Carbuncle is an acute purulent inflammation of tissues around a group of hair follicles and glands secreting a sebaceous secret - in fact - a cluster of adjacent furuncles that have merged with each other to form a large area of tissue necrosis in the cellulose.
The name pathology was obtained because of the thick dark color of purulent-necrotic masses, since "carbo" is translated from Greek as "coal."In this material, we will tell you about the medical history, the causes and treatment of carbuncles on the neck, the priest, the face and other places, show photos of patients, give advice on therapy.
Features of the disease in humans
Carbuncle is a severe form of manifestation of the activity of staphylococcal microflora on the skin. External signs of pathology is similar to a boil, the development of which causes the same pathogen. However, the carbuncle has other features of the flow, much more pronounced signs and a complex prediction. In connection with the severity of the course of the disease, a high degree of intoxication and a high probability of complications, carbuncle treatment is often performed in a hospital.
An unfavorable feature of the pathology is that the process of suppuration with the growth of carbuncle rapidly spreads, causing inflammation of neighboring healthy skin areas and affecting the deep layers of the dermis, and the area of purulent necrotic densification( accumulations of elements impregnated with pus tissue, blood, lymph) is much larger than whenfuruncle.
About carbuncle, their nature and features will tell Elena Malysheva in this video:
Stages and localization of
In the development of carbuncle, specific stages are identified:
- Under the skin, dense nodules are formed, which are festering hair follicles that form a single infiltrate( adipose tissue cells with an admixture of pus, leukocytes and lymph), swelling over the skin. Due to the violation of supply of this site with blood, the skin becomes purple-cyanotic color. For 9 - 12 days the size of the infiltrate reaches 10 - 12 cm. The skin over the swollen carbuncle is stretched, swells and becomes hot. The more swelling, the stronger the tension and the sharper the pain.
- When maturing carbuncle on its surface, multiple pustules( bubbles with pus) form. They burst, forming a lot of tiny holes resembling a small sieve, through which oozes greenish-gray pus, mixed with blood and dead cells. The stage of maturation and tissue necrosis can last up to 2 - 3 weeks.
- In the "sieve" area, as the pus expires, ulcers with necrotic rods are formed, which merge, and after pouring out the bulk of the pus, a deep ulcer develops, often reaching the muscles. Necrotized tissue along the edges of the wound turn black - hence the name of the pathology "carbuncle", which in Latin means - carbon( carbunculus).The wound is slowly tightened, filling with a new tissue( granulation) and forming a dense scar, soldered to the skin.
Carbuncles developing on the face - in the region of the nose and upper lip - are especially dangerous, because of the blood and lymph vessels from this zone, pathogenic microbes easily enter the intracranial veins and cause brain, vascular inflammation and lesion of the central nerve trunks. The most dangerous of them is a purulent meningitis threatening the life of the patient.
Causes of the emergence of the carbuncle
The causative agent of the pathological process leading to the appearance of carbuncle is more often staphylococcal flora, less often - streptococcal. In rare cases, pathology is provoked by enterococci, Pseudomonas aeruginosa, proteas, anaerobes.
Predisposing conditions for infection and inflammation of the hair bulb:
- endocrine diseases, disorders in the metabolism of fats;
- diabetes mellitus( in 70 - 85%), obesity;
- increased secretion of sweat and secretion of sebaceous glands on the background of contamination( skin) of the skin with dust, coal, lime, oil products;
- reduced immune defense;
- microtrauma, wet abrasions, boils;
- squeezing out pimples, combing after insect bites and insufficient bactericidal treatment of the skin;
- depletion of the body, nervous system, anemia, severe illness.
External signs of carbuncle:
- Large convex and dense infiltrate( stage 1).
- Skin in the zone of inflammation hot, stretched, shiny, blue-purple with black( 1 - 3 stage).
- Small openings in the whole area of suppuration with oozing pus of greenish color( 2nd stage).
- Deep ulcer with necrotic blackened edges and bottom( stage 3).
In addition to skin changes, the development of carbuncle is accompanied by:
- tearing, pulling pain in the focus of infection;
- chills and fever;
- headache, exhaustion, nausea with bouts of vomiting;
- decrease in urine output;
- high number of leukocytes in the blood, high ESR( sedimentation rate of erythrocytes);
- decreased appetite;
- restriction of movements, incapacity for work.
In malignant development of pathology in depleted patients, elderly people suffering from severe diabetes, psychiatric disorders, additionally observed:
- neuralgic pain;
- septic fever;
- is a state of delirium, profound prostration.
Diagnosis of carbuncle, as a rule, is not difficult, given the specificity of clinical manifestations and appearance of the carbuncle. However, differential diagnostics is necessary to prevent common carbuncle and carbuncle arising from an anthrax caused by an aerobic anthrax bacillus( Gram-positive) in a similar clinical picture. Also, carbuncle should be distinguished from phlegmon, hydradenitis and other ailments.
Sampling and sowing of excretions from the infiltrate allows:
- to immediately exclude or confirm the activity of an anthrax bacillus;
- determine the sensitivity of identified pathogens to specific types of antibiotics.
Next, we will talk about how to treat carbuncle on the pope, neck, face, and other areas, providing information to patients' photos.
Usually carbuncle treatment is performed in a hospital. Especially, under the following conditions:
- if the carbuncle developed on the face, neck, in the nose;
- its dimensions are larger than average;
- purulent process actively spreads to neighboring tissues and deep into;
- in the patient observed pronounced intoxication, fever, neurologic disorders;
- the patient is exhausted, suffers from a severe form of diabetes mellitus.
The main tasks in the treatment of carbuncle:
- Acceleration of maturation of the abscess and effective removal of purulent-necrotic masses from the wound.
- Elimination of intoxication associated with poisonous secretions of staphylococci and streptococci.
- Use of therapeutic agents that limit the spread of pyogenic infection to other organs, and eliminate the focal spot.
- Prevention or treatment of advanced complications.
Since carbuncle is classified as a surgical infection, 2/3 of the cases require surgical intervention. However, in certain cases, therapeutic treatment is feasible and appropriate.
Therapeutic approach in the treatment of carbuncle is used in the following cases: The
- carbuncle is small in size and has originated in a site located remotely from the brain( on the waist, shoulder blades, buttocks, limbs);
- complications at the beginning of the development process is not identified;
- presence of cosmetic requirements, taking into account that after a surgical intervention a scar remains.
Physiotherapy is an effective additional method of treating carbuncle at all stages of development.
- If pathology is detected in the first stage, x-ray therapy with a single dose of 40-50 x-ray and an interval of 5 days is performed. The course is determined by the attending physician. Exceeding the dose of 40 roentgen is not permissible in the treatment of facial carbuncles. Local treatment during the period of X-ray therapy is not carried out.
- Assign UHF( magnetic field therapy of ultra-high frequency), magnetotherapy, laser therapy, which promote the activation of blood circulation in the area of inflammation and rapid rejection of necrotic cells and cleaning the wound, significantly reducing the area of necrosis, and prevent the spread of infection to healthy areas of the skin, providing antimicrobial effect.
Local treatment of
To purify the carbuncle from pus and dead tissue and suppress the activity of pyogenic microorganisms, carry out a sanation, including:
- daily removal of necrotic masses with a change of dressing;
- wound cleaning using ultrasonic cavitation of low frequency when exposed to ozone - a physical method of treatment.
In addition, with topical treatment:
- uses bandages impregnated with liniment of synthomycin, Dimexide solution( 20-30%), Ihtiolova and Vishnevsky ointments with the purpose of accelerating the ripening of carbuncle and drawing out pus, these "old" remedies are time-tested, actively used in military medicineand do their job well;
- is administered by antibiotics and novocaine in the infiltration site;
- uses bandages with proteolytic enzymes that play the role of biological antiseptics that contribute to the rejection of nonviable tissues: trypsin, hemotrypsin, pancreatic ribonuclease, bromoamine, streptokinase, collagenase.
In the treatment of carbuncle, all methods are used that mutually complement each other. If the need for surgery is not detected, antibacterial agents are used, which are prescribed in large dosages.
Assign antibiotics of the penicillin series that have an effective effect on a wide range of pathogenic microorganisms:
- Dicloxacillin, Flukloxacillin. For adult patients - inside 250-500 mg 4 times a day, the daily dose to children is calculated by the formula: 40 - 50 mg x child weight in kg, and divide it by 4 times.
- Amoxicillin-clavulanate. Adult daily dose of 1 - 2 grams, children's - 40 mg / 1 kg of weight. Accept for 4 admission.
- Cefalexin. Adults 250 - 500 4 times a day, children every 6 hours a quarter of the daily dose, calculated on the basis of the norm 40 - 50 mg per kilogram of the child's weight.
- Azithromycin. Adults drink once a day for 250 mg, the standard duration of treatment is 5 to 7 days.
If antibiotic-penicillins cause an allergic reaction, use a group of macrolides, fluoroquinolones( Ciprofloxacin), glycopeptides( Vancomycin).
Together with antibiotics for the treatment of carbuncles prescribed:
- anti-inflammatory( Ibuprofen, Analgin, Paracetamol);
- analgesics that relieve soreness( Ketonal in injections, Ketanov, Naise), vitamin complexes;
- antiaggregants, preventing the pooling of blood cells into clots - Trental, Pentoxifylline, Trombo Ass;
- agents that stimulate the rejection of non-viable cells - Retasol, Acriderm SK, Skinoren;
- medications that excrete staphylococcal toxins - Polysorb, Legalon, Zorex, Dufalac, Agri.
With the development of carbuncle, it is not often possible to stop the process until the stage of formation of the necrosis site, but it is the formation of the necrotic focus that is the main indication for the surgical treatment of pathology.
Carbuncle excision is performed under local or general( with major damage) anesthesia with a 0.5-0.25% novocaine solution according to the following scheme:
- The zone of the infiltrate is dissected crosswise( for the subsequent better tightening of the wound) to the depth of the necrosis layer to the site of viable tissues. All pockets, zatekas are opened with the removal of dead, impregnated with pus tissue. This creates conditions for the removal of general intoxication, restoration of cell metabolism, rapid wound healing.
- The operation is completed by introducing into the cleaned wound drainage tampons saturated with hypertonic NaCl solution or proteolytic enzymes, which is necessary for the outflow of the remaining pus volume and the final rejection of the necrotic masses. Tamponade is changing daily.
- After cleansing the wound, active anti-inflammatory ointments are used to accelerate cell regeneration, granulation tissue growth and healing process such as Metiluracil, Vinilin, Levomekol, Levosin.
- After the operative removal of the carbuncle, a course of antibacterial agents is also mandatory, but the dosage is prescribed much less than at the stage of ripening of the carbuncle.
The use of radio waves is considered to be a modern, effective and sparing method of removing carbuncle. Usually the entire procedure takes no more than half an hour and is performed under local anesthesia. The cost of the usual operation and the radio wave method of carbuncle removal in different clinics is in the range of 1100 - 1800 rubles.
- After tightening the wound and forming the scar, it is immediately started to treat it using special ointments that help to dissolve the dense scar tissue( Kelofibraz, Dermatix, Zeraderm, Scarguard).
- Silicone plasters are also used. Moisture accumulated under the silicone coating does not allow the tissues to condense and form a coarse scar.
Autopsy of the carbuncle on the shoulder is presented in the video below:
On how to treat carbuncle at home with folk remedies quickly, we will tell below.
Treatment of carbuncle home folk remedies is extremely undesirable and dangerous. It is permissible to use certain prescriptions after consulting with a surgeon and only at the first stage - before the formation of the necrotic focus.
Safe effective recipes:
- Infusion from flowers of sweet clover to accelerate maturation of carbuncle. Two tablespoons of flowers are poured with warm vegetable oil, insisting 24 hours. Use for compresses.
- Calendula ointment: crushed fresh flowers or dry raw material mixed with smaltse( proportion 1 to 4).Lubricate the carbuncle, covering with a dry cloth.
- Kashitsu from fresh leaves of a plantain put on a carbuncle and close with a bandage.
- 4 - 5 cloves of garlic is turned into gruel, put in two- or three-layer gauze dressings and put on the affected area. In case of severe burning, remove immediately.
- The leaves and St. John's wort flowers are crushed to a mushy state and used for compresses.
- Strawberry orchis cook in milk until soft, rub and combine with smaltsev in proportion 1 to 1. The product is spread on the bandage and applied to the carbuncle.
Standard measures to prevent the development of carbuncles:
- daily take a shower with antibacterial soap;
- keep your hands and nails clean;
- use disposable razors;
- wash the skin after sports training, work with petrochemicals, paint and varnish, after staying in places contaminated with coal, limestone, cement dust;
- do not use other people's towels, washcloths, razors;
- not to squeeze out pus from acne, boils;
- not to comb the body after insect bites, with irritation, abrasions, erosions;
- should not wear tightly fitting and synthetic clothing that enhances sweating and helps accumulate bacterial flora on the skin.
Complications likely during the development of carbuncle usually arise when a staphylococcal infection spreads into the tissue, with blood flow and lymphatic fluid - into the meninges and other organs. Develop under the following factors:
- in critically ill patients with low overall and local body resistance;
- in the absence of timely and competent treatment.
The following types of complications of carbuncles occur:
- Abscess of soft tissues, phlegmon.
- Osteomyelitis with infection in the bone takna.
- Phlebitis and purulent thrombophlebitis with rupture and bleeding from vessels.
- Lymphadenitis, lymphangitis, adenophlegmon, periadenitis - when involved in the pathology of lymphatic vessels and nodes.
- Purulent meningitis( when the carbuncle is located on the face and neck).
- Sepsis - when pyogenic microflora enters the blood and sprays it throughout the body( the patient may die).
- With competent treatment of uncomplicated carbuncle, the prognosis is favorable.
- Malignant severe carbuncle with complications can lead to death of the patient due to profuse( breakthrough and massive) bleeding from a large vessel and infection of blood.
However, a complicated carbuncle in modern conditions of treatment of purulent infections has a high probability of a favorable outcome with:
- timely hospitalization of the patient;
- prompt choice of the correct scheme of therapy of carbuncle and accompanying complications.
- active restorative treatment with the use of immunomodulators and medications for effective detoxification of the patient.
Often, treatment of neglected cases is performed in intensive care.
More information about carbuncles is provided in the video below: