Importance of distinguishing
The main factors contributing to the development of pathologies:
- decrease in local tissue resistance to the introduction of pathogens;
- decreased immunity;
- hypothermia, the spread of microbial flora with blood from places of inflammation.
More often patients face such kinds of suppuration, as a furuncle, a carbuncle, an abscess, phlegmon, appearing at various depths, in different types of tissues. Competent diagnosis and differentiation( distinction) of purulent pathologies contributes to the quick appointment of the correct therapy regimen.
Often there are difficulties in diagnosing hydradenitis, which is confused with the maturing carbuncle. Therefore, it is necessary to distinguish between carbuncle and furuncle, abscess, phlegmon and hydradenitis.
For the removal of the carbuncle and its features, see in this video:
What is the difference between the furuncle and the carbuncle
Let's first go to work out how to distinguish a boil from a carbuncle.
What is a furuncle
A furuncle is an acute pyesis that occurs around the sebaceous gland of a hair bulb, the causative agent of which is the most harmful Staphylococcus aureus. Furuncles appear only on the areas of hair growth. Outwardly, the furuncle looks like a large dense abscess, red and painful. If the boil is large, the inflamed tissue around it is hot to the touch.
The causes of boils - the introduction of pathogens in places of damage - erosion, abrasions, cracks in the background:
- non-compliance with hygiene, skin contamination;
- to reduce local skin defenses and overall resistance;
- deficiency of vitamins, hypothermia;
- of diabetes mellitus, autoimmune diseases( lupus erythematosus, rheumatoid arthritis, herpes infections, hepatitis).
How does the furuncle and carbuncle look( photo)
Development and symptomatology
- A pustule with a pus forms around the hair bulb, and the inflammation spreads and seizes the subcutaneous tissue, appearing as a dense, convex, painful knot up to 20 mm. In the middle of the pimple is a rod of dead cells.
- Skin blushes, getting bluish shade, becomes hot and painful, and swelling captures the tissues surrounding the boil.
- From the spontaneously opened furuncle, liquid pus pours out and a ulcer with an outcrop of a greenish-yellow necrotic stem is formed on the top of the furuncle, which is squeezed out by a healthy tissue for 1 to 2 days.
- Pain ceases almost immediately after the expiration of pus, swelling resolves gradually. The cavity, where the rod was located, is filled with granulations( a young tissue) and gradually tightens with the formation of a scar. Healing lasts up to 7 - 10 days, with large boils - up to 3 weeks.
Dangerous disturbances in the patient's condition do not usually occur. Note:
- slight pain, more often - "pulling" character;
- small puffiness, the degree of skin redness reaches a dark red color( rarely - with a slight cyanosis).
If large or multiple boils are formed,
- pulsating pains, especially severe ones - in the external auditory canal, on the upper lip under the nose, on the neck, fingers, shins;
- symptoms of poisoning with Staphylococcus toxins - temperature, headache, weakness.
- with furuncles on the face, in the scrotum - a massive swelling of the tissue, lymph nodes, due to the friability of the fiber in these areas.
Complications of
Large furuncles on the head, face, neck, neck often flow heavily and can be complicated:
- purulent inflammation of blood vessels( thrombophlebitis) - especially in patients with diabetes mellitus;
- by ingestion of pus in the veins and brain tissue and the development of basal meningitis( inflammation of the brain tissue with CNS damage, fever above 40 C, edema of the face, stiffness of the occipital muscles);
- general infection of blood - sepsis.
- when a large number of boils - furunculosis - bacteria often enter the heart valves, joints, spine, bones, kidneys( bacteremia).
About treatment of boils and carbuncles let's talk further.
