Erysipelas (erysipelas) is a fairly common disease of an infectious nature. During such an ailment, soft tissues are affected by streptococci, due to which some parts of the body begin to flow strongly and outwardly resemble a swollen roller.

Faced with such a disease, a person is at risk of repeated relapse, which most often then ends with elephantiasis and lymphostasis. In addition to streptococcal lesions, this disease can be caused by a violation of the flow of lymph and blood in the lower extremities. And in order not to provoke serious complications, you need to know how to treat the onset of erysipelas of the leg, arm or other parts of the body.

Initial stages of treatment

Treatment of such a disease first of all begins with increasing and strengthening the immune system. If you do not pay attention to this, then the ailment will then return again, each time proceeding more and more difficultly. And this can ultimately lead to disability. Therefore, it is necessary to treat erysipelas comprehensively.

First, the focus of the underlying infection is identified, and a course of antibiotics is prescribed to eliminate it. Next, it is necessary to restore the disturbed microflora of the body. To do this, you need to include in the daily diet a large amount of fermented milk products containing lactobacilli.

To remove toxins and medicinal poisons, it is necessary to drink mineral alkaline waters. But you need to do this in small portions (three sips) throughout the day. When the body is seized with a fever, the drinking regimen increases. At such a moment, it is recommended to consume at least three liters of liquid.

The diet during the treatment period should consist mainly of proteins, which will be easily absorbed by a weakened body. These are lean meats, fish, seafood and cheese. All products are used boiled or stewed. Protein is necessary for erysipelas, as it helps to create antibodies that effectively fight streptococci.

Do not forget about fats that promote the rapid recovery of the affected epidermis. Therefore, vegetable oil, seeds and nuts, and fatty fish must be present on the table. To restore internal and physical strength, you need to eat vegetable and fruit fruits containing many vitamins and minerals.

A disease such as erysipelas can cause anemia. Therefore, iron supplements are taken or hematogen is used. For a speedy recovery, ultraviolet radiation may be prescribed. But the duration and number of procedures is set only by a doctor.

During the period of treatment, one should not allow hypothermia and overwork of the body. And also a strong nervous strain. Caffeine, chocolate, salty and spicy foods, alcoholic beverages are excluded from the diet.

Drug treatment

The following antibacterial drugs help to effectively treat erysipelas:

• penicillins;
• tetracyclines;
• chloramphenicol;
• macrolides.

Penicillins quickly block the growth of dangerous bacteria and inhibit their activity. Most often they are used in conjunction with Streptocide or Furazolidone. Among the penicillins, benzylpenicillin is prescribed in the form of intramuscular injections, Bicillin-5 and Phenoxymethylpenicillin in the form of tablets or syrup. The drug Bicillin-5 is usually prescribed for the prevention of relapse, one injection once a month. The duration of the course is two years.

Drugs from the penicillin group help quickly eliminate erysipelas

Of the tetracyclines, doctors use Doxycycline the most. It stops protein synthesis, which is necessary for the formation of new bacterial cells. The drug is taken twice a day after the main meal. Levomycetin slows down the reproduction of streptococci. It is used three times a day for ten days. With advanced stages of the disease and if such an ailment was promoted by blood cancer, the duration of therapy can be increased.

Macrolides also stop the growth of pathogenic bacteria and resist their reproduction. More often, a remedy such as Erythromycin is prescribed. It is taken at 0.25 mg one hour before meals four times a day.

In order for the treatment to give its positive and prolonged result, in addition to antibiotics, other drugs are prescribed:

• drugs that eliminate allergies;
• sulfonamides;
• nitrofurans;
• glucocorticoids;
• biostimulants;
• multivitamin products;
• preparations based on thymus;
• enzymes of proteolytic action.

Antiallergic drugs (Suprastin, Tavegil, Diazolin) eliminate swelling of soft tissue and promote faster resorption of the internal accumulation of lymphatic fluid. They are taken for ten days twice a day, one tablet. Sulfonamides (Streptocid, Biseptol) destroy the cellular structure of bacteria and inhibit their growth. They are prescribed in a dosage of one tablet four times a day.

Nitrofurans (Furadonin, Furazolidone) also slow down the growth of dangerous bacteria, and, with an increased amount, provoke their death. Drinking such drugs should be two tablets four times a day. Glucocorticoids are usually prescribed for the resulting lymphostasis. Such drugs are hormonal drugs, so they are prescribed only by the attending physician based on individual indicators.

Biostimulants (Pentoxil, Methyluracil) activate the growth of immune cells and accelerate the regeneration of the epidermis in the area of ​​erysipelas. The duration of the course can be 20 days.

Multivitamin preparations (ascorbic acid, Ascorutin) strengthen weakened vascular walls several times and enhance local immunity. If such concomitant problems are not treated in time, the risk of a recurrence of the disease increases.

Thymus-based drugs (Taktivin, Timalin) are administered intramuscularly.

They also have a beneficial effect on the human immune and internal system, and they also increase the number of lymphocytes in the blood. Proteolytic enzymes (Trypsin, Lidaza) are prescribed as subcutaneous injections. They contribute to the resorption of formations and improve the nutrition of the affected tissue. Such a complex drug therapy allows you to quickly relieve unpleasant symptoms and get rid of erysipelas.

External treatment technique

In addition to taking medications inside, erysipelas is also treated through applications, as well as various compresses. This is especially true when the disease affects the upper or lower extremities.

Dimexide solution is used as applications. To do this, a piece of gauze is folded in several layers and abundantly moistened with Dimexide, after which it is applied to the affected area. Such a bandage should be kept for two hours, and the procedure itself will have to be repeated in the morning and in the evening.

Dimexide will eliminate inflammation and reduce the manifestation of pain

Dimexidum solution not only eliminates the inflammatory process, but relieves pain, stimulates blood circulation and increases the effectiveness of antibiotic treatment. You can use the drug Enteroseptol in the form of powders. The treated leather must be completely dry.

For the procedure itself, several tablets of this medicine need to be crushed and the resulting powder should be sprinkled on the diseased area of ​​one of the limbs. Thanks to such manipulations, bacteria die, while the risk of other dangerous microorganisms joining this disease is reduced.

Dressings based on Furacilin and Microcid also have antimicrobial properties. The advantage of such solutions is that they are able to penetrate into the deep layers of the epidermis and eliminate the pathogenic environment there. Dressings moistened with these preparations are kept on the skin for about three hours twice a day.

It is possible to treat the erysipelas on the leg with the help of Oxycyclosol aerosol. This product is simply sprayed onto the affected area twice a day. The composition of the drug creates a protective film on the skin, which has anti-inflammatory, antibacterial and anti-allergic effects.

But it is forbidden to use Vishnevsky ointment to treat a disease such as erysipelas of the extremities. It will contribute to the development of inflammation and can provoke the formation of an abscess. The same goes for ichthyol ointment.

Physiotherapy for erysipelas

Antibiotics can be used to treat erysipelas on the arm or leg with physical therapy. In this case, the healing process will be faster and more efficient. With this disease, the following methods are used:

• UFO and UHF;
• magnetotherapy;
• electrophoresis;
• laser therapy;
• paraffin applications.

Ultraviolet irradiation is connected to therapy from the very first days when antibacterial drugs are prescribed. The course of such treatment can consist of 12 sessions. With a small lesion, there may be much fewer procedures.

Also, the patient is recommended to undergo a UHF course (ten sessions). Thanks to this procedure, the tissues are warmed up, the focus of inflammation is reduced and the disturbed blood supply is restored. But before treating an unpleasant disease in this way, a course of antibiotics is first prescribed.

High-frequency magnetic therapy acts on the adrenal gland area. Their activity is stimulated, and they contribute to the formation of more steroid hormones. Thanks to this, inflammation is eliminated, pain and swelling of the affected area decreases. Allergic skin reaction is eliminated. This technique is used at the very beginning of treatment, but only if autoantibodies have been found in the blood.

Magnetotherapy blocks inflammation and relieves edema in erysipelas

A procedure such as electrophoresis can be done using potassium iodide, ronidase, or lidase. Under this influence, the outflow of lymphatic fluid occurs. The entire course consists of seven procedures. Electrophoresis is prescribed on the fifth day of therapy.

Laser therapy with infrared radiation activates the protective properties of cells, improves the nutrition of inflamed tissue, and removes puffiness. The procedure is being carried out already at the stage of recovery. It is she who helps to speed up the healing of wounds from ulcers, which are formed during the complicated stage of erysipelas. And after a full course of laser exposure, the question of how long you can live with such a skin lesion will not arise.

Applications with paraffin help eliminate all residual effects. They are usually prescribed as prevention and to reduce the risk of possible relapses. But they can also be used on the seventh day of the main treatment.

ethnoscience

You can get rid of a disease such as erysipelas on the arm or leg with folk remedies. But it is better to resort to such treatment if the disease is in its initial stage. The following recipes may be most effective:

• chalk compress;
• burdock applications;
• elderberry broth.

To make a compress from chalk, a small piece of this component must be thoroughly crushed and the resulting powder must be sprinkled on the lesion. A gauze bandage is applied on top, and the compress is left overnight.

At home, fresh burdock can be used against erysipelas. The leaves of this plant are thoroughly washed, beaten off a little and applied to the affected area with the side where the burdock has let the juice most of all. The plant is fixed with a bandage or bandage and also left overnight.

Elderberry broth, which is taken internally, helps to reduce the symptoms of inflammation and relieve general intoxication of the body. Young twigs and elderberry leaves are used to prepare a healing drink. These components are crushed and filled with hot water, after which they are simmered for another 15 minutes. The finished broth is infused for two hours, and then filtered and taken in 50 ml twice a day.

