposite.
Use special products (gels and oils) for washing that do not dry out the skin. Regular soap is not suitable for regular use.
Carefully monitor the condition of your skin in hot weather or if you have folds that constantly sweat. In this case, it is necessary to use special powders.
Pay close attention to your health if you have problems with blood vessels or lymph stagnation. Such people are recommended for massages and various procedures that disperse fluids in the body.
Treat your skin immediately if you have frostbite, chapping, or sunburn.
Wear comfortable, breathable, natural clothing if possible that fits loosely on the body.
Carefully monitor your immunity and eliminate all factors that can weaken it.

Remember that you cannot insure against this disease, but you can do everything to reduce the risks of its occurrence.