Therapy
Local( with one or a small number of abscesses):
- alcohol( 70%) treatment of the skin over the abscess;color solutions are not recommended because of burns and masking of the degree of inflammation;
- application of salicylic acid in the form of powder, ointment 10% for softening the skin and ripening the head of the boil;
- warm dry compresses( 15 minutes 4 times a day) - to relieve pain and ripening of the abscess head;
- active ointments that accelerate the opening of the boil: Vishnevsky( liniment balsamic), Ichthyol, Bactroban, liniment synthomycin, Ilon, Ioddicerin;
- ointments are antibacterial, cleansing, which are used after breakthrough of pus and wound treatment with hydrogen peroxide: Tetracycline, Gentamicin, Bactrian, Baneocin, Levomecol, Oxycort, Dimexid, Joddicerin Levosin, Polcortolone.
General:
- analgesic( analgesic) and inflammatory drugs( paracetamol, Nice, Ketanol) with pronounced "jerking" of the furuncle;
For the prescription of a dermatologist:
- antibacterial agents( in tablets and injectively);
- short blockade with novocaine injections and antibiotics;
- electrophoresis with antiseptics, UHF.
Surgical dissection of the boil is performed if medication is unsuccessful. At the dissection, pus and necrotic rod are removed, drainage for outflow of remaining pus is applied, applying bandages with NaCl solution and enzymes for complete cleansing and non-scarring tightening of the wound.
This video tells about the treatment of carbuncles and boils:
Carbuncle
Carbuncle is the union in a limited area of several furuncles that merge around adjacent hair follicles and form a common infiltrate with necrosis of skin cells and fat.
Carbuncle usually grows with the drawing in the process of neighboring follicles and the spread of suppuration in depth. Inflammation occurs on the face, head, neck, buttocks, in the armpits.
Development and signs of
For 4 - 5 days, a dark red convex seal forms around 7-10 cm, extremely painful when palpated. After the formation of necrosis areas, the inflammatory focus acquires a dark blue-purple color. On the seal appear small holes, similar to the "sieve", out of which expires pus with the sugars and elements of dead cells.
After pouring out the main volume of pus, first separate ulcers with a greenish-yellow necrotic stem are formed, then they merge, forming a large ulceration with uneven edges, leaving into the thickness of the cellulose.
Recovery lasts up to 4 weeks, as rejection by a healthy stem tissue, filling the wound with a new connective tissue and scarring is slow enough.
Other than furunculous symptomatology
- Skin tension on the inflamed area with the "gloss" effect;
- more massive necrosis( necrosis) of tissues, due to violation of blood supply of cells in the carbuncle zone;
- intense bursting pain;
- seal has a more pronounced coloration( to blackness), the color of pus is greenish-gray;
- is characterized by multi-chamber abscesses in adipose tissue, epidermal pustules( pus with pus) and "honeycomb" - very small holes, from which the purulent liquid gradually swells;
- severe intoxication, reaching fever, vomiting, impaired consciousness, severe insomnia.
When diagnosing carbuncle must necessarily differentiate with anthrax carbuncle, which is distinguished by the absence of pain and the emergence of a dense black scab from the dead tissue in the center.
Treatment of
Patients with carbuncle are treated in the hospital, where the following measures are carried out:
- when carbuncle is located on the neck, head, face - forbid talking and chewing solid foods;
- enter bed rest.
When medication is prescribed:
- medications with antiplatelet action( preventing clotting of platelets and formation of blood clots);
- means, softening the skin and helping tissues easier to tear off necrotic rods - Akriderm SK, Skinoren, Belosalik, Retasol;
- medicines to facilitate intoxication and elimination of poisons of pathogenic microbes - Polysorb MP, Zorex( allergen), Dufalak, Agri, Legalon;
- Locally - around inflammation - an injection blockade with antibiotics is used;
- dressings with Vishnevsky ointment, shintomycin liniment, Dimexide solution( 20 - 30%);
- UHF - to accelerate the maturation of carbuncle and rejection of rods;
- antibacterial drugs, mandatory for weakened patients, and also - when placing carbuncle on the face, complications, high temperature, strong increase in leukocytes, with the use of hormonal and cytostatic drugs.