Folk recipes have some effectiveness and are able to give a therapeutic result for erysipelas. But they will not be able to completely eliminate such a serious disease. Asking the question of whether it is possible to cure such an ailment only with home remedies, you need to understand that you cannot do without drug therapy.

RCHD (Republican Center for Healthcare Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical Protocols of the Ministry of Health of the Republic of Kazakhstan - 2016

Short description

Approved
Joint Commission on the Quality of Medical Services
Ministry of Health and Social Development of the Republic of Kazakhstan
dated June 9, 2016
Protocol No. 4

Erysipelas(English erysipelas) is an infectious human disease caused by group A β-hemolytic streptococcus and proceeding in an acute (primary) or chronic (recurrent) form with severe symptoms of intoxication and focal serous or serous-hemorrhagic inflammation of the skin and mucous membranes.

The ratio of the ICD-10 and ICD-9 codes (if the number of codes is more than 5, highlight in the appendix to the clinical protocol):

ICD-10		ICD-9
The code	Name	The code	Name
A46.0	Erysipelas	035	Erysipelas

Protocol development date: 2016 year.

Protocol users: infectious disease specialists, therapists, general practitioners, emergency doctors, paramedics, surgeons, dermatovenerologists, obstetrician-gynecologists, physiotherapists.

Evidence level scale:

BUT	High quality meta-analysis, systematic review of RCTs, or large RCTs with very low probability (++) bias, the results of which can be generalized to the relevant population.
IN	High quality (++) systematic review of cohort or case-control studies or high-quality (++) cohort or case-control studies with very low risk of bias or RCTs with low (+) risk of bias that can be generalized to the relevant population ...
FROM	A cohort or case-control study or controlled study without randomization with a low risk of bias (+), the results of which can be generalized to the relevant population, or RCTs with a very low or low risk of bias (++ or +), the results of which cannot be directly extended to the relevant population.
D	Description of a series of cases or uncontrolled research or expert opinion.

Classification

Clinical classification of erysipelas(Cherkasov V.L., 1986).

By the frequency of flow:
· Primary;
Repeated (if the disease recurs two years or more after the primary disease or at an earlier date, but with a different localization of the process);
· Recurrent (relapses occur in the period from several days to 2 years with the same localization of the process. Often recurrent erysipelas - 3 relapses or more per year with the same localization of the process). Early relapses of erysipelas occur in the first 6 months from the onset of the disease, late - after 6 months.

By the nature of local manifestations:
Erythematous;
Erythematous-bullous;
· Erythematous-hemorrhagic;
Bullous hemorrhagic.

Localization of the local process:
· Faces;
• scalp;
· Upper limbs (by segments);
Lower limbs (by segments);
· Trunk;
· Genitals.

By severity:
Easy (I);
· Moderate (II);
Severe (III).

By the prevalence of local manifestations:
Localized (the local process covers one anatomical region (for example, the lower leg or face));
Widespread (migratory) (the local process covers several adjacent anatomical areas);
Metastatic with the appearance of distant foci of inflammation (eg, lower leg, face, etc.).

Complications of erysipelas:
Local (abscess, phlegmon, necrosis, phlebitis, periadenitis, etc.);
General (sepsis, ITSh, pulmonary embolism, nephritis, etc.).

Consequences of erysipelas:
Persistent lymphostasis (lymphedema, lymphedema);
· Secondary elephantiasis (fibredema).
A detailed clinical diagnosis indicates the presence of concomitant diseases.

Examples of wording a diagnosis:
Primary erysipelas of the right half of the face, erythematous-bullous form, moderate severity.
Recurrent erysipelas of the left leg and foot, bullous hemorrhagic form, severe. Complications: Phlegmon of the left lower leg. Lymphostasis.
Concomitant disease: Epidermophytosis of the feet.

Diagnostics (outpatient clinic)

DIAGNOSTICS AT THE AMBULATORY LEVEL **

Diagnostic criteria

Complaints:
· Increase in body temperature up to 38 - 40 ° С;
Chills;
· headache;
• weakness, malaise;
· muscle pain;
· nausea, vomiting;
Paresthesia, a feeling of bloating or burning, mild pain, redness in the skin area.

Anamnesis:
· Acute onset of the disease.

Provoking factors:
· Violations of the integrity of the skin (abrasions, scratches, scratches, injections, abrasions, cracks, etc.);
· Bruises;
· A sharp change in temperature (hypothermia, overheating);
· Insolation;
· Emotional stress.

Predisposing factors:
Background (concomitant) diseases: mycoses of the feet, diabetes mellitus, obesity, chronic venous insufficiency (varicose veins disease), chronic (acquired or congenital) insufficiency of the lymphatic vessels (lymphostasis), eczema, etc.;
· The presence of foci of chronic streptococcal infection: tonsillitis, otitis media, sinusitis, caries, periodontal disease, osteomyelitis, thrombophlebitis, trophic ulcers (more often with the erysipelas of the lower extremities);
· Occupational hazards associated with increased trauma, skin contamination, wearing rubber shoes, etc.;
· Chronic somatic diseases, due to which anti-infectious immunity decreases (more often in old age).

Physical examination:

Erythematous erysipelas:
· Erythema (a clearly demarcated area of ​​hyperemic skin with uneven borders in the form of teeth, tongues of flame, "geographical map");
Infiltration, skin tension, moderate pain on palpation (more on the periphery), local temperature rise in the area of ​​erythema;
· "Peripheral roller" in the form of infiltrated and raised edges of erythema;
· Edema of the skin, extending beyond the erythema;
Regional lymphadenitis, tenderness on palpation in the region of regional lymph nodes, lymphangitis;
· Preferential localization of the local inflammatory process on the lower extremities and face;
· The absence of severe pain in the focus of inflammation at rest.

Erythematous-bullousthe formfaces:
Blisters (bullae) against the background of erythema erythema (see above).

Erythematous-hemorrhagicthe formfaces:
Hemorrhages of various sizes (from small petechiae to extensive drainage hemorrhages) into the skin against the background of erythema erythema (see above).

Bullous hemorrhagicthe formfaces:
Blisters (bulls) of different sizes against the background of erythema erythema, filled with hemorrhagic or fibro-hemorrhagic exudate;
· Extensive hemorrhages in the skin in the area of ​​erythema.

Severity criteria faces:
· The severity of symptoms of intoxication;
· The prevalence and nature of the local process.

Light (I) form:
Subfebrile body temperature, symptoms of intoxication are mild, the duration of the febrile period is 1-2 days;
Localized (usually erythematous) local process.

Moderate (II) form:
An increase in body temperature to 38 - 40 ° C, the duration of a febrile period is 3-4 days, symptoms of intoxication are moderately expressed (headache, chills, muscle pain, tachycardia, hypotension, sometimes nausea, vomiting),
· A localized or widespread process involving two anatomical regions.

Severe (III) form:
Body temperature 40 ° C and above, the duration of the febrile period is more than 4 days, symptoms of intoxication are expressed (weakness, severe headache, repeated vomiting, sometimes delirium, confusion, occasionally meningism, convulsions, significant tachycardia, hypotension);
· A pronounced local process, often widespread, often with the presence of extensive bullae and hemorrhages, even in the absence of pronounced symptoms of intoxication and hyperthermia.

Laboratory research:
Complete blood count (CBC): moderate leukocytosis with neutrophilic shift of the formula to the left, moderate increase in erythrocyte sedimentation rate (ESR);
General urine analysis (OAM): in severe cases - oliguria and proteinuria, in urine sediment - erythrocytes, leukocytes, hyaline and granular casts.

Instrumental research: are not specific.

Diagnostic algorithm:(diagram)

Diagnostics (hospital)

DIAGNOSTICS AT STATIONARY LEVEL **

Diagnostic criteria at the inpatient level [ 1,2]

Complaints:
Fever (T 38-40 o C);
Chills;
Weakness;
Lethargy;
• malaise;
· headache;
· sleep disturbance;
· Decreased appetite;
Body aches;
· nausea and vomiting;
• impairment of consciousness;
· Convulsions;
Paresthesias, a feeling of bloating or burning, mild pain, redness, the presence of rashes in the skin area.

Anamnesis:
· Acute onset of the disease.
The presence of provoking factors:
· Violations of the integrity of the skin (abrasions, scratches, wounds, scratches, injections, abrasions, cracks, etc.);
· Bruises;
· A sharp change in temperature (hypothermia, overheating);
· Insolation;
· radiation therapy;
· Emotional stress.
Presence of predisposing factors:
Background (concomitant) diseases: mycoses of the feet, diabetes mellitus, obesity, chronic venous insufficiency (varicose veins disease), chronic (acquired or congenital) insufficiency of the lymphatic vessels (lymphostasis), eczema, etc.;
· The presence of foci of chronic streptococcal infection: tonsillitis, otitis media, sinusitis, caries, periodontal disease, osteomyelitis, thrombophlebitis, trophic ulcers (more often with the erysipelas of the lower extremities);
· Occupational hazards associated with increased trauma, skin contamination, wearing rubber shoes, etc.;
· Chronic somatic diseases, due to which anti-infectious immunity decreases (more often in old age).

Physical examination:
Local process (occurs 12-24 hours after the onset of the disease) - pain, hyperemia and edema of the affected area of ​​the skin (in the face, trunk, extremities and, in some cases, on the mucous membranes).

