Purulent wounds. Purulent inflammation on the skin The most common cause of purulent inflammation

It is characterized by a predominance of PMN (preserved and decaying) in the exudate.

The most common cause is pyogenic microorganisms (staphylococci, streptococci, gonococci, meningococci, Pseudomonas aeruginosa, etc.).

A characteristic morphological feature is histolysis, the melting of tissue by proteolytic enzymes of leukocytes (neutral proteases collagenase, elastase, cathepsin and acid hydrolases).

Purulent inflammation can be limited (abscess) and diffuse (phlegmon); purulent inflammation in pre-existing cavities with the accumulation of pus in them is called empyema.

A. Abscesses can be single or multiple; the latter are often formed in organs during septicopyemia due to microbial embolism.

Embolic purulent nephritis.

Macroscopic picture: the kidneys are enlarged (affected symmetrically), with a flabby consistency. In the cortex and medulla, a section reveals numerous round small lesions of a grayish-yellow color, the size of a pinhead (1-2 mm), often surrounded by a hemorrhagic rim.

Microscopic picture: in the cortex and medulla, numerous foci of purulent inflammation (abscesses) are visible, represented by an accumulation of PMNs; in the center of the foci, the kidney tissue is melted, microbial emboli are visible. Around the foci of inflammation, the vessels are dilated and full of blood.

Outcome of the abscess: scars form at the site of abscesses (histolysis); in some cases, the abscess takes a chronic course: a connective tissue capsule is formed around it, the inner layer of which is represented by granulation tissue (pyogenic membrane).

b. Phlegmon - diffuse (diffuse) purulent inflammation:

More often it occurs in the subcutaneous tissue, in the area of ​​fascia, along the neurovascular bundles;

Inflammation 137

Diffuse purulent inflammation can also occur in parenchymal organs, in the soft meninges.

Purulent mite about meningitis - occurs with meningococcal infection, as well as with septicopyemia due to microbial embolism.

Macroscopic picture: the soft meninges are thickened, dull, saturated with a thick greenish-yellow mass (pus). The furrows and convolutions are smoothed. More significant changes are expressed on the surface of the frontal, temporal and parietal lobes, making the brain look as if covered with a “green cap”.

Microscopic picture: the soft meninges are sharply thickened and diffusely infiltrated by PMNs. The vessels of the membranes and the substance of the brain adjacent to them are dilated and full of blood. Fibrin threads are found in the subarachnoid space. Perivascular and pericellular edema is expressed in the brain substance.

Outcome: resorption of exudate, recovery.

Complications:

a) meningoencephalitis - occurs when inflammation passes from the membranes to the substance of the brain;

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

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

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

Abscess

Phlegmon

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

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

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

Empyema

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

Purulent wound

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

The human skin serves, in particular, as a barrier that protects the human body from external adverse influences. In addition, the skin performs a number of other important functions.

Among them we can mention:

• Protection from exposure to sunlight.
• Reducing harm from various mechanical damage.
• Exchange of substances and energy with the outside world.
• Regulation of human body temperature.
• Participation in the breathing process.
• Protection from pathogenic influences of the surrounding world.

The list goes on. However, sometimes it can happen that the skin receives certain damage or comes under the influence of certain pathogenic infections.

In such situations, it is necessary to cure the skin and restore its functions. The causes of such diseases or injuries may vary.

One of the most common is this is a purulent skin lesion. This article will be devoted to consideration of this issue.

What are the types of purulent skin lesions?

First of all, let’s clarify what exactly purulent lesions of the skin can be? In order to answer this question, you need to classify them according to one or another criterion. There may be several such classifications. Let's look at them.

Of course, every purulent inflammation is one or another infection. They can be distinguished by the types of such infections. There are many of them.

Here are a few of them as an example:

• vulgar ecthyma;
• impetigo;
• sycosis;
• ostiofolliculitis;
• hidradenitis;
• impetigo.

This list is, of course, not exhaustive.

Another classification tells us that purulent inflammations can be superficial or deep. The latter, in turn, are divided into mild, acute or chronic lesions.

It's important to note that skin has a rather complex structure. Purulent inflammation can occur in its various layers. We are talking about both the outer layer and the deeper ones. You also need to remember that purulent inflammation rarely has only one cause. Usually we are talking about exposure to several types of infections at the same time.

Now let's move on to describing specific types of purulent inflammation.

Let's start with superficial lesions of the skin.

