What are purulent inflammations of different types and why do they develop. General ideas about purulent infection, various purulent Treatment of purulent inflammation

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 can be gangrenous, phlegmous or abscessing.

Types of purulent inflammations on the skin

Consider the main purulent skin diseases.

Furuncle. hair follicle during the period of acute purulent inflammation, it involves surrounding tissues (for example, adipose tissue or sebaceous glands). The cause of this disease is most often staphylococcus aureus or white, penetrating deep into the 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). Furuncles appearing in the plural are called furunculosis.

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

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 focus of inflammation can be chipped with a solution of antibiotics and novocaine, UHF therapy is indicated.

After "maturing" furuncle open, the rod is removed, and then dressings with proteases are applied, with a sorbent - hypertonic solution. It will not be superfluous 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 rejection of the rod by locally acting on it with powders with salicylic acid.

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. In case surgery is needed, ichthyol must be removed from the skin, and this is not easy and rather painful.

Furuncle- this is not just a pimple that can be cured with Vishnevsky's ointment. This disease can become dangerous at any time, lead to sepsis or meningitis. Never put off a visit to the doctor if furuncle appeared on the face!

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

Purulent focus carbuncle opens after “ripening” with numerous holes, from where purulent-necrotic masses come out, from above it resembles a honeycomb.

The main difference between a carbuncle and a boil is the general condition of the patient. Almost always there is weakness, fever up to 39-40 degrees, sleep disturbance, leukocytosis. Pain of high intensity, skin color is blue-purple, lymphadenitis or lymphangitis is often manifested, thrombophlebitis is possible. The most dangerous carbuncles appearing in the region of the head and face.

Carbuncle always treated in a hospital, patients are prescribed antibiotic detoxification therapy. At the first stage of the development of this disease, doctors tend to give the inflammation an abortive course, the methods of treatment are almost the same as with furuncle.

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

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

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

Cause abscess Staphylococcus is also often present, as well as Proteus, Escherichia 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, 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 can break through, the consequences are unpredictable.

Serous-infiltrative stage of abscess involves antibiotic treatment, physiotherapy, compresses help well, it is possible to use a short novocaine blockade with antibiotics. Surgical treatment is required for purulent-necrotic stage development abscess while general anesthesia is used. In the postoperative period, in addition to other drugs 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 adipose tissue, and unlike abscess this inflammation is unlimited. Pathogenesis and etiology abscess And phlegmon almost identical.

The exudative inflammatory process quickly becomes purulent-necrotic, fiber undergoes purulent or putrid fusion, while there is no purulent capsule, which could prevent the penetration of inflammation 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, before surgery, infusion therapy is performed.

After surgery, drainage and tamponade are indicated (as in 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

For the treatment of harmless purulent diseases, it is necessary to decide which ointment is able to draw out pus and which ointment is advisable to apply in the case of interest to you.

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's ointment is applied to tampons, dressings or compresses to treat wounds and ulcers. A gauze bandage with this ointment will help the maturation of the abscess, you need to keep it for 8-10 hours, then dry the skin and wipe it with alcohol.

On the other hand, Vishnevsky's 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, 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-treatment, but immediately go to the doctor.

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

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

A short list of folk remedies for pulling pus:

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

What can be said in conclusion? This article is intended for a thoughtful reader who understands well that in the event of any purulent skin disease, first of all, you should consult a doctor.

A skin abscess is an intradermal inflammatory process caused by bacterial flora, most often a combination of various microorganisms. Purulent fusion affects the hair follicle, sweat and sebaceous glands next to it, the surrounding connective tissue. At the same time, it is clearly delimited from healthy structures by a capsule, not having a tendency to spread to the sides, causing a deterioration in the general condition of a person when inflammation products and pyogenic flora enter the blood. Most often, an abscess develops on the scalp, armpits, neck, lower extremities, the area around the anus, and in women also on the labia majora.

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

How does a skin abscess appear?

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

The integumentary tissue of a person is a two-layer organ. Above is the epidermis - a series of cells that protect against microbes, thermal and chemical damage. The bottom layer is the dermis.

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

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

1. In places where the integrity of the skin is broken, bacterial flora enters. A focus of inflammation is formed around this place, accompanied by swelling and redness, as a result, a hill appears around the follicle.
2. In the infected area, the influx of lymph and tissue fluid increases. These fluids try to clear the site of infection.
3. The immune system is activated, which tries to simultaneously kill bacteria and delimit the focus of inflammation from healthy tissues. As a result, pus is formed - a mixture of leukocytes and other immune cells, dead bacteria, and proteins.
4. Increasing in volume, this content increases interstitial pressure, and when it reaches a critical value, the abscess breaks. At this stage, complications associated with the ingress of foreign proteins and infection into the blood can develop.
5. After opening the abscess, a crater remains, which is gradually tightened. If purulent inflammation has penetrated into the layers lying below the skin, a scar forms as a result of healing.

Why does skin purulent inflammation develop

A skin abscess develops as a result of pathogenic microorganisms entering the skin tissues. This happens due to trauma, friction or severe contamination of the skin. Especially often this situation in men occurs when shaving the face, axillary areas. In women, the cause of infection in the skin is also shaving the legs, as well as hair removal or frequent friction during hygiene measures in the genital area. Festering hematomas, cysts can cause pathology. Often, skin abscesses appear at the site of intradermal (less often), subcutaneous (more often) injections that were not performed according to the rules.

Local and systemic factors increase the likelihood of infection entering the skin. The locals include:

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

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

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

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

1. streptococcus;
2. the proteus family;
3. coli;
4. most often - a combination of staphylococcal, streptococcal flora and Escherichia coli.

Skin abscess symptoms

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

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

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

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

When the rejection of pus has occurred, the wound remaining in this place heals. If the inflammation has affected only the skin layers, after healing, a small light or dark spot remains, which soon disappears. In case of destruction of deeper layers, or if the abscess was located in place over the bone, a scar remains due to healing.

Features of localization of some skin abscesses

Facial abscess occurs very often. This is the most common localization of the abscess, since the skin of the face is the richest in sebaceous glands. Most often, abscesses appear on the lip, nose, in the area of ​​\u200b\u200bthe ear canal. Located in the region of the nasolabial triangle, they are dangerous for the spread of infection into the cranial cavity. Like an abscess of the scalp, its facial localization is often accompanied by a headache, fever, and general malaise. Here, similar symptoms, unlike abscesses of other localization, do not always mean the development of complications, but still require an examination.

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

Diagnostics

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

In case of a general violation of the condition: an increase in temperature, the appearance of a cough, a decrease in appetite or a decrease in the amount of urine, diagnostics (ultrasound, x-ray and laboratory) of the condition of the kidneys, liver, lungs are performed.

Treatment

Therapy at home

Often, treatment of a skin abscess is possible at home. To do this, it is recommended to first conduct a test with the Dimexide preparation, diluting it four times with boiled water and applying it to the skin of the inner side of the forearm. If after 15 minutes there is no visible redness, blistering or itching, this drug can be used to treat a purulent process. For this:

1. Dilute "Dimexide" ("Dimethyl sulfoxide") 3-4 times with boiled water.
2. Wet the sterile gauze with the solution (it will be hot).
3. Attach gauze to the abscess, cover with polyethylene on top.
4. Fix the compress with a bandage or gauze bandage.

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

You can do the same with:

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

b) baked onion peel;

c) fresh grated raw potatoes;

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

Such compresses, in addition to those with baked onion peel, are used throughout the day, with a change in the composition to a new one every 3-4 hours. Onions are applied for 1 hour 3 times a day.

Attention! Compresses should not be warm!

Surgical removal

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

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

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

Purulent inflammation is characterized by the formation of purulent exudate. This is a creamy mass, consisting of cells and tissue detritus of the focus of inflammation, microorganisms, blood cells. The number of the latter is 17–29%, mainly viable and dead granulocytes. In addition, the exudate contains lymphocytes, macrophages, and often eosinophilic granulocytes. Pus has a specific odor, a bluish-greenish color of various shades, the protein content in it is more than 3-7%, globulins usually predominate, the pH of the pus is 5.6-6.9.

Purulent exudate contains various enzymes, primarily proteases, capable of splitting dead and dystrophically altered structures in the lesion, including collagen and elastic fibers, so purulent inflammation is characterized by tissue lysis. Along with polymorphonuclear leukocytes capable of phagocytizing and killing microorganisms, bactericidal factors (immunoglobulins, complement components, etc.) are present in the exudate. Bactericidal factors produce viable leukocytes, they also arise from the decay of dead leukocytes and enter the exudate along with blood plasma. In this regard, pus retards the growth of bacteria and destroys them. Neutrophilic leukocytes of pus have a diverse structure depending on the time of their entry from the blood into the area of ​​suppuration. After 8-12 hours, polymorphonuclear leukocytes in pus die and turn into "purulent bodies".

The cause of purulent inflammation is pyogenic (pyogenic) staphylococci, streptococci, gonococci, typhoid bacillus, etc. Purulent inflammation occurs in almost any tissues and organs. Its course can be acute and chronic. The main forms of purulent inflammation: abscess, phlegmon, empyema, purulent wound, acute ulcers.

● Abscess - delimited purulent inflammation with the formation of a cavity filled with purulent exudate. It occurs in viable tissues after a strong impact of microorganisms or in dead tissues, where autolysis processes increase.

◊ A few hours after the onset of purulent inflammation around the accumulation of exudate, a shaft of blood cells is visible: monocytes, macrophages, lymphocytes, eosinophils, fibrin accumulations containing polymorphonuclear leukocytes. At the same time, fibrin, which has chemotaxis to polymorphonuclear leukocytes, stimulates their emigration from the vessels and entry into the inflammation site. On fibrin, circulating immune complexes are deposited - chemoattractants for complement, which has pronounced histolytic properties. After three days, the formation of granulation tissue begins around the abscess and a pyogenic membrane appears. Through the vessels of the granulation tissue, leukocytes enter the abscess cavity and partially remove decay products from it. With immunodeficiency, the patient has a tendency to melt the tissues surrounding the abscess. In the chronic course of an abscess, the granulation tissue matures, and two layers appear in the pyogenic membrane: the inner one, facing the cavity, consisting of granulations, fibrin, detritus, and the outer one, of mature connective tissue.

● Phlegmon-purulent diffuse inflammation with impregnation and exfoliation of tissues with purulent exudate. The formation of phlegmon depends on the pathogenicity of the pathogen, the state of the body's defense systems, the structural features of the tissues where the phlegmon arose and where there are conditions for the spread of pus. Phlegmon usually occurs in the subcutaneous fat, intermuscular layers, appendix wall, meninges, etc. (Fig. 4-4). Phlegmon of fibrous fatty tissue is called cellulite.

◊ Phlegmon is of two types:

mild if lysis of necrotic tissues predominates;

hard, when coagulative necrosis and gradual rejection of tissues occur in the inflamed tissue.

Rice. 4-4. Purulent leptomeningitis and encephalitis. Stained with hematoxylin and eosin (x150).

◊ Complications of phlegmon. Arterial thrombosis is possible, and necrosis of the affected tissues occurs, for example, gangrenous appendicitis. Often, the spread of purulent inflammation to the lymphatic vessels and veins, in these cases, purulent thrombophlebitis and lymphangitis occur. Phlegmon of a number of localizations, under the influence of gravity of pus, can drain along the muscle-tendon sheaths, neurovascular bundles, and fatty layers into the underlying sections, forming accumulations there that are not enclosed in a capsule (cold abscesses, or swells). More often, such a spread of pus causes acute inflammation of organs or cavities, for example, purulent mediastinitis is an acute purulent inflammation of the mediastinal tissue. Rejection of necrotic and coagulated tissues with solid phlegmon can lead to bleeding. Sometimes there are complications associated with severe intoxication, which always accompanies purulent inflammation.

◊ Outcomes. The healing of phlegmonous inflammation begins with its delimitation with the formation of a rough scar. Usually, the phlegmon is removed surgically, followed by scarring of the surgical wound. With an unfavorable outcome, generalization of infection with the development of sepsis is possible.

● Empyema - purulent inflammation of body cavities or hollow organs. The reasons for the development of empyema are both purulent foci in neighboring organs (for example, lung abscess, empyema of the pleural cavity), and a violation of the outflow of pus in case of purulent inflammation of hollow organs (gall bladder, appendix, fallopian tube, etc.). At the same time, local defense mechanisms are violated (constant renewal of the contents of hollow organs, maintenance of intracavitary pressure, which determines blood circulation in the wall of a hollow organ, synthesis and secretion of protective substances, including secretory immunoglobulins). With a long course of purulent inflammation, obliteration of hollow organs occurs.

● A purulent wound is a special form of purulent inflammation that occurs as a result of suppuration of a traumatic, including a surgical wound, or when a focus of purulent inflammation is opened into the external environment with the formation of a wound surface. There are primary and secondary suppuration in the wound.

◊ Primary suppuration occurs immediately after trauma and traumatic edema.

◊ Secondary suppuration - recurrence of purulent inflammation.

The participation of bacteria in suppuration is part of the process of biological cleansing of the wound. Other features of a purulent wound are associated with the conditions of its occurrence and course.

◊ Complications of a purulent wound: phlegmon, purulent-resorptive fever, sepsis.

◊ The outcome of a purulent wound is its healing by secondary intention with the formation of a scar.

● Acute ulcers are most often in the gastrointestinal tract, less often on the surface of the body. By origin, primary, secondary and symptomatic acute ulcers are distinguished.

◊ Primary acute ulcers occur on the surface of the body, in the esophagus or stomach with direct action on the skin or mucous membrane of damaging factors (acids, alkalis, thermal exposure, microorganisms). Sometimes primary acute ulcers are a consequence of dermatitis (erysipelas, contact dermatitis, etc.). Purulent-necrotic tissue changes are characteristic, and the predominance of one or another component depends on the etiological factor. The healing of such ulcers usually leaves scars.

◊ Secondary acute ulcers occur with extensive burns of the body, ischemia of the gastrointestinal tract, etc.

◊ Symptomatic acute ulcers occur with stress, endocrinopathies, medication, neuro-reflex, trophic, vascular, specific.

The morphology of secondary and symptomatic acute ulcers is largely similar. Their localization is mainly the stomach and duodenum. Often there are several such ulcers. Their size is initially small, but multiple ulcers tend to merge. At the bottom of the ulcer - necrotic detritus impregnated with fibrin and covered with mucus. In the submucosal layer expressed neutrophilic, sometimes eosinophilic infiltration. Steroid ulcers are characterized by a mild inflammatory reaction around the ulcer and intense sclerosis.

◊ Complications of acute ulcers: vessel erosion and gastrointestinal bleeding, with steroid ulcers, sometimes perforation of the organ wall.

◊ The outcome of uncomplicated secondary acute ulcers is usually tissue healing.

Like any other, purulent inflammation is the body's response to the impact of any irritant, aimed at limiting the pathological site, destroying provoking agents and restoring damage. The inflammatory response consists of three successive phases: injury, swelling, repair. It is the nature of the edema that determines the type of inflammation.

Purulent inflammation develops with the predominance of pathogenic pyogenic bacteria in the edematous fluid (exudate). It can be Pseudomonas aeruginosa and Escherichia coli, staphylo-, gono-, streptococci, Klebsiella, Proteus. The degree of contamination of the lesion with bacteria determines the likelihood and nature of the inflammatory reaction.

Pus is a liquid medium containing in its composition dead blood cells (leukocytes, phagocytes, macrophages), microbes, enzymes (proteases), destroyed and dead tissues, fats, protein fractions. It is the proteases that are responsible for the dissolution of tissues (lysis) in the lesion.

There are the following types of purulent inflammation:

• empyema - accumulation of pus in the cavity, represented by the walls of the organ;
• abscess - a cavity resulting from tissue melting, filled with purulent exudate;
• phlegmon - spilled purulent throughout the vessels, nerves, in the fascia.

One of the most common benign tumors in the subcutaneous tissues is atheroma. It is formed in the places of the greatest distribution of the sebaceous glands: head, coccyx area, face, neck. Atheroma has the appearance of a rounded formation, is a cavity enclosed in a capsule, containing fat, cholesterol, skin cells.

It occurs as a result of the fact that the excretory duct of the sebaceous gland is clogged. Atheroma can be single, but in most cases there is a multiple distribution of these formations of various sizes. This tumor is painless and, in addition to cosmetic discomfort, does not cause inconvenience.

There are primary (congenital) and secondary atheromas that occur with seborrhea. On palpation, they are dense, moderately painful, have a bluish tint. Secondary tumors are localized on the face, chest, back, neck. After their opening, ulcers with undermined edges are formed.

In ambulatory surgery, atheroma inflammation is a common problem. Predisposing factors for this are the following conditions:

• insufficient hygiene;
• independent squeezing of acne, especially if antiseptic rules are not followed;
• microtrauma (scratches and cuts);
• pustular skin diseases;
• decreased local immunity;
• hormonal disorders;
• cosmetic abuse.

Festering atheroma is characterized by soreness, local redness and swelling. At large sizes, fluctuation can be noted - a feeling of fluid flow in an elastic cavity. Sometimes the formation breaks out on its own and fat-like pus is released.

Inflammation of atheroma is treated only surgically. A skin incision is made, the contents are peeled off with the obligatory removal of the capsule. When it is not completely removed, a relapse is possible after the operation. If atheroma is re-formed, inflammation can develop in the same area.

Suppuration of wounds

Wounds arise for numerous reasons: domestic, industrial, criminal, combat, after surgery. But inflammation of the wound is not always purulent. It depends on the nature and location of the damage, the condition of the tissues, age, contamination with microbes.

Factors predisposing to inflammation of the wound surface are as follows:

• wound with a contaminated object;
• non-observance of hygiene rules;
• the use of steroid hormones and / or cytostatics;
• excess body weight;
• malnutrition;
• vitamin deficiency;
• elderly age;
• decrease in local and general immunity;
• chronic skin diseases;
• severe somatic diseases;
• hot, humid weather;
• insufficient drainage of the wound after surgery.

Usually, suppuration of the wound is characterized by the accumulation of purulent inflammatory exudate in the tissue defect. At the same time, hyperemia (redness) and a “warm” edema appear around the edges, due to vasodilation. In the depth of the wound, "cold" edema predominates, associated with impaired lymphatic outflow due to vascular compression.

Against the background of these signs, bursting, pressing pain appears, and the temperature is locally elevated in the affected area. Under a layer of pus, a necrotic mass is determined. Absorbed into the blood, decay products, toxins cause symptoms of intoxication: fever, weakness, headaches, loss of appetite. Therefore, if inflammation of the wound occurs, treatment should be immediate.

Suppuration of postoperative sutures

The process of inflammation of the postoperative suture occurs, as a rule, on the 3rd-6th day after surgical procedures. This is due to the ingress of pyogenic microorganisms into the site of tissue damage. Bacteria can be brought into the wound primarily (by the subject of injury, poorly processed instruments, by the hands of medical personnel and / or the patient himself) and indirectly from the focus of chronic infection: caries, tonsillitis, sinusitis.

Predisposing factors to the development of the pathological process in the suture area:

• insufficient disinfection of medical equipment;
• non-compliance with the rules of asepsis, antisepsis;
• reduced immunity;
• poor drainage of wound discharge;
• damage to the subcutaneous tissue (hematomas, necrosis);
• low-quality suture material;
• non-compliance with hygiene by the patient;
• areas of ischemia (lack of blood supply) due to clamping of the vessel ligature.

If inflammation of the suture has developed, then symptoms such as redness and swelling of the skin around, soreness will be observed. First, serous fluid mixed with blood can separate from the suture, and then suppuration occurs.

With a pronounced process of inflammation, fever with chills, lethargy, refusal to eat appear.

A festering surgical suture should be treated only under the supervision of a physician. Incorrect independent actions can lead to the spread of infection, deepening of inflammation and the development of formidable complications up to. In this case, a rough tortuous scar is formed.

Purulent lesions of the skin and subcutaneous tissue

Pathological processes in the skin and underlying layers are very common in surgical practice. The skin and its appendages are the body's first protective barrier against various adverse effects.

Negative factors provoking the development of skin inflammation are the following:

• mechanical damage (scratches, abrasions and cuts, scratches);
• exposure to high and low temperatures (burn, frostbite);
• chemical agents (household alkalis, acids, abuse of antiseptics and detergents);
• excessive sweating and sebum secretion can cause purulent inflammation of the skin;
• poor hygiene (especially in obese people);
• diseases of internal organs (pathologies of the endocrine, digestive systems;
• ingrown nail.

Purulent inflammation of the skin and subcutaneous tissue can be caused by microbes introduced from the outside, and / or representatives of opportunistic flora. Suppurations of the skin are diverse in terms of localization and clinical course.

Furuncle

Suppuration and sebaceous gland - boil. It can be localized in areas of the skin where there is hair. Occurs at any age. Most common in diabetic and/or obese patients.

Clinical manifestations are expressed in typical inflammation: hyperemia, pain, increased local temperature, swelling. Sometimes this condition is accompanied by a reaction of closely spaced lymph nodes.

Complications of furunculosis can be lymphadenitis, abscess, thrombophlebitis (inflammation of the veins), phlegmon, reactive purulent arthritis, sepsis, meningitis.

Carbuncle

Carbuncle is an acute infectious inflammation of several hair follicles with sebaceous glands at the same time. It occurs more often in adults and the elderly. Endocrine disorders play an important role in the development of this inflammation. Typical localization is the back of the neck, back, abdomen, buttocks.

At the site of infection, a dense diffuse edema occurs, the skin becomes purple and painful. There is a necrotic fusion of tissues. The carbuncle is opened in several places, creamy pus is released. The lesion with such inflammation of the skin looks like a honeycomb.

Hydradenitis

Inflammation of the sweat glands occurs mainly with uncleanliness, diaper rash, scratching. In the first place among the provoking factors is shaving the armpits. There are microtraumas of the skin, and the use of deodorant contributes to blockage of the excretory ducts of the glands.

In the area of ​​the armpit, a dense, painful tubercle is formed, the skin becomes purple-cyanotic. As the inflammation develops, the pain intensifies and interferes with movement. There is a fluctuation, the skin in the center becomes thinner, and thick pus breaks out.

With the spread of inflammation to other areas, due to the abundance of lymphatic tissue, a conglomerate of nodes with protruding papillae of the skin is formed - “bitch's udder”. If treatment is not carried out, the process can spread - an abscess or phlegmon is formed. A formidable complication of hidradenitis is sepsis.

Abscess

A cavity of a purulent-necrotic nature, limited by a capsule, is an abscess. It often occurs as a complication of inflammation, pustular diseases on the skin.

The cause of the development of a purulent cavity can be inflammation of a stab wound or injection site, when the outflow of pus is impaired.

Clinically, the abscess is manifested by edema and hyperemia of the skin in the affected area. In the depths of the tissues, a densely elastic painful formation is palpated. The skin over the abscess is hot to the touch. Symptoms of intoxication appear.

When opening an abscess and incomplete emptying or the presence of a foreign body in the cavity, the walls of the capsule do not fully close, and a fistula is formed. A breakthrough of pus can occur on the skin, into the surrounding tissues, into the cavity of the organs.

Phlegmon

A purulent-necrotic process of inflammation, located in the cellular space, without clear boundaries. The causes of phlegmon are the same as with an abscess.

In connection with the development of aesthetic medicine, the formation of phlegmon can be provoked by corrective procedures: liposuction, the introduction of various gels. The places of localization can be any, but the areas of the abdomen, back, buttocks, and neck are more likely to become inflamed. Not uncommon - damage to the tissues of the leg.

Gradually melting the tissues, the phlegmon spreads through the fiber, fascial spaces, destroying the vessels and provoking necrosis. Often phlegmon is complicated by an abscess, hydradenitis, furuncle.

Paronychia and felon

Panaritium - inflammation of the soft tissues, bones and joints of the fingers, less often the foot. Pain with panaritium can be unbearable, deprive of sleep. At the site of inflammation - hyperemia and swelling. With the development of the process, the function of the finger is disturbed.

Depending on the localization of the lesion, panaritium can be of different types:

• skin - the formation of suppuration between the epidermis and the following layers of the skin with the formation of a "bubble";
• subungual - flow of pus under the nail plate;
• subcutaneous - purulent-necrotic process of the soft tissues of the finger;
• articular - damage to the phalangeal joint;
• tendon - suppuration of the tendon (tendovaginitis);
• bone - the transition of a purulent process to the bone, proceeding according to the type of osteomyelitis.

Paronychia - damage to the roller near the nail. maybe after a manicure, cuticle trimming. There is a throbbing pain, redness, separation of pus in this condition.

Treatment

Purulent inflammation of the soft and other tissues of the body deals with surgery. If symptoms appear that indicate a purulent lesion, be sure to consult a doctor. Self-treatment is fraught with the spread of the process and aggravation of the situation. The main directions of treatment:

For surgical treatment of wounds, the following methods are used:

• physical (laser radiation, plasma flows, vacuum treatment of the inflammation zone);
• chemical (various enzyme preparations: Trypsin, Chymotrypsin, Lysosorb);
• biological (removal of necrotic tissues by larvae of green flies).

With conservative therapy, the following drugs are used:

• antiseptics (Povidone-iodine, Miramistin, Etacridine, Chlorhexidine);
• water-soluble ointments (Dioxidin, Methyluracil);
• creams (Flamazin, Argosulfan);
• draining sorbents (collagenase);
• aerosols (Lifuzol, Nitazol).

In the period of regeneration (healing) after surgery, the following means are used:

• dressings with antibacterial ointments (Levomekol, Tetracycline, Pimafucin), stimulants (Vinilin, Actovegin, Solcoseryl);
• special wound dressings against inflammation and for healing (Vokopran);
• preparations based on natural polymers (Algipor, Kombutek).

Purulent inflammation of various parts of the body is common and has many different forms. The course of the process can be smooth or bring terrible complications leading to death. Therefore, treatment should be approached comprehensively and the full range of prescribed therapeutic measures, preventive measures to prevent the secondary occurrence of the disease should be carried out.