Erythematous form:
· The affected area of ​​skin is characterized by erythema, swelling and tenderness. Erythema of uniform bright color with clear boundaries with a tendency to peripheral spread, rises above intact skin. Its edges are irregular in shape (in the form of "tongues of flame", "geographical map"). Subsequently, peeling of the skin may appear at the site of erythema.

Erythematous-bullous form:
· Onset is the same as erythematous. However, after 1-3 days from the moment of the disease, at the site of the erythema, the epidermis detaches and bubbles of various sizes are formed, filled with serous contents. Subsequently, the bubbles burst and a brown crust forms in their place. After their rejection, young, delicate skin is visible. In some cases, erosions appear in place of the bubbles, which can transform into trophic ulcers.

Erythematous-hemorrhagic form:
· Against the background of erythema, hemorrhages appear in the affected areas of the skin.

Bullous hemorrhagic form:
· It proceeds similarly to the erythematous-bullous form, however, the bubbles formed in the process of the disease at the site of erythema are filled not with serous, but with hemorrhagic exudate.
Regional lymphadenitis (an increase and soreness of the lymph nodes regional in relation to the affected area of ​​the skin).
Lymphangitis (longitudinal changes in the skin, accompanied by hyperemia, induration and soreness).

Severity criteria faces:
· The severity of symptoms of intoxication;
· The prevalence and nature of the local process.

Light (I) form:
Subfebrile body temperature, symptoms of intoxication are mild, the duration of the febrile period is 1-2 days;
Localized (usually erythematous) local process.

Moderate (II) form:
An increase in body temperature to 38 - 40 ° C, the duration of a febrile period is 3-4 days, symptoms of intoxication are moderately expressed (headache, chills, muscle pain, tachycardia, hypotension, sometimes nausea, vomiting);
· A localized or widespread process involving two anatomical regions.

Severe (III) form:
Body temperature 40 ° C and above, the duration of the febrile period is more than 4 days, symptoms of intoxication are expressed (weakness, severe headache, repeated vomiting, sometimes delirium, confusion, occasionally meningism, convulsions, significant tachycardia, hypotension);
a pronounced local process, often widespread, often with extensive bullae and hemorrhages, even in the absence of pronounced symptoms of intoxication and hyperthermia.

Laboratory research
KLA: leukocytosis, neutrophilia with stab shift, thrombocytopenia, increased ESR.
OAM: proteinuria, cylindruria, microhematuria (with severe course of the disease as a result of toxic damage to the kidneys).
· C-reactive protein: increased content.
· Biochemical blood test (according to indications): determination of the content of total protein, albumin, electrolytes (potassium, sodium), glucose, creatinine, urea, residual nitrogen).
· Coagulogram: in case of violations in the vascular-platelet, procoagulant, fibrinolytic links in patients with severe hemorrhagic forms of erysipelas - determination of blood coagulation time, activated partial thromboplastin time, prothrombin index or ratio, fibrinogen, thrombin time.
· Blood sugar (according to indications);
· Immunogram (according to indications).

ECG (according to indications);
· X-ray of the chest organs (according to indications);
· Ultrasound of the abdominal cavity organs, kidneys (according to indications).

Diagnostic algorithm

List of main diagnostic measures:
· UAC;
· OAM.

List of additional diagnostic measures:
· Biochemical blood test: C-reactive protein, total protein, albumin.
With the development of acute renal failure - potassium, sodium, glucose, creatinine, urea, residual nitrogen;
In case of violations in the vascular-platelet link: coagulogram - blood coagulation time, activated partial thromboplastin time, prothrombin index or ratio, fibrinogen, thrombin time.
· Blood sugar (according to indications);
· Immunogram (according to indications).

Instrumental research
ECG (according to indications);
· X-ray of the chest organs (according to indications);
· Ultrasound of the abdominal cavity organs, kidneys (according to indications).

Differential diagnosis

Differential diagnosis and justification for additional research

Diagnosis		Surveys	Diagnosis exclusion criteria
Phlegmon	General symptoms: acute onset, severe symptoms of intoxication, fever, erythema with edema, changes in the general blood count (neutrophilic leukocytosis, increased ESR)	Consultation with a surgeon	In the place of localization of the process, there is a strong, sometimes throbbing pain, sharp pain on palpation. Hyperemia of the skin has no clear boundaries, is brighter in the center, develops against the background of an excessively dense infiltrate. Later, the infiltrate softens and fluctuations are detected. Characterized by hyperleukocytosis with a significant neutrophilic shift to the left, significantly increased ESR.
Thrombophlebitis of the saphenous veins		consultation with a surgeon / vascular surgeon,	Pain, areas of hyperemia along the veins, palpable in the form of painful cords. Often a history of varicose veins. Body temperature is usually subfebrile, intoxication and the phenomenon of regional lymphadenitis are absent.
Shingles	Erythema, fever		The onset of erythema and fever is preceded by neuralgia. Erythema is located on the face, trunk, along the branches of one or another nerve, most often the branches of the trigeminal, intercostal, sciatic, which determines the size of the skin lesion, always unilateral, within 1-2 dermatomes. The edema is not pronounced. On the 2-3rd day, against the background of erythema, numerous bubbles appear, filled with serous, hemorrhagic, sometimes purulent contents. In place of the bubbles, yellow-brown or black crusts are gradually formed; the disease often takes a protracted course, accompanied by persistent neuralgia.
Anthrax (cutaneous)	Fever, intoxication, erythema, edema	Consultation with an infectious disease specialist	The boundaries of hyperemia and edema are indistinct, there is no local soreness; in the center - a characteristic anthrax carbuncle, "gelatinous" edema, its trembling (Stefansky's symptom). Epid. anamnesis: work with carcasses of slaughtered animals or with secondary raw materials.
Erysipeloid (pig erysipelas)	Erythema	Consultation with an infectious disease specialist or dermatologist	Absence of intoxication, fever, regional lymphadenitis. Erythema is localized in the area of ​​the fingers, hands, red, pinkish-red or purple-red color. The edges of the erythema are brighter in comparison with the center, the edema is insignificant. Against the background of erythema, vesicular elements sometimes appear. Epidemiological data: skin microtrauma during processing of meat or fish, stay in natural foci of erysipeloid.
Eczema, dermatitis	Erythema, skin infiltration	Dermatologist consultation	Itching, oozing, peeling of the skin, small blisters on the background of skin hyperemia. There are no regional lymphadenitis, fever, intoxication, soreness of the focus.
Erythema nodosum	Acute onset, fever, symptoms of intoxication, erythema, history of chronic tonsillitis	Consultation with a rheumatologist, dermatologist	Formation in the area of ​​the legs, less often the thighs and forearms, occasionally on the abdomen, limited, not merging, dense, painful nodes, somewhat rising above the surface of the skin, with local reddening of the skin above them. The skin over the nodes is bright pink in color, later acquires a bluish tint. Pains in the limbs, knee and ankle joints are characteristic.

Differential diagnosis for localization of erysipelas on the face

Diagnosis	Rationale for differential diagnosis	Surveys	Diagnosis exclusion criteria
Quincke's edema	Common symptoms: erythema, edema	Allergist consultation	Sudden onset, hyperemia, and dense edema that does not form a fossa when pressed. Anamnesis: connection with the use of certain food products, medications, etc.
Periostitis of the upper jaw.	Erythema, edema, local tenderness	Dentist / Maxillofacial Surgeon Consultation	Formation of a subperiosteal abscess, edema of the peri-maxillary soft tissues, pain in the area of ​​the affected tooth radiating to the ear, temple, eyes.
Abscess nasal furuncle	Erythema, edema, fever	ENT doctor consultation	After 3-4 days, an abscess may appear at the top of the infiltrate, which is a boil core.

Treatment

Preparations (active ingredients) used in the treatment

Azithromycin (Azithromycin)

Amoxicillin

Benzylpenicillin (Benzylpenicillin)

Vancomycin (Vancomycin)

Warfarin

Gentamicin

Heparin sodium

Dextrose

Diclofenac (Diclofenac)

Ibuprofen (Ibuprofen)

Imipenem

Indomethacin (Indomethacin)

Clavulanic acid

Clindamycin

Levofloxacin

Loratadine

Mebhydrolin (Mebhydrolin)

Meglumine

Meropenem

Sodium chloride

Nimesulide

Paracetamol (Paracetamol)

Pentoxifylline

Prednisolone

Roxithromycin (Roxithromycin)

Spiramycin

Sulfamethoxazole (Sulphamethoxazole)

Teicoplanin

Trimethoprim

Quifenadine

Chloropyramine

Cetirizine

Cefazolin

Cefotaxime (Cefotaxime)

Ceftriaxone

Cefuroxime

Ciprofloxacin (Ciprofloxacin)

Enoxaparin sodium

Erythromycin (Erythromycin)

Groups of drugs according to ATC used in treatment

Treatment (outpatient clinic)

TREATMENT AT THE AMBULATORY LEVEL **

Treatment tactics.
On an outpatient basis, mild forms of erysipelas are treated.

Drug-free treatment

Bed rest
Diet: common table (No. 15), plentiful drink. In the presence of concomitant pathology (diabetes mellitus, kidney disease, etc.), an appropriate diet is prescribed.