• One of these lesions affects the hair follicles. This is where its name came from - folliculitis. The infection can result in a pigmented spot or scar.
• Sometimes inflammations are grouped in one place. If the disease is not treated, it can lead to localized baldness in the affected area.
• Ostiofolliculitis is a similar inflammation. It differs from the previous one in that there is hair at the site of inflammation. Usually occurs as a result of mechanical damage to the skin.
• Let's talk about another variety. Sycosis. Unlike the cases described here, it is a chronic disease. It has two main features. It is not point-specific, but affects a specific area of ​​the skin.

Second feature- this is the flickering nature of inflammation. Damage occurs in those places that are periodically exposed to adverse effects.

For example, with a chronic runny nose, the skin under the nose may be affected. In some cases, this can happen as a result of shaving. The period of ripening of suppurations is not very long. As a result, a dried crust appears on the skin and, in some cases, a slightly bluish tint appears on the skin.

The cause of these and similar infections can be not only various kinds of mechanical influences, but also insufficient hygiene. The most common treatment is local in nature and consists of treating the affected area with an antiseptic.

Along with inflammation of the skin surface, damage to the inner layers of the skin may occur.

• One example of deep-seated lesions is the formation of a boil. In this case, the inflammation covers not only the outermost layer of the skin, but also spreads to its inner layers.

In this case, the sebaceous glands become inflamed and skin necrosis may occur in certain areas. With such inflammation, a strong twitching pain is usually felt.

This is due to the fact that inflammation also affects nerve endings. If a boil occurs on the face, this creates an increased risk of the staphylococcal infection spreading through the blood vessels to other parts of the body.

• Another type of deep skin lesion is the formation of a carbuncle. In this case, simultaneous deep inflammation of several hair follicles with necrosis of the shafts usually occurs, which is accompanied by acute pain. Subsequently, a round, crater-shaped ulcer may form at the site of the lesion. After healing, it will heal, but a scar will form in its place.
• Hidradenitis manifests itself differently. When it appears, no formation of purulent rods occurs. Moreover, such purulent inflammation is acute and quite painful. It usually forms in the armpits or groins, on the skin located behind the ears. At the site of the lesion, suppuration occurs, with pus oozing out. Treatment of this disease is based on excision of the sweat glands and subsequent relief of inflammation.

Purulent infections without extensive pus formation can also occur. In this case, we are talking about a lesser degree of skin damage, however, such diseases are also very unpleasant. Examples include diaper rash caused by staphylococcal infection, erysipelas and cellulitis. The latter look like small, chaotically located reddening of the skin.

Reasons for appearance

In a normal state, a person is surrounded by a huge variety of microorganisms. If he has a strong immune system, they are practically unable to harm him.

The situation changes in cases To When a person gets sick, receives mechanical injuries, does not do enough hygiene, and in a number of other cases, some microorganisms become active and can cause purulent skin lesions.

If a person’s sebaceous glands are too active, during certain age periods there is an increased likelihood of purulent inflammation. Also, sometimes hormonal changes can lead to this. If this does happen, it is necessary to take measures to cure them.

What ointments can draw out pus?

If an abscess has formed, then one of the most obvious ways to cure it is to lubricate the affected area of ​​skin with a certain ointment in order to draw out the pus. What can we apply in such cases? What can medicine offer us for this?

• If you start treatment at an early stage of abscess formation, then it will be effective to use Vishnevsky ointment. It has been successfully used for many years since the last century and time has confirmed its effectiveness. Read about here

It also has an official name: balsamic liniment. The ointment includes xeroform, birch tar and castor oil. The first of these components has an antiseptic and drying effect.

Tar improves blood microcirculation in the affected tissue and normalizes metabolic processes in it. Castor oil promotes active absorption of drugs, which ensures their therapeutic effect. This ointment has worked well in the treatment of boils and carbuncles.

It is used by placing it on a gauze pad and pressing it against the sore spot. It is enough to perform the procedure three times every day until cure occurs. The effectiveness of treatment will be higher if you simultaneously use antibiotics for treatment.

This ointment not only treats ulcers, it completely removes pathogenic agents in this area. This completely eliminates the possibility of repeated suppuration in this place.

• Sulfur ointment is used to treat pimples or blackheads.. Usually this type of suppuration occurs due to blockage of skin pores. The ointment is also effective in cases where pustular inflammation occurs in places where there is hair.

It is used similarly to Vishnevsky ointment. It is recommended to change the dressing periodically. This needs to be done every couple of hours. When treating ulcers such as boils, this ointment is not very effective.

• Ichthyol ointment is an inexpensive and effective remedy. It draws out pus well and also has a good antiseptic effect.
• Syntomycin ointment is also known for its ability to draw out pus. It will also be effective if the treatment of the abscess has been started. Answer to the question: read here.
• Elon ointment activates metabolic processes and has an antiseptic effect. As a result of its use, the pus gradually resolves.
• When treatment for the abscess ends, you need to continue treatment, use cleansing and healing ointments (tetracycline, Bactrian and others).