Schemes of antibiotic therapy:
| Description | Description of symptoms |
|---|---|
| Typical general and local( local) | Manifestations of acute purulent inflammation with intoxication( poisoning) with poisons that release pyogenic microbes: severe general weakness;abnormal fatigue, loss of appetite;pallor of the skin and mucous membranes;paroxysmal vomiting. |
| Specific symptoms of renal inflammation | blunt, drawing back pain;tremendous chills in the background of fever( up to 40 - 41C);plentiful cold sweat, dripping with drops;oliguria( pronounced decrease in the volume of urine);lowering of blood pressure. |
| Local( not always shown) | muscle strain when pressing on the peritoneum and lower back;pronounced soreness with a slight tapping of the lumbar region in the kidney( Pasternatsky's symptom);a noticeable increase and soreness of the organ during palpation. |
| Abdominal | Manifestations simulating a set of symptoms of the "acute abdomen": sharp pains in the stomach and stomach( spilled and localized);nausea and frequent vomiting;gas retention, constipation;tension of the peritoneum when attempting to palpate( feel);And also: tenderness and swelling of the lumbar tissues in the area of the kidney location( late symptom);high level of leukocytes: 10 - 20x109 / l, but when a carbuncle occurs for the first time - at an early stage of the disease urine, as a rule, sterile;piuria of medium degree( appearance of pus in urine). |
| Gastrointestinal | Symptoms that simulate the development of dysentery: spastic and dull pain in the stomach and abdomen;frequent stool with pain and irritation of the anus area, false desires;nausea, vomiting;presence in the stool of blood, mucus. |
| Clinic of cardiovascular pathologies | tachycardia or, conversely, bradycardia( decrease in the frequency of myocardial contractions);decreased or increased blood pressure;symptoms of an acute disorder of the blood supply to the tissues of the heart muscle;failure of right ventricular function;disturbance in conduction of the myocardium;swelling of the extremities. |
| Neuropsychomorphous symptomatology of | In patients with renal carbuncle, the actual clinical picture is "erased", and the signs of psychoneurological disorders predominate: excessive activity, agitation;insomnia, delirium, hallucinations are possible;abnormal excitation of the subcortical layers of the brain accompanied by tonic( prolonged muscle spasm) and clonic( cyclic spasm) convulsions;symptoms of dysfunction of the central nervous system trunks In this complex case, only an analysis of an experienced diagnostic specialist can determine the true origin of the neurological signs caused by severe intoxication with suppuration in the kidney. |
| Hepatopathy and nephropathic | There are cases when local signs of carbuncle are poorly expressed, the composition of urine is practically unchanged, and in the foreground there are symptoms of severe liver damage: acutely developing jaundice with severe yellowing of the skin, mucous membranes, sclera;blunt pulling pain in the right hypochondrium;an increase in the organ and tenderness when feeling;nausea with urge to vomit;signs of acute violations of the liver and kidneys. Such symptoms are observed in elderly people, weakened, more often with the presence of multiple carbuncles in the kidney, and also with their localization in both kidneys. |
| Erased symptoms of | Observe absence: pain and hyperthermia( fever);changes in the pattern of blood or changes not characteristic of acute suppuration;changes in the composition of urine. The general symptoms of undiagnosed disorders prevail in the functioning of the organism and in the preceding diseases. Atypical symptomatology often leads to an incorrect diagnosis and treatment strategy. |
| Pulmonary | Sometimes there is thromboembolism of the vessels of the brain and lungs - clogging of the lumen of the vessel with a clot of pathogenic bacteria. If the diagnosis is wrong, the patient dies, and the carbuncle of the kidney is detected only at the autopsy. |
- And also additional antibiotics acting on Staphylococcus aureus: Minocycline, Ciprofloxacin, Vancomycin( in severe cases - intravenously).