Drug treatment

Etiotropic therapy. When treating patients in a polyclinic, it is advisable to prescribe one of the following antibiotics:
· 1 000 000 UNITS x 6 times / day, i / m, 7-10 days [UD - A];
or
· Amoxicillin / clavulanate inside at 0.375-0.625 g every 2-3 / once a day for 7-10 days [UD - A];
or macrolides:
· Erythromycin inside 250-500 mg 4 times / day for 7-10 days [LE - A];
· Azithromycin inside - on the 1st day, 0.5 g, then within 4 days - 0.25 g once a day (or 0.5 g for 5 days) [UD - A],
or
· Spiramycin inside - 3 million IU twice a day (course of treatment 7-10 days) [LEO - A]
or
· Roxithromycin inside - 0.15 g twice a day (course of treatment 7-10 days) [UD - A] or others.
or fluoroquinolones:
· Levofloxacin inside - 0.5 g (0.25 g) 1-2 times a day (course of treatment 7-10 days) [LE - A].

Pathogenetic therapy:
Non-steroidal anti-inflammatory drugs (contraindicated in hemorrhagic forms of erysipelas):
· Indomethacin 0.025 g 2-3 times a day, by mouth, for 10-15 days [UD - B]
or
· Diclofenac 0.025 g 2-3 times a day, by mouth, for 5-7 days [UD - B]
or
· Nimesulide 0.1 g 2-3 times a day, by mouth, for 7-10 days [UD - B]
or
· Ibuprofen 0.2 g, 2-3 times a day, by mouth for 5-7 days [UD - B].

Symptomatic therapywith fever,

or
paracetamol 500 mg, by mouth [DD - B].

Desensitizing therapy:
· Mebhydrolin inside 0.1-0.2 g 1-2 times a day [UD - C];
or
· Hifenadine inside at 0.025 g - 0.05 g 3-4 times a day [UD - D];
or

or

or
· Loratadine 0.01 g orally 1 time per day [UD-B].

Antibacterial therapy:
· Benzylpenicillin sodium salt, powder for preparation of a solution for intramuscular administration in a vial of 1,000,000 units [UD - A];
or
· Amoxicillin / clavulanate 375 mg, 625 mg, by mouth [UD - A];
or
· Azithromycin 250 mg, by mouth [UD - A];
or
· Erythromycin 250mg, 500 mg, by mouth [DD - A];
or
· Spiramycin 3 million IU, inside [UD - A];
or
· Roxithromycin 150mg, inside [UD - A];
or
· Levofloxacin 250 mg, 500 mg, by mouth [DD - A].

or

or
· Nimesulide 100 mg orally [DD - B];
or
· Ibuprofen 200 mg, 400 mg, by mouth [DD - A];
or
· Paracetamol 500 mg, by mouth [UD - A];
or

or

or

or

or
· Cetirizine 5-10 mg, by mouth [DD - B].

Drug comparison table

Class	INN	Benefits	disadvantages	UD
Antibiotic,			It is not resistant to beta-lactamases. "-" m / o.	BUT
Antibiotic, combined penicillin	amoxicillin / clavulanate	Possesses a wide spectrum of antibacterial action.	Side effects (very rare and weakly expressed): dysfunction of the gastrointestinal tract (nausea, diarrhea, vomiting), allergic reactions (erythema, urticaria)	BUT
Macrolides	erythromycin	Active against gram "+", gram "-" m / o.	Low activity against Escherichia coli, Pseudomonas aeruginosa, Shigella spp., Salmonella spp., Bacteroides fragilis, Enterobacter spp. and etc.	BUT
	azithromycin	Active against gram "+". It is rapidly absorbed from the gastrointestinal tract, which is due to its stability in an acidic environment and lipophilicity.	Low activity against anaerobic pathogens	BUT
	spiramycin	Active against Streptococcusspp. (Incl. Streptococcus pneumoniae)		BUT
	roxithromycin	Active against gram "+", gram "-" m / o.	low activity against anaerobic pathogens	BUT
Fluoroquinolones	levofloxacin	Active against gram "+", gram "-" m / o.	low activity against anaerobic pathogens.	BUT
Antihistamines	mebhydrolin		absolute contraindication - stomach ulcer, duodenal ulcer, hyperacid gastritis, ulcerative colitis.	FROM
	hifenadine	Antihistamine and anti-allergic action.		D
	chloropyramine			C
	loratadine			B
	cetirizine			IN
NSAIDs	indomethacin	Strong anti-inflammatory activity	Frequent development of undesirable reactions can lead to the development of aspirin bronchial asthma.	IN
	diclofenac	Strong anti-inflammatory activity	Increased risk of developing cardiovascular complications.	IN
	nimesulide			IN
	Ibuprofen		Increased risk of toxic amblyopia.	IN
	Paracetamol		Hepatotoxic and nephrotoxic effects (with prolonged use in large doses)	IN

· Consultation of an endocrinologist: in case of concomitant diseases - diabetes mellitus, obesity;
· Consultation with a rheumatologist: for differential diagnosis with erythema nodosum;
· Consultation of an obstetrician-gynecologist: with erysipelas in pregnant women;
· Consultation of a clinical pharmacologist for correction and justification of treatment;

Preventive actions:

At PHC: primary prevention:
· Informing the patient about the prevention of microtrauma, diaper rash, hypothermia, careful adherence to personal hygiene, fungal and pustular skin diseases.

Secondary prevention (relapses and complications):
· Timely and full-fledged etiotropic and pathogenetic therapy of primary disease and relapses;
· Treatment of pronounced residual effects - erosion, persistent edema in the area of ​​the local focus, the consequences of erysipelas (persistent lymphostasis, elephantiasis);
· Treatment of long-term and persistent chronic skin diseases, leading to a violation of its trophism and the appearance of an entrance gate for infection;
· Treatment of foci of chronic streptococcal infection (chronic tonsillitis, sinusitis, otitis media, etc.);
· Treatment of disorders of lymph and blood circulation in the skin as a result of primary and secondary lymphostasis and elephantiasis; chronic peripheral vascular disease; treatment of obesity, diabetes mellitus (frequent decompensation of which is observed with erysipelas);
· Bicillin prophylaxis.
Prophylactic administration of bicillin-5 is carried out at a dose of 1,500,000 U once every 3-4 weeks for convalescents after full therapy of erysipelas in the acute period of the disease. An injection of desensitizing drugs is recommended 15-20 minutes before its introduction to prevent allergic complications.
There are the following methods of bicillin prophylaxis:
Year-round (with frequent relapses) for 2-3 years with an interval of 3 weeks of drug administration (in the first months, the interval can be reduced to 2 weeks);
· Seasonal (three seasons within 4 months). The drug begins to be administered one month before the onset of the disease season;
· One-course for the prevention of early relapses within 4-6 months after the disease.

Patient monitoring: is carried out by KIZ doctors / general practitioners with the involvement of doctors of other specialties through medical examination.

Medical examination is subject to:
· 1 group - persons who have frequent, at least 3 in the last year, relapses of erysipelas;
· Group 2 - persons with a pronounced seasonal nature of relapses;
Group 3 - persons with prognostically unfavorable residual events at discharge from the hospital.

For the 1st group:
· Regular, at least 1 time in 3 months, medical examination of patients, which allows timely detection of the deterioration of their condition, an increase in lymphostasis, exacerbation of chronic concomitant skin diseases and foci of chronic streptococcal infection, contributing to the development of relapses of erysipelas.
· Systematic laboratory examination of patients, including a clinical blood test, determination of the level of C-reactive protein. Prophylactic year-round (continuous) administration of Bicillin-5 for 2–3 years, 1.5 million U once every 3-4 weeks, intramuscularly (1 hour before the administration of Bicillin-5, antihistamines must be prescribed).
· Repeated physiotherapy treatment in the presence of persistent lymphostasis.
· Remediation of foci of chronic ENT infection.
· Treatment of skin diaper rash, mycoses and other concomitant skin diseases.
· Treatment in specialized medical institutions of chronic vascular diseases, endocrine diseases.
· Employment of patients under unfavorable working conditions. Dispensary observation of patients in this group is advisable for 2-3 years (in the absence of relapses). Patients with particularly aggravated concomitant diseases (trophic ulcers, other skin defects, lymphorrhea, deep skin cracks with hyperkeratosis, papillomatosis, who have undergone surgery for elephantiasis) need the maximum observation period (3 years).

For the 2nd group:
· Regular medical examination at least once every 6 months.
· Annual laboratory examination before relapse season (CBC, C-reactive protein level).
· Prophylactic seasonal administration of bicillin-5 (1.5 million units 1 time per day, intramuscularly (1 hour before the administration of bicillin-5, antihistamines must be prescribed) 1 month before the start of the morbidity season in a patient with a 3-week interval for 3-4 months annually 3 seasons.
In the presence of appropriate indications - sanitation of foci of chronic ENT infection, treatment of concomitant chronic skin diseases, etc.

For the 3rd group:
· Medical examination after 1-4 months, if necessary, and 6 months after the previous illness.
· Laboratory examination at the beginning and at the end of dispensary observation (clinical blood test, determination of the level of C-reactive protein).
· Physiotherapy treatment of prognostically unfavorable residual erysipelas.
· Course prophylactic administration of Bicillin-5 at intervals of 3 weeks for 4-6 months.

Criteria for the effectiveness of dispensary observation and treatment of persons who have undergone erysipelas:
· Prevention of relapses of the disease, reduction of their number;
· Relief of edematous syndrome, persistent lymphostasis, and other residual effects and consequences of the disease.

Treatment (ambulance)

DIAGNOSTICS AND TREATMENT AT THE STAGE OF EMERGENCY EMERGENCY

If outpatient treatment is possible, transfer the asset to the clinic at the patient's place of residence.

Hospitalization according to indications.