Folk remedies for the treatment of ulcers

Along with official medical means. There are also folk remedies for treating ulcers.

Let's talk about a few of them.

• Marshmallow is recommended to be used with olive oil.
• Raw grated potatoes should be applied to the abscess several times a day.
• A paste of finely chopped fresh onions will cure purulent inflammation if applied to the sore spot several times during the day.
• Freshly crushed plantain litas can also be used effectively for treatment.

Surgery

In especially severe or advanced cases, a surgeon is consulted for treatment of ulcers.

Treatment usually occurs by cutting and draining the abscess. This is done under anesthesia. Cleansers and antiseptics are used in parallel.

Precautions during treatment

• When affecting ulcers, it is necessary to avoid contact of drugs with surrounding areas of the skin. In some cases, this may irritate them.
• After curing the abscess, you need to cleanse this place of pathogenic agents that caused the infection. This will prevent the recurrence of purulent infection in this area.
• During treatment the necessary hygiene rules must be carefully observed. This will speed up treatment and limit the possible expansion of suppuration.

When to see a doctor?

Treat this disease, of course. You can do it yourself. But this comes with serious risks.

With improper treatment, various kinds of complications are possible. In addition, the basis of quality treatment is a correct and comprehensive diagnosis, which can be obtained from a doctor. Therefore, you need to see a doctor in most cases. This is especially important when it comes to particularly difficult situations.

You also shouldn’t forget that suppuration can sometimes itself be a symptom of other diseases, and the sooner you figure out what’s going on, the more effective your treatment will be.

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

Types of purulent skin inflammations and their treatment

Furuncle

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

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

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

Carbuncle

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

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

Hidradenitis

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

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

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

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

Abscess or ulcer

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

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

Treatment of abscesses involves both drug therapy and surgery.

Phlegmon

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

Why these problems arise, how to treat them and how to treat them, we will talk in this article.

Stages of purulent inflammation on the skin

Inflammatory diseases of a purulent nature have two stages of development:

• serous-infiltrative
• purulent-necrotic

In this case, the second stage in terms of the prevalence of the process may be gangrenous, phlegmous or abscess.

Types of purulent inflammations on the skin

Let's look at the main purulent skin diseases.

Furuncle. Hair follicle during the period of acute purulent inflammation, it involves surrounding tissues (for example, fatty tissue or the sebaceous gland). The cause of this disease is most often staphylococcus, golden or white, penetrating deep through injured areas of the skin (abrasions, wounds, cracks). If only one hair follicle is inflamed, they usually talk about folliculitis (these include sycosis of the beard, teenage acne). Boils appearing in the plural are called furunculosis.

Serous inflammation quickly develops into necrotic stage: first a hyperemic skin tubercle appears, the touch of which is very painful, and the intensity of the pain increases. After two or three days furuncle increases as much as possible, the purulent pustule located inside bursts. If you remove the crust, a whitening purulent-necrotic core will be visible. Over the next 3-5 days, the necrotic area is rejected and a scar forms at the wound site.

At the initial stage of development boil the doctor may prescribe antibiotics and antiseptics, it is also recommended to treat the problem area locally: with alcohol, iodine, apply bandages containing antiseptics, the source of inflammation can be injected with a solution of antibiotics and novocaine, UHF therapy is indicated.

After "ripening" furuncle They are opened, the rod is removed, and then bandages with proteases and a sorbent - a hypertonic solution - are applied. It would not be amiss to use an ointment for purulent wounds on a hydrophilic basis (for example, Levomekol, Reparef-1 and others). You can speed up the process of rod rejection by topically treating it with salicylic acid powders.

Ichthyol ointment is used for boils surgeons do not advise: it can clog the sweat and sebaceous glands and contribute to the spread of the inflammatory process. If surgical intervention is required, ichthyol must be removed from the skin, which is not easy and quite painful.

Furuncle- this is not just a pimple that can be cured with Vishnevsky ointment. This disease can become dangerous at any time, leading to sepsis or meningitis. Do not delay visiting your doctor under any circumstances if furuncle appeared on the face!

Carbuncle. Several hair follicles located nearby draw the surrounding sebaceous glands and fatty tissue into acute purulent inflammation. Pathogenesis and etiology boils And carbuncles similar: these are related diseases, the difference lies in the number of affected hair follicles.

Purulent focus carbuncle It opens after “ripening” with numerous holes from which purulent-necrotic masses emerge; on top it resembles a honeycomb.

The main difference between a carbuncle and a boil is the general condition of the patient. Weakness, fever up to 39-40 degrees, sleep disturbance, and leukocytosis are almost always observed. Painful sensations of high intensity, skin color is blue-purple, lymphadenitis or lymphangitis often appears, thrombophlebitis is possible. Most dangerous carbuncles appearing in the area of ​​the head and face.

Carbuncle They are always treated in a hospital; patients are prescribed antibacterial detoxification therapy. At the first stage of development of this disease, doctors strive to give the inflammation an abortive course; the treatment methods are almost the same as for boil.

Purulent-necrotic stage requires surgical intervention. After excision of tissue affected by necrosis, tampons containing 10% sodium chloride are placed on the wound. Ointment that draws out pus helps well: dioxykol, levomekol and others. Vishnevsky ointment, the use of which was very popular not so long ago, is now used less frequently.

Timely visit to the doctor during development carbuncle will protect you from a lot of unpleasant consequences.

Abscess. Focal purulent inflammation of tissues causes them to melt, after which a so-called pyogenic capsule is formed, which separates purulent masses from healthy organs and tissues.

Reason abscess Staphylococcus is also often present, as well as Proteus, Escherichia coli or Pseudomonas aeruginosa and other microorganisms. In most cases abscess develops in muscle tissue or under the skin, although it can form in any tissue or organ due to infection through a hematoma, injury, purulent process, or gray. Also the appearance abscess Foreign bodies and injections may contribute.

If the necessary measures are not taken in time, abscess will progress, the purulent cavity may burst, the consequences can be unpredictable.

Serous-infiltrative stage of abscess involves treatment with antibiotics, physiotherapy, compresses help well, it is possible to use a short novocaine blockade with antibiotics. Surgical treatment is required for purulent-necrosis stage development abscess, in which general anesthesia is used. In the postoperative period, in addition to other medications and procedures prescribed by the doctor, it is advisable to use ointments that have a dehydrating effect, this is again levomekol. During regeneration, biostimulants are indicated: helium-neon laser, metabolites, various multicomponent ointments, physiotherapy.

Phlegmon. Acute purulent inflammation occurs in fatty tissue, and unlike abscess this inflammation is unlimited. Pathogenesis and etiology abscess And phlegmon almost identical.

The exudative inflammatory process quickly becomes purulent-necrotic, the fiber undergoes purulent or putrid melting, while there is no purulent capsule that could prevent the inflammation from penetrating into other tissues and organs.

Sick phlegmon are, as a rule, in a serious condition: intoxication, leukocytosis, throbbing pain of high intensity, signs of septic shock, edema. Treatment of phlegmon is carried out only in a hospital; infusion therapy is carried out before surgery.

After surgery, drainage and tamponade are indicated (as with abscess), intensive antibiotic therapy, increased immunity, general detoxification of the body. Despite the high level of modern science, the likelihood of deaths from phlegmon.

Treatment of purulent inflammations on the skin

To treat harmless purulent diseases, you need to decide which ointment is capable of drawing out pus and which ointment is advisable to use in the case you are interested in.

Balsamic liniment according to Vishnevsky is a drug traditionally used to treat such problems. Its main component is birch tar. On the one hand, it is able to improve blood circulation in tissues affected by a purulent disease; it can dry, soften and disinfect the desired areas. Most often, Vishnevsky ointment is applied to tampons, bandages or compresses to treat wounds and ulcers. A gauze bandage with this ointment will help the abscess to mature; you need to keep it on for 8-10 hours, then dry the skin and wipe it with alcohol.

On the other hand, Vishnevsky ointment from boils or acne can help by accelerating spontaneous opening if the abscess is close to the surface and the wound has not yet formed. In such cases, the broken furuncle heals quickly. But if the focus of purulent inflammation is located deep in the subcutaneous tissue, then there is a risk of involving nearby tissues in the pathophysiological process. Modern doctors (and especially surgeons) strongly advise not to engage in any self-medication, but to immediately go to see a doctor.

Ichthyol ointment, the use of which we have already briefly discussed above, has the same properties as Vishnevsky’s ointment and has similar pros and cons. It is applied to the damaged area, a gauze bandage is placed on top (can be glued with a bandage), then left for some time. A categorical contraindication for the use of both drugs is only individual intolerance to any of its components.

Historically, it so happened that for treatment boils and similar purulent skin diseases, people most often use traditional medicine.

A short list of folk remedies for drawing out pus:

• baked onion
• baked onion + grated laundry soap
• cabbage leaf
• beeswax
• warm salt baths
• aloe leaf
• essential oils of chamomile and lavender

What can you say in conclusion? This article is intended for a thoughtful reader who understands well that if any purulent skin disease occurs, you must first consult a doctor.