FURUNCLE

From Big Medical Encyclopedia

FURUNCLE (Latin of furunculus) — acute it is purulent - the necrotic inflammation of a hair follicle and surrounding connecting fabric caused by implementation of pathogenic microorganisms is more often than stafilokokk.

The contributing reason to development single F. pollution of skin, especially is chemicals (lubricating oils, cooling mixtures, etc.), dust particles (coal, lime, cement, etc.) in a combination, as a rule, to long friction of the respective sites of skin. A certain role in development single F. play also microtraumas (see), in particular raschesa (e.g., at the skin diseases which are followed by an itch, quite often appear F.). Separate F. can arise at the increased sweating and sebaceous secretion. Recurrence F. are quite often caused by a sensitization to a staphylococcal infection (see). In some cases at immunodeficiency (see. Immunological insufficiency), genetically caused enzymopathies (see), diseases of exchange, napr, a diabetes mellitus (see a diabetes mellitus), hypovitaminoses (see. The vitamin deficiency), etc. can arise a furunculosis — hron. the recurrent disease of skin which is characterized by emergence multiple F., being at different stages of development.

At gistol. a research find a necrosis of a hair follicle (see Hair) and surrounding connecting fabric, in the center to-rogo the center of accumulation of stafilokokk is defined. Necrotic fabrics are surrounded with shaft from neutrophils and the macrophages who are getting into a zone of a necrosis, and partially englobing staphylococcus. Around a shaft in connecting fabric of a derma note ogek, expansion circulatory and limf, vessels and the infiltrate consisting of neutrophils, lymphocytes, a small amount of plasmocytes.

Clinical picture. The furuncle arises in the beginning, as a rule, in the form of an osteofolliculitis — the superficial pustule (see) which is located in the field of the mouth of a hair follicle, or the small painful small knot located in the thickness of a derma (see the Folliculitis). Irrespective of character of the beginning of process in 1 — 2 days in a derma inflammatory infiltrate in the form of unsharply limited painful node appears, to-ry quickly increases and konusoobrazno towers over surrounding healthy skin. Skin over infiltrate has purple-red color. On 3 — the 4th days in the center of infiltrate insignificant fluctuation comes to light. Then T. it is opened and from its thickness a small amount of pus is allocated; in the place of break necrotic fabric — a top of a so-called necrotic core is visible. In the next days the amount of the separating pus increases also together with it and blood tears away the necrotic core which underwent demarcation. The formed defect of fabric quickly is filled with granulations and in 2 — 3 days begins to live with formation of the small, slightly involved hem. Development cycle F. 8 — 10 days proceed.

Size F. can vary, on average reaching 2 — 3 cm in the diameter. Increase results from it sometimes excessive accumulation of pus. In such cases the necrotic core is exposed to almost full fusion and T. actually turns into abscess (see) — the abscessing furuncle. In some cases, on the contrary, insignificant suppuration — a so-called dry furuncle is observed. T. can develop on any site of skin, except for skin of palms and soles. It is most often localized on the places which are exposed to long irritation, pollution, especially in conditions of production — face skin, forearms, a neck, brushes, a waist. Depending on localization F. nek-ry features of a current are inherent. So, at F. face skin (upper lip, superciliary arches, eyelids), and also T. scrotums sharp hypostasis is usually noted. At localization on sites of skin, skintight to the subject fabrics and poor in a fatty tissue (e.g., a pilar part of the head, a nape, the back of fingers, outside acoustical pass), T. differ in extreme morbidity. In most cases F. does not cause the general reaction, at certain patients sozrevanio it is followed by fervescence and a febricula.

At expression f., cutting of its initial elements the razor, irrational topical treatment it can be formed so-called malignant F., to-ry it is characterized by sharp increase in inflammatory infiltration and hypostasis; skin over it becomes intense and dense. Quite often outside hypostasis the affected veins in the form of dense are palpated by tyazhy. Megalgias are at the same time noted. The general reaction is shown by high temperature of a body, a leukocytosis and acceleration of ROE.

In some cases, most often at localization on extremities (a back of the hand, fingers), T. can become complicated limfangiity (see) and lymphadenitis (see). The heaviest complication observed at localization malignant F. on face skin (especially median part — an upper lip, a nasolabial triangle), purulent thrombophlebitis of facial veins is, it is frequent with the subsequent development of purulent meningitis (see), sepsis or a septicopyemia (see Sepsis), at to-rykh multiple abscesses in various bodies and fabrics are formed. T. can be an origin of metastatic abscesses in bodies and fabrics, it is the most frequent in bones, muscles, pararenal cellulose and kidneys.

Treatment. Before opening F. locally use antiseptic solutions (iodine, tetraethyl-diamino-triphenyl-carbohydride sulfate, etc.). On opened F. apply a bandage with hypertensive solution, and after removal of pus — with antibacterial ointment (geliomi-tsinovy, sintomitsinovy, tetracycline, etc.). For reduction of terms of treatment and reduction of pain it is reasonable to appoint at the same time dry heat (hot-water bottles, lighting a lamp sollyuks, UVCh). It is necessary to avoid use of the warming compresses. The toilet of surrounding healthy skin is necessary (rubdown of 2% spirit solution salicylic to - you or camphoric alcohol). In some cases (F. face skin, a pilar part of the head, large folds of skin) the roentgenotherapy is shown. At abscessing F. carry out operational treatment. At localization F. on a face and complications appoint antibiotics. Malignant F. demands urgent hospitalization. The general treatment at single uncomplicated F. (except for F. face skin) it is not obligatory. At single, but often recurrent F. for the purpose of desensitization conduct a course of an immunotherapy (a staphylococcal vaccine, especially an autovaccine, anatoxin, antiphagin) or autohemotherapies. At a furunculosis, except antibacterial therapy, identification and elimination (or partial correction) patol is necessary. the states promoting its development (e.g., treatment of a diabetes mellitus, the immunostimulating therapy, vitamin therapy, etc.) *

The forecast is usually favorable, however the course of a disease depends on localization F. and timeliness of treatment.

Prevention consists in observance of rules of personal hygiene, and also in protection of skin from traumatizing and the prevention of maceration (see the Pyoderma, prevention). Identification and treatment of the diseases promoting its emergence is important for prevention of a furunculosis. Bibliography: Ashmarin Yu. Ya. and

To p e y N and N V. M. Furunkulez, M., 1974; Glukhenky B. T., D e-lecturing V. V. and Fedorovskaya R. F. Pustulous diseases of Cauchy, page 61, Kiev, 1983; Smoke r-with to and y L. Yu. and Timofeev of N. S. Klinik and treatment of furuncles and anthrax of the person, L., 1951; M and sh to and l of l e y-with about L. N N. Infectious and parasitic diseases of skin, page 9, M., 1960; Pavlov S. T. Furuncles and furunculosis, L., 1957, bibliogr.; T r about and c to and I A. D. Piodermita, page 33, L., 1958; T a k an u e Y. and. T about to and m and and M. of Staphylococcal skin lesions and acute glomerulonephritis, New Engl. J. Med., v. 307, p. 1213, 1982. S. T. Pavlov.

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