Transport the patient by ambulance in the supine position, taking into account the pain syndrome and signs of intoxication.
To reduce body temperature and relieve pain, the administration of 2.0 ml of a 50% solution of analginum (it is possible in combination with a 1% solution of diphenhydramine 2.0).

Treatment (hospital)

STATIONARY TREATMENT **

Treatment tactics

Drug-free treatment

Bed rest- until the temperature is normalized, with lesions of the lower extremities - during the entire period of the disease.
Diet No. 15 - complete, easily digestible food, drink plenty of fluids. In the presence of concomitant pathology (diabetes mellitus, kidney disease, etc.), an appropriate diet is prescribed.

Drug treatment

Etiotropic therapy

Standard treatment regimen for moderate forms	Standard treatment regimen for severe forms	Standard treatment regimen for recurrent erysipelas, severe form and complications	Alternatives	Alternatives treatment regimen for severe forms and complications №2
Benzylpenicillin sodium salt 1,000,000 units x 6 times / day. i / m, 10 days Reserve drug: Ceftriaxone 1.0 - 2.0 g x 2 times / day, i.m., i.v., 7-10 days or cefazolin 2-4 g / day, i.m., 7-10 days or cefuroxime 2.25-4.5 g / day in 3 doses i / m, i / v, 7-10 days or cefotaxime 2-8 g / day in 2-4 doses i / v or i / m, 7- 10 days.	Benzylpenicillin sodium salt 1,000,000 units x 6-8 times / day. i / m, i / v, 10 days + Ciprofloxacin 200 mg x 2 times / day. intravenous cap., 10 days (single dose may be increased to 400 mg); or cefazolin 1.0 g 3-4 times a day, 10 days; orceftriaxone 2.0 - 4.0 g / day, i / m, i / v, 10 days or cefuroxime 0.75-1.5 g 3 times a day i / m, i / v, 10 days or cefotaxime 1-2 g 2-4 times a day i / v or i / m, 10 days	Ceftriaxone 2.0 x 2 times / day, i.m., i.v., 10 days + Clindamycin 300 mg x 4 times a day. i / m, i / v 10 days	1.Benzylpenicillin sodium salt 1,000,000 units x 6-8 times / day. i / m, 10 days + Gentamicin sulfate 80 mg x 3 times a day / m, 10 days.	Benzylpenicillin sodium salt 1,000,000 U x6-8 times / day. i / m, 10 days + Clindamycin 300 mg x 4 times a day. i / m, i / v (a single dose may be increased to 600 mg), 10 days

In case of intolerance to antibiotics of the penicillin and cephalosporin classes, one of the antibiotics of other classes is used (macrolides, tetracyclines, sulfonamides and co-trimoxazole, rifimycins).
Reserve drugs for the treatment of severe forms of erysipelas - carbapenems (imipenem, meropenem), glycopeptides (vancomycin, teicoplanin).

Treatment of recurrent erysipelas carried out in a hospital setting. Mandatory prescription of reserve antibiotics that were not used in the treatment of previous relapses - cephalosporins:
Cefazolin 1.0 g 3-4 times a day, 10 days;
or
Ceftriaxone 1.0 - 2.0 g x 2 times / day, i.m., i.v., 10 days;
or
Cefuroxime 0.75-1.5 g 3 times a day IM, IV, 10 days;
or
· Cefotaxime 1-2 g 2-4 times a day, i / v, i / m, 10 days.
With frequently recurrent erysipelas, 2 courses of treatment:
1 course: cephalosporins (10 days), break 3-5 days,
2 course: antibiotics of bacteriostatic action (drug of choice - antibiotics of a number of lincosamides: lincomycin 0.6-1.2 g 1 - 2 times a day intramuscularly or 0.5 g orally three times a day or others), 7 days.

Pathogenetic therapy:

Detoxification therapy(the amount of fluid is strictly controlled according to the indicators of daily urine output, the volume of injected fluid, taking into account the severity) :
With a moderate severity of the infectious process, patients should drink plenty of fluids at the rate of 20-40 ml / kg.
With a severe degree of the infectious process - parenteral administration of isotonic (0.9% sodium chloride solution, 400; 0.5% dextrose solution, 400.0, etc.) and colloidal (sodium meglumine succinate, 400.0) solutions in a ratio of 3- 4: 1 in a total volume of 1200-1500 ml for 3-5 days.

Non-steroidal anti-inflammatory drugs(simultaneously with antibiotic therapy, taking into account contraindications, the course is 7-10 days):
· Indomethacin 0.025 g 2-3 times a day, inside [UD - B];
or
· Diclofenac 0.025 g 2-3 times a day, by mouth, for 5-7 days [UD - B];
or
· Nimesulide 0.1 g 2-3 times a day, by mouth, for 7-10 days [UD - B];
or
· Ibuprofen 0.2 g, 2-3 times a day, by mouth for 5-7 days [UD - B].

Desensitizing therapy:
· Mebhydrolin inside 0.1-0.2 g 1-2 times a day [UD - C];
or
· Hifenadine inside at 0.025 g - 0.05 g 3-4 times a day [UD - D];
or
· Chloropyramine inside 0.025 g 3-4 times a day [UD - C];
or
· Cetirizine inside at 0.005-0.01 g 1 time per day, 5-7 days [UD-B];
or
· Loratadine 0.01 g orally 1 time per day [UD-B].

Glucocorticosteroids are prescribed for persistent recurrent erysipelas, with the development of lymphostasis: prednisolone orally, 30 mg per day with a gradual decrease in the daily dose (course dose 350-400 mg) [UD - B].

To improve microcirculation and rheological properties of blood, with an antiplatelet purpose(taking into account the indicators of the coagulogram):
· Pentoxifylline 2% solution 100 mg / 5 ml, 100 mg in 20-50 ml of 0.9% sodium chloride, intravenous course from 10 days to 1 month [UD - B];
or
· Heparin subcutaneously (every 6 hours) 50-100 U / kg / day for 5-7 days [LE - A];
or
Warfarin 2.5-5 mg / day, by mouth;
or
Enoxaparin sodium 20-40 mg 1 time / day n / a.

Symptomatic therapy

For fever:
one of the following drugs:
· Ibuprofen 200 mg, 400 mg, 3-4 times a day [LE - B];
or
· Diclofenac 75 mg / 2 ml, IM [UD - B];
or
· Paracetamol 500 mg, by mouth, with an interval of at least 4 hours [DD - B];
or
· Paracetamol (1 g / 6.7 ml) 1.5 g-3 g per day iv [UD - B].

List of essential medicines
Benzylpenicillin sodium salt, for intramuscular injection of 1,000,000 units;
· Or ceftriaxone, for injection for intramuscular and intravenous administration 1 g.
Or ciprofloxacin, for infusion 0.2%, 200 mg / 100 ml; 1% solution of 10 ml (concentrate to be diluted);
Or gentamicin sulfate, 4% for injection 40 mg / 1 ml in 2 ml ampoules;
· Clindamycin, for intramuscular and intravenous administration, 150 mg / ml, in 2 ml.
Or cefazolin, for intramuscular and intravenous administration, 0.5 g, 1.0 g, 2.0 g.
Or lincomycin, for intramuscular and intravenous administration, 300 mg, 600 mg.
Or cefuroxime, i / v and i / m administration, 750 mg, 1.5 g.
Or cefotaxime, intravenous and intramuscular administration, 1.0 g.

List of additional medicines
Sodium chloride 0.9% - 100, 200, 400 ml
Dextrose 5% - 400 ml;
Megglumine succinate for infusion 400.0
· Indomethacin 25 mg, by mouth [DD - B];
or
· Diclofenac 25 mg, 100 mg, by mouth [DD - B];
or
· Nimesulide 100 mg orally [DD - B];
or
· Ibuprofen 200 mg, 400 mg, by mouth [DD - B];
or
· Paracetamol 500 mg, by mouth [DD - B];
· Mebhydrolin, 100 mg, by mouth [UD-S];
or
Hifenadine 25 mg by mouth [UD-D];
or
· Chloropyramine 25 mg, by mouth [UD - C];
or
· Loratadine 10 mg, by mouth [DD - B];
or
· Cetirizine 5-10 mg, by mouth [DD - B];
· Prednisolone 5 mg, by mouth [DD - A];
Pentoxifylline 2% solution 100 mg / 5 ml, 100 mg in 20-50 ml of 0.9% sodium chloride, ampoules.
Heparin, 1 ml / 5000 U, ampoules 1.0 ml, 5.0 ml, 5.0 ml each.
or
· Warfarin 2.5 mg, by mouth;
or
Enoxaparin sodium 20-40 mg, s / c syringes.

Drug comparison table:

Class	INN	Benefits	disadvantages	UD
Antibiotic, biosynthetic penicillins	benzylpenicillin sodium salt	Active against gram "+" cocci (streptococci)	It is not resistant to beta-lactamases. Low activity against most grams "-" m / o.	BUT
Antibiotic, III generation cephalosporin	ceftriaxone	Active against gram "+", gram "-" m / o. Resistant to beta-lactamase enzymes. It penetrates well into tissues and liquids. The half-life is 8-24 hours.	Low activity against anaerobic pathogens.	BUT
Antibiotic, 1st generation cephalosporin	cefazolin	Active against gram "+", and some gram "-" m / o., Spirochaetaceae and Leptospiraceae.	Ineffective in relation to P. aeruginosa, indole-positive strains Proteusspp., M. tuberculosis, anaerobic microorganisms	BUT
Antibiotic, cephalosporin II generation	cefuroxime	Has a bactericidal effect. Highly active against gram "+", and some gram "-" m / o.	Inactive against Clostridium difficile, Pseudomonas spp., Campylobacter spp., Acinetobacter calcoaceticus, Listeria monocytogenes, methicillin-resistant strains of Staphylococcus aureus, Staphylococcus epidermidis, Entero goris spp., Streptococcus morphogenes (Entero fauna) Citrobacter spp., Serratia spp., Bacteroides fragilis.	BUT
Antibiotic, cephalosporin III generation	cefotaxime	Broad-spectrum antibiotic. Has a bactericidal effect., Highly active against gram "+", gram "-" m / o.	Resistant to most beta-lactamases of gram-positive and gram-negative microorganisms.
Fluoroquinolones	ciprofloxacin	It is active against some gram "+", gram "-" m / o. antipseudomonal drug	Moderate activity towards Str.pn. If you suspect or have an infection caused by Pseudomonas aeruginosa	A
Antibiotic, aminoglycoside	gentamicin sulfate	Potentiates the action of b-lactam antibiotics	Low activity against anaerobic pathogens. Oto-nephrotoxic action	BUT
Antibiotic, lincosamide	clindamycin	Bacteriostatic, active against gram "+", gram "-" m / o (Strept., Staph.)	Low activity for Clostridium sporogenes and Clostridiumtertium	BUT
Antibiotic, lincosamide	lincomycin	Bacteriostatic, active against gram "+", gram "-" o / o (Strept., Staph.), Corynebacterium diphtheriae, anaerobic bacteria Clostridium spp., Bacteroidesspp., Mycoplasmaspp.	Low activity against most gram-negative bacteria, fungi, viruses, protozoa.	BUT
Antihistamines	mebhydrolin	Antihistamine and antiallergic action	Side effects: increased fatigue, dizziness, paresthesia; when using high doses - slowing down the speed of reactions, drowsiness, blurred visual perception; rarely - dry mouth, nausea, heartburn, irritation of the gastric mucosa, pain in the epigastric region, vomiting, constipation, urinary disorders. granulocytopenia, agranulocytosis.	FROM
	hifenadine	Antihistamine and anti-allergic action.	Has a moderate antiserotonin effect.	D
	chloropyramine	It does not accumulate in blood serum, therefore, even with prolonged use, it does not cause an overdose. Due to its high antihistamine activity, a quick healing effect is observed.	Side effects - drowsiness, dizziness, lethargy of reactions, etc. - are present, although they are less pronounced. The therapeutic effect is short-term, in order to prolong it, chloropyramine is combined with H1-blockers that do not have sedative properties.	C
	loratadine	High efficiency in the treatment of allergic diseases, does not cause the development of addiction, drowsiness.	Cases of side effects are rare, they are manifested by nausea, headache, gastritis, agitation, allergic reactions, drowsiness.	B
	cetirizine	Effectively prevents the occurrence of edema, reduces capillary permeability, relieves spasm of smooth muscles, does not have anticholinergic and antiserotonin effects.	Improper use of the drug can lead to dizziness, migraine, drowsiness, allergic reactions.	IN
NSAIDs	indomethacin		Frequent development of undesirable reactions. can lead to the development of aspirin bronchial asthma	IN
	diclofenac	Strong anti-inflammatory activity	Increased risk of developing cardiovascular complications.	IN
	nimesulide	It has anti-inflammatory, analgesic, antipyretic and antiplatelet effects.	In case of an overdose, life-threatening conditions can develop: a drop in pressure, irregularities in heart rhythm, breathing, acute renal failure.	IN
	ibuprofen	Analgesic and antipyretic effect prevails	Increased risk of toxic amblyopia.	IN
	paracetamol	Predominantly "central" analgesic and antipyretic action	Hepatotoxic and nephrotoxic effects (with prolonged use in large doses)	IN

Surgical intervention

In the acute period with erythematous-bullous form of erysipelas:
· Opening intact blisters, removing exudate, applying a bandage with liquid antiseptics (0.02% furacilin solution, 0.05% chlorhexidine solution, 3% hydrogen peroxide solution).

With extensive weeping erosion:
· Local treatment - manganese baths for the extremities, then applying a bandage with liquid antiseptics.

With purulent-necrotic complications of erysipelas:
· Surgical treatment of wounds - excision of necrotic tissue, dressing with liquid antiseptics.
Ointment dressings (ichthyol ointment, Vishnevsky's balm, antibiotic ointments) are categorically contraindicated in the acute period of the disease.

Other treatments

Physiotherapy
Suberythemal doses of UFO to the area of ​​inflammation and ultrasonic frequency currents to the area of ​​regional lymph nodes (5-10 procedures);
The method of low-intensity laser therapy with an anti-inflammatory purpose, to normalize microcirculation in the focus of inflammation, restore the rheological properties of blood, enhance reparative processes from 2 to 12 sessions, at intervals of 1-2 days.

Indications for specialist consultation:
· Consultation with a surgeon: for differential diagnosis with abscess, phlegmon; with severe forms of erysipelas (erythematous-bullous, bullous-hemorrhagic), surgical complications (phlegmon, necrosis);
· Consultation of an angiosurgeon: with the development of chronic venous insufficiency, thrombophlebitis, trophic ulcers;
· Consultation with a dermatovenerologist: for differential diagnosis with contact dermatitis, mycoses of the feet;
· Consultation of a resuscitator: determination of indications for transfer to OARIT;
· Consultation of an endocrinologist: in case of concomitant diseases - diabetes mellitus, obesity.
· Consultation of an otorhinolaryngologist: in case of diseases of the ENT organs;
· Consultation of a clinical pharmacologist for the correction and justification of therapy;
· Consultation of a physiotherapist: for the appointment of physiotherapy;
· Consultation with an allergist in the differential diagnosis with Quincke's edema.

Indications for transfer to the intensive care unit and intensive care unit:
With the development of complications:
· Infectious-toxic encephalopathy;
· Infectious toxic shock;
· Secondary pneumonia and sepsis (in persons suffering from immunodeficiency).

Treatment effectiveness indicators:

Clinical indicators:

With primary erysipelas:

· Relief of local inflammatory process;
· Restoration of working capacity.
With recurrent erysipelas:
Relief of general toxic syndrome (normalization of body temperature);
· Elimination or reduction of edematous syndrome, persistent lymphostasis, other residual effects and consequences of the disease;
· Decrease in the number of relapses.

Laboratory indicators:
· Normalization of UAC indicators.

Hospitalization

Indications for planned hospitalization: no.

Indications for emergency hospitalization(infectious diseases hospital / department or surgical department):
- moderate and severe erysipelas, regardless of the localization of the process (especially the bullous-hemorrhagic form of erysipelas);
- the presence of severe concomitant diseases, regardless of the degree of intoxication, the nature of the local process and its localization;
- the age of patients over 70 years of illness, regardless of the degree of intoxication, the nature of the local process and its localization;
- the course of erysipelas against the background of persistent disorders of lymph circulation and peripheral vascular disease of the extremities, pronounced skin defects (scars, ulcers, etc.), regardless of the degree of intoxication, the nature of the local process and its localization;
- frequent relapses of erysipelas and early relapses, regardless of the degree of intoxication, the nature of the local process and its localization;
- complications of erysipelas.

Information

Sources and Literature

1. Minutes of meetings of the Joint Commission on the Quality of Medical Services of the Ministry of Health and Social Development of the Republic of Kazakhstan, 2016
   1. 1) Infectious Diseases: National Guide / Ed. N. D. Yushchuk, Yu. Ya. Vengerova. M .: GEOTAR-Media, 2009, pp. 441–53. 2) Cherkasov V.L. Erysipelas. Guide to Internal Medicine: Volume Infectious Diseases / Ed. IN AND. Pokrovsky. M., 1996. S. 135-150. 3) Amireev S.A., Bekshin Zh.M., Muminov T.A. and others. Standard case definitions and algorithms of measures for infectious diseases. Practical guide, 2nd edition revised. - Almaty, 2014 - 638 p. 4) Erovichenkov A.A. Erysipelas. Streptococci and streptococcosis / Ed. IN AND. Pokrovsky, N.I. Briko, L.A. Ryapis. M., 2006. S. 195-213. 5) Ryapis L.A., Briko N.I., Eshchina A.S., Dmitrieva N.F. Streptococci: general characteristics and methods of laboratory diagnostics / Ed. N.I. Bricaud. M., 2009. 196s. 6) Erysipelas, a large retrospective study of aetiology and clinical presentation / Anna Bläckberg, Kristina Trell, and Magnus Rasmussen. BMC Infect Disease. 2015.7) A systematic review of bacteremias in cellulitis and erysipelas / Gunderson CG1, Martinello RA. JournalofInfection 2012 Feb.4. 8) A.A. Glukhov A modern approach to the complex treatment of erysipelas / Fundamental research.-№.10.-2014. 411-415.

Information

Abbreviations used in the protocol:

ITSH	infectious toxic shock
KIZ	office of infectious diseases
INR	international normalized ratio
UAC	general blood analysis
OAM	general urine analysis
Surge arrester	acute renal failure
ESR	erythrocyte sedimentation rate
CRB	C-reactive protein
Ultrasound	ultrasound procedure
UFO	ultraviolet irradiation
ECG	electrocardiogram

Developer list:
1) Kosherova Bakhyt Nurgalievna - Doctor of Medical Sciences, Professor, Republican State Enterprise at the Karaganda State Medical University, Vice-Rector for Clinical Work and Continuing Professional Development, chief freelance adult infectious disease specialist of the Ministry of Health and Social Development of the Republic of Kazakhstan.
2) Kulzhanova Sholpan Adlgazyevna - Doctor of Medical Sciences, JSC "Astana Medical University", Head of the Department of Infectious Diseases and Epidemiology.
3) Kim Antonina Arkadyevna - Candidate of Medical Sciences, RSE at the REM "Karaganda State Medical University", Associate Professor, Head of the Department of Infectious Diseases and Dermatovenereology.
4) Mukovozova Lidiya Alekseevna - Doctor of Medical Sciences, State Medical University of Semey State Medical University, Professor of the Department of Neurology and Infectious Diseases.
5) Nurpeisova Aiman ​​Zhenayevna - PSE "Polyclinic No. 1" Health Department of Kostanay region, head of department, infectious disease doctor, chief freelance infectious disease specialist of Kostanay region.
6) Khudaybergenova Mahira Seydualievna - National Scientific Center of Oncology and Transplantology JSC, doctor - clinical pharmacologist.

Conflict of interest: absent.

List of reviewers: Duysenova Amangul Kuandykovna - Doctor of Medical Sciences, Professor, RSE at the REM “Kazakh National Medical University named after S.D. Asfendiyarov ", Head of the Department of Infectious and Tropical Diseases.

Terms of protocol revision: revision of the protocol 3 years after its publication and from the date of its entry into force or in the presence of new methods with a level of evidence.

Attached files

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Many have probably heard about the erysipelas disease. It is an infectious disease that is caused by the group A staphylococcal virus. The disease affects the mucous membranes ...

Erysipelas disease: photos, symptoms, diagnosis and treatment

From Masterweb

27.05.2018 04:00

Today it is difficult to find such a person who thoroughly monitors his health. As a result, people are overtaken by various ailments, leading to negative consequences. Many have probably heard about the erysipelas disease. It is an infectious disease caused by the group A staphylococcal virus. The disease affects the mucous membranes and skin. Serous or serous-hemorrhagic inflammation appears, which is accompanied by general intoxication and fever. An obvious symptom is a bright red edematous skin lesion with signs of lymphostasis. If measures are not taken in time to treat this disease, abscesses, necrotic foci, thrombophlebitis, hyperkeratosis and lymphodema may develop.

The nature of the disease

Let's dwell on this in more detail. Today, erysipelas is a common bacterial infection. It is caused by the causative agent of the species Streptococcus pyogenes. This microorganism can also be present on the skin of a healthy person. Erysipelas is transmitted by airborne droplets or by contact. The infection can penetrate through microtraumas on the mucous membranes and skin. The risk of infection increases significantly if hygiene rules are not followed. Also, the development of the disease under discussion can be facilitated by factors of individual predisposition.

It is believed that women suffer from the disease more often than men. With prolonged use of drugs of the group of steroid hormones, the susceptibility increases significantly. The risk of developing erysipelas in people with chronic tonsillitis is quite high. Also, erysipelas can develop in patients with diseases of the ENT organs. The defeat of the limbs and chest usually occurs in patients suffering from lymphedema and edema, fungal infections. Often, erysipelas develops in the area of ​​postoperative and post-traumatic scars. The peak incidence occurs in late summer - early autumn.

The pathogen can enter the body through damage to the skin or penetrate into the capillaries of the skin with the blood flow. Streptococcus multiplies in lymphatic cells. It is in them that a focus of infection arises, which provokes the development of active inflammation. Due to the active reproduction of bacteria, there is a massive release of their metabolic products into the blood. As a result, the patient may feel signs of intoxication, fever, toxic-infectious shock.

Classification

How is erysipelas treated? Symptoms of the disease can vary depending on the type of disease.

Pathology is classified according to the following features:

1. By the nature of the manifestation: erythematous-bullous, erythematous, erythematous-hemorrhagic, bullous-hemorrhagic.
2. According to the severity of treatment: light, heavy, moderate.
3. By the prevalence of the process: migratory, localized, widespread, metastatic.

The disease can also be of the primary, recurrent, or recurrent type. The interval of recurrence of symptoms of the disease can be from two days to two years. Usually, inflammation develops in the same area. As a rule, repeated erysipelas occurs no earlier than two years later. Its localized form is characterized by the limitation of the site of infection to one anatomical region. If it goes beyond its boundaries, then the disease is widespread. Necrotic changes in the affected tissues are already considered complications.

Symptoms

This issue should be given special attention. How does the erysipelas disease manifest itself? Symptoms and treatment depend on the type of disease. On average, the incubation period can last from a few hours to five days. Erysipelas in most cases begins to develop quite rapidly. Clinical symptoms may appear within 2 hours. Fever appears, and with it signs of intoxication, such as general weakness, chills, headache, body aches.

In severe cases, there may be bouts of vomiting, delirium, convulsions. Local symptoms appear a few days later. A characteristic burning sensation is felt on the mucous membrane or a limited area of ​​the skin. Moderate soreness may occur when palpating. With erysipelas of the scalp, severe pain is characteristic. In the area of ​​the lesion, edema and erythema are formed.

During the peak period, the focus area turns out to be painted in a bright red color. The spot has clearly defined, uneven borders. The color can range from cyanotic to brownish. After pressing, a short-term disappearance of redness is noted. Usually, a seal develops on the affected area. On palpation, the area is quite painful.

Signs of intoxication persist for 7 days. Then the temperature gradually returns to normal. Skin symptoms disappear much later. After erythema, small scaly peeling remains. In some cases, age spots may appear at the site of the lesion. Early relapse may be indicated by skin infiltration and regional lymphadenitis. Persistent edema testifies to the development of lymphostasis. The most common disease is erysipelas on the leg. The reasons lie in the specifics of the development of the infection.

Also, cases of erysipelas on the face are often recorded. Usually we are talking about the area around the nose and lips, the corners of the mouth and ear. In some cases, pus-filled or blood-filled blisters form. When they burst, the contents form crusts, after the rejection of which, you can see the renewed youthful skin.

Features of the course of the disease

Erythematous-hemorrhagic erysipelas is characterized by the presence of hemorrhages in the area of ​​the lesion. In this form of the disease, the fever usually lasts a little longer. The inflammation itself can be complicated by necrosis of local tissues.

Bullous hemorrhagic form is accompanied by the appearance of bubbles. It is considered one of the most dangerous. Often this form is complicated by necrosis or phlegmon. Even after a complete recovery, pigmentation and scars may remain on the skin.

Dependence on the patient's age

How does erysipelas usually manifest itself? You can see a photo of the affected skin areas in the article. The manifestation of symptoms can vary greatly depending on the age of the patient. As a rule, the older the person is, the more severe the primary and secondary inflammations are. The fever period can last for a month. Against the background of erysipelas, chronic diseases can worsen. Symptoms resolve very slowly and the likelihood of relapse is very high. Their frequency ranges from rare episodes to frequent exacerbations.

Recurrent erysipelas is considered a chronic condition. At the same time, intoxication becomes very moderate. By itself, erythema may not have clear boundaries and be quite pale.

Complications

What do you need to know about them? What complications can erysipelas cause? Photos, symptoms, and treatment of which are considered in this review, pathology often leads to the formation of abscesses and necrotic lesions. Unpleasant consequences can also be the formation of phlebitis and thrombophlebitis, or, more simply, inflammation of the veins. In some cases, secondary pneumonia and sepsis can develop.

As a result of the appearance of prolonged stagnation of lymph, lymphema can form. Possible complications also include eczema, papillomas, lymphorrhea, hyperkeratosis.

Diagnostic methods

What are they like? How can you tell if you really have erysipelas? Symptoms in adults in the early stages of the development of the disease can be quite contradictory. To distinguish erysipelas from other diseases, you will need to consult a dermatologist. Blood tests usually show signs of a bacterial infection. As a rule, doctors do not resort to specific diagnostics aimed at isolating the causative agent of the infection.

Erysipelas: therapy methods

Treatment of the ailment in question is usually carried out on an outpatient basis. Only in severe cases, when the disease is accompanied by a number of purulent-necrotic complications, the doctor can prescribe inpatient treatment. With etiotropic erysipelas, a course of first and second generation cephalosporin antibiotics is prescribed. The treatment period is 7 to 10 days. Sulfonamides and erythromycin are less effective.

If the patient regularly has relapses, then he can be sequentially prescribed antibiotics of different groups. Usually, after taking beta-lactams, "Lincomycin" is prescribed.

If the disease of erysipelas on the face proceeds in a bullous form, then the treatment includes procedures for opening the blisters and treating them with antiseptic compounds. To avoid unnecessary skin irritation, it is not recommended to use ointments. Topical preparations such as "Silver sulfadiazine" and "Dexpanthenol" are usually prescribed. For the speedy regeneration of the skin, the doctor may also prescribe physiotherapy. With frequent relapses, the patient is prescribed intramuscular injections of "Benzylpenicillin".

If, despite all the measures taken, the disease still regularly manifests itself, injections are prescribed in courses for 2 years. In case of detection of residual effects after discharge of patients, antibiotics may be recommended for another six months.

Prevention

Is it possible to protect yourself from such a nuisance as an erysipelas? The disease, the causes of which are most often reduced to non-compliance with sanitary and hygienic requirements, will not manifest itself if the infection is properly counteracted. Individual prophylaxis consists mainly of proper treatment of skin lesions. If abrasions or wounds form, they must be immediately wiped with disinfectants. Take extra care when handling them.

Forecast

This question interests all patients. With proper therapy, erysipelas disease responds well to treatment. However, with the appearance of complications and frequent relapses, the likelihood of a quick recovery is markedly reduced. Negative factors that reduce the rate of regeneration of the skin are also weak immunity and body resistance, old age, vitamin deficiency, chronic diseases associated with intoxication, disruption of the lymphovenous and digestive systems.

In order to never experience for yourself what erysipelas is, you must lead a healthy lifestyle. Try to timely engage in the correct treatment of all pathologies, do not allow any of the diseases to become chronic. Since erysipelas often occurs on the lower extremities, try to avoid wearing other people's shoes. Choose comfortable shoes and shoes to avoid calluses and calluses.

Try to improve your body's natural defenses. To do this, you need to regularly consume vitamins and carefully select the diet. Also watch your own weight: being overweight is one of the factors that contributes to the occurrence of complications with erysipelas.

Be sure to engage in strengthening the immune system: exercise and temper. But do not go to extremes - sudden changes in temperature can cause inflammation in the body. At the first signs of infection of the body with streptococcal infection, use special antibiotics to prevent its reproduction.

Conclusion

In this article, we examined the disease of erysipelas. Symptoms and treatment, photos and methods of prevention - all these issues were disclosed in detail. The causative agent of the disease is a bacterial infection. It can enter the body both by airborne droplets and through contact. The incubation period is 5 to 15 days. The first symptoms of erysipelas are fever and general weakness. After about a week, dark brown spots may appear on the body. The focus of inflammation is also characterized by increased soreness and induration. Treatment should be started as soon as possible. It is mainly carried out on an outpatient basis, but in severe cases, hospitalization may be required.

By what signs can you determine that you have an erysipelas disease? Treatment, photos, description of the main symptoms were discussed in detail in this review. However, the final diagnosis can only be made by a qualified doctor. There are also a number of factors that negatively affect the development of the disease. These include a weakened immune system, chronic illness, and old age.

There are a number of preventive measures that can help reduce the likelihood of getting sick. Hygiene requirements must be strictly followed. If injuries and microcracks appear on the skin, be sure to treat them with an antiseptic. This will help prevent infection.

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In the world, millions of people are infected with infectious diseases every day. One of them is erysipelas, which has long been known to medicine.

Erysipelas disease - what is it

Erysipelas is an acute infectious disease caused by beta-hemolytic streptococcus. It is characterized by the appearance of redness on the skin, while it is accompanied by fever and general intoxication of the body (including headache, weakness and nausea).

There are 2 forms of erysipelas:

• Erythematous... In a different way - the initial stage. The patient has a burning sensation, pain, swelling and becomes hot place of inflammation. Sometimes small punctate hemorrhages occur.
• Bullous... It is characterized by the presence of bubbles containing a clear liquid. After a few days, they dry out, forming a crust on the skin.

In both forms, inflammation is accompanied by damage to the lymphatic system.

Important! Primary erysipelas most often appears on the face, while relapses of the disease are "chosen" by the lower extremities of a person. The duration of the disease is 5 - 8 days. Residual manifestations of erysipelas can remain for life, if you do not resort to the help of cosmetologists.

Features of the structure of the skin on the legs, arms and face

The skin is the largest human organ, made up of three layers. She weighs approximately 15% of the total body weight. She has various structural features on her legs, arms and face. For example, the skin on the soles of the feet has a high concentration of sweat pores. In this place, its thickest layers.

There are no hair follicles and sebaceous glands in the skin on the palms. The inner side of the arms is very elastic, thin and soft. On the face, or rather on the eyelids, there is the thinnest layer of skin on the entire human body. In the area of ​​the eyelids, ears, forehead and nose, the skin does not have a lower layer. The skin of the face is most susceptible to aging.

Causes of the disease

Erysipelas disease - is it contagious to others? The cause of the disease is a streptococcal infection trapped in soft tissues. Its source is streptococcus. Most often, the “entrance door” for microorganisms into the human body is minor injuries, abrasions, cuts in the skin or mucous membranes.

Who is at risk?

According to statistics, most often people over 18 years old suffer from erysipelas. Moreover, in 65% of cases, doctors diagnose erysipelas in persons over 50 years of age. Often men and women are infected, whose work is associated with microtraumatization and skin pollution. Erysipelas can also provoke neglect of personal hygiene.

Symptoms of erysipelas

There are 7 main symptoms of erysipelas:

1. Fever development(convulsions, delirium).
2. Manifestation of symptoms of intoxication(including headache, chills).
3. On confined areas of the skin there is a burning sensation, itching... Painful sensations appear when interacting with this area. Over time, the skin becomes redder and stronger. After a few days, swelling sets in and the pain intensifies.
4. Insomnia.
5. Elevated temperature.
6. Nausea and vomiting.
7. Muscle weakness.

Erysipelas in a child - the first signs

Erysipelas in children occurs almost always in the spring-autumn period. The initial phase in babies is faster and sharper than in adults. However, the first signs and symptoms of the disease are the same. A distinctive feature is only heartburn, which is experienced by 99% of children infected with the infection.

Important! Girls get sick together more often than boys.

Diagnostic measures

Diagnosis of erysipelas is carried out on the basis of clinical symptoms and laboratory tests that indicate the presence of a bacterial infection. The dermatologist then draws up a treatment plan.

Treatment

How to treat erysipelas? There are several treatments for erysipelas disease. All of them are divided into 3 types:

• Drug treatment... It has been scientifically proven that hemolytic streptococci, which provoke the disease, have a high sensitivity to nitrofurans, penicillin antibiotics and sulfonamides. This means that in the fight against the disease, drugs will be useful, which contain: penicillins, erythromycin, oleandomycin, clindamycin. They can be taken by mouth or by injection. The treatment lasts 5-7 days. After 1-3 days from the moment it began, the temperature returns to normal, the inflamed areas gradually turn pale. After 10 days, the antibacterial agent Biseptol is prescribed. For topical use, that is, directly for use on the affected areas of the skin, the doctor prescribes erythromycin ointment and powder in the form of crushed tablets, which contain enteroseptol. Medicinal treatments are often supplemented with biostimulants and vitamins.
• Physiotherapy... In this case, we are talking about ultraviolet radiation, which bacteriostatically affects active bacteria. It is often prescribed for patients with erythematous erysipelas. In the treatment of relapses of the disease, ultra-high frequency and laser therapy are sometimes used. But short-term freezing with a jet of chloroethyl of the surface layers of the skin until whitening, in combination with atnibacterial therapy, is practiced in cases where the disease is especially acute.
• Surgery... It should be noted that the need for this method of treatment arises when the patient has a bullous form of erysipelas or purulent-necrotic complications have occurred. During the operation, the bulls are opened and the pathological fluid is evacuated. Only antiseptic agents are used locally.

Prevention

First of all, it is necessary to monitor the cleanliness of the skin, treat various wounds and cracks, and treat pustular diseases in a timely manner. And also, during medical procedures, observe asepsis and use only sterile instruments. Then the risk that a person will undergo erysipelas is minimized.

The consequences of erysipelas

In addition to the typical residual effects of erysipelas, which include skin peeling and pigmentation, lymphedema, which is the accumulation of protein-rich fluid in the interstitial space, can become more severe. In this case, surgical intervention is necessary in combination with physical anti-edema therapy.

Skin restoration after a disease

Both cosmetology and an independent fight against the consequences of the disease can help restore the skin after erysipelas. It is best to consult a specialist before using any medication.

Erysipelas treatment at home - folk recipes

To combat an ailment at home, they often use:

• Pork fat... They are smeared with the affected skin 2 times a day.
• Kalanchoe juice... It is canned with alcohol to a strength of no more than 20%, then a napkin is dipped in it and in a 5% solution of novocaine, after which it is applied to the inflamed area.
• Plantain. The plant is crushed and mixed with honey. After that, boil and apply a bandage with cooled ointment to the skin, changing it every 4 hours.

Important! Some remedies that people at home have been trying to treat erysipelas for several centuries, not only do not contribute to recovery, but can also cause even greater harm to human health. These include, for example, injecting the affected skin with mercury salts.

Video: erysipelas in adults - causes and treatment.

Erysipelas or erysipelas is one of the variants of streptococcal lesions of the skin and underlying tissues, accompanied by general inflammatory reactions of the body. This is an infectious disease, but its infectivity is not high. Most of the manifestations occur in the spring and summer.

The reasons

The disease is based on the defeat of a special type of streptococcus, beta-hemolytic, which, along with erysipelas, causes scarlet fever, streptoderma and tonsillitis.

With a sharp weakening of immunity in the course of the disease, other microbes can also be mixed, causing purulent complications and difficulties in treatment.

For the development of erysipelas, an important role is played by:

• violation of the integrity of the skin, dystrophic processes in the skin,
• fungal infection of the skin,
• the presence of diabetes mellitus, capillary lesions, venous insufficiency,
• professional skin injuries, constant wearing of non-breathable clothing and shoes,
• exposure to the skin of dust, soot, occupational hazards,
• hypovitaminosis, decreased immunity, chronic diseases.

The pathogen gets on the skin from carriers or patients with streptococcal infections. For its penetration, special conditions are needed - abrasions, abrasions, skin defects. It develops more often in people with problems of immunity and local protection of the skin - in pregnant women, weakened women, the elderly, people with diabetes and chronic skin diseases.

Views

Three forms of erysipelas are distinguished:

• erythematous with redness and swelling of the skin,
• hemorrhagic, with bruising and bleeding of the skin,
• bullous, with blistering in areas of redness.

Photo: website of the Department of Dermatovenereology of the Tomsk