- If drug treatment is ineffective, an operation is performed under general anesthesia, in which dead tissue impregnated with pus is completely excised. Further - hemostasis, drainage and treatment according to the scheme of therapy of purulent wounds.
Differences from abscesses
Abscesses occur not only in the subcutaneous tissue, but in the muscle and bone tissue, internal organs and cavities between them, often - when foreign objects enter the tissue, stab wounds, wrong injections.
Abscess is an inflammation with accumulation of pus in a limited area, which is accompanied by cell death and purulent melting( destruction) of tissues. The peculiarity of the abscess is the formation of the so-called pyogenous granuloma from young cells and intensively expanded capillaries, which surrounds the purulent focus and limits it from healthy areas.
Development of
First a painful and hard knot with noticeable redness appears. After 4-7 days( acute form) or weeks( sluggish form) cells die, tissues are destroyed, and in the middle of the abscess a capsule with pus and elements of dead cells is formed. At this stage, when you feel the area of the abscess, there is a fluctuation( sensation of movement of the tissue over the abscess).
Next - along the edges of the hearth, a red-pink pyogenous shell is formed. Uncomplicated abscesses usually burst with outward outflow or into anatomical cavities of thick yellowish pus with a sweet and sour smell. Pus contained live white blood cells, but the microbes in it are completely destroyed. Cicatrization of the cavity takes 5 to 7 days, if the outflow of pus from the capsule is not hindered.
If the outflow of pus is disturbed, then, after the expiration of its main volume, a narrow channel is formed - a fistula that connects the purulent capsule with the place where there is an outlet for pus flow.
Signs of
The main manifestations of the abscess coincide with the typical symptoms of purulent inflammation: headache, fever( up to 41), chills, nausea, general weakness.
Visible edema, hyperemia over the abscess and fluctuation of the tissues over it are not determined if the abscess lies in the thickness of tissues or inside the organs.
Treatment of
- Most often, surgical intervention in the hospital is made, but small superficial suppuration is treated on an outpatient basis.
- If the abscess is formed in the liver, the lung is often punctured to remove pus from the capsule of the abscess( interventional sonography) and through the tube into the cleaned cavity of antibacterial solutions.
- In cases of extremely severe course, the organ is excised together with the abscess.
- After the capsule with pus is opened, the ulcer is also treated like an open carbuncle. Completely remove pus, applying bandages, impregnated with antibiotics and ointments for healing.
- In addition to local treatment, rational antibiotic therapy is used.
Comparison with Hydradenite
Hydradenitis, or in common terminology - bony udder - acute suppuration of sweat glands located in the perineum, basins of the armpits, groin, around the nipples. Infectious agents( staphylococcus) through the lymphatic vessels or through skin erosions penetrate into the ducts of the sweat glands and actively multiply, which is facilitated by the abundant release of sweat and its alkaline environment.
Causes may also be violations in the metabolism of fats, the function of the gonads.
Development of and symptoms of
In adipose tissue, painful pea-sized seals are formed, which are converted into pear-shaped, tightly connected to the skin nodes of 30-40 mm. In the middle of the focus there is a softening of the tissue, accumulation of pus and the formation of a fistulous channel for the release of pus on the surface. But with hydradenitis there is no central necrotic stem, as in carbuncle.
Sometimes, several abscesses combine, creating a dense uneven formation with a lot of fistulas. Fused abscesses with hydradenitis resemble phlegmon, but unlike it - the surface of the skin above the purulent conglomerate is knobby, similar to the nipples of the dog, where the name "bony udder" originated. Purulent masses pouring out at the rupture of hydradenite are thick, sometimes with an admixture of blood.
Recovery is long - up to 2 - 3 weeks, and in the case of the formation of bilateral abscesses - up to 2 - 4 months. With the "bough of the udder", when the abscesses "burst" in the thickness of the tissues, simultaneously there are new abscesses.
Symptoms:
- inflammation in the form of tuberous painful knots, similar to pears;
- intense pain when pressed, moving, bursting - at rest;
- red-cyanotic hot skin on the abscess site;
- signs of poisoning with toxins - headaches, weakness, fever, increased ESR and leukocytes.
When diagnosed, hydradenitis is differentiated with phlegmon, lymphadenitis, sarcoma and tuberculosis of lymph nodes, abscess, and lymphogranulomatosis. The difference is that the "bony udder" develops in the thickness of the tissues, and, for example, inflammation of the lymph nodes of different species - in adipose tissue.
Therapy
- General treatment of hydradenitis is carried out using antibiotics( Doxycycline, Erythromycin).
- When the abscess ripens, the hair is removed at the site of inflammation and treated with antiseptics: iodine, ethyl alcohol( 96%), salicylic acid solution( 2%).With a major infiltration and intense pain, blockage of the focus is carried out with injections of antibiotics with novocaine 0.5-1%.
- The first 5 - 7 days impose fast drying bandages with alcohol( 50% solution).
- The use of ointments and compresses is contraindicated in order to avoid possible damage to the skin and increase inflammation. To mature the abscess successfully use dry heat: a heated towel, warming up the "blue lamp"( 5 minutes), in the summer - solar heating( 10 - 30 minutes).
- The ripe( softened) abscess is excised completely to healthy tissues. After removing pus and inflamed fiber. The usual opening of hydradenitis is not effective, because the abscess is a set of abscesses that are at different stages of maturation.
- At the stage of infiltrate formation, UHF, UFO and CMV therapy, recommended at the stage of maturation of the abscess, are often prescribed.
Difference between carbuncle and phlegmon
Phlegmon - diffuse acute suppuration of the cellulose( subcutaneous, perineal, intermuscular, rectal, retroperitoneal), which extends actively to tissues, muscles, tendons and bones. The outline of phlegmon - unlike carbuncle - is not clear. The pyogenic shell, as with abscess, is also absent.
Phlegmon can be purulent, putrefactive, gas( anaerobic), which directly depends on the type of pathogen that penetrates into the tissue - staphylococcus, Escherichia coli, anaerobic bacteria, streptococcus. The introduction of microbial flora comes from foci of inflammation of adjacent organs, through lesions on the skin, with blood from vessels from distant purulent foci.
Signs of
Symptoms of phlegmon are similar to the development of any purulent-inflammatory process: fever, chills, thirst, soreness.
It is observed with phlegmon:
- Typical for diffuse forms of inflammation is swift edema.
- Reddened skin redness in the shallow phlegmon area.
Development of and types of
On the inflamed area, swelling swelling( with subcutaneous phlegmon) is rapidly growing, the skin is red, hot, tense, shiny. When palpating, an immobile compaction is revealed - extremely painful without certain boundaries. As the suppuration is determined by softening in the place of compaction or the formation of a fistulous course with a deep deposition of the abscess.
- With serous phlegmon, the fatty tissue resembles jelly, soaking with watery pus.
- The putrefactive form is characterized by the development in the tissues of a multitude of necrosis zones with a large volume of fetid pus.
- With a gas phlegmon, tissue suppuration with large areas of dead cells and the presence of many small gas bubbles are detected.
- Chronic course occurs with the development of foci of suppuration of abnormal density of cyanotic color. Phlegmon Reclus, which develops when pathogenic bacteria is introduced into the nasopharynx, presents itself as a painless and pronounced compaction on the neck, the inflamed tissues of which become hard as a tree.
Complications and treatment
Complications of phlegmon that develop without timely treatment: meningitis, purulent arthritis, osteomyelitis, erysipelas, pleurisy, tendovaginitis, peritonitis, thrombophlebitis of veins of the face.
Treatment - surgical, is carried out in a hospital. The earlier the operation is performed, the more effectively the spread of pus is prevented. After the operation, local treatment and antibiotic therapy are necessary.
On the difference between carbuncle and similar ailments, the expert will tell in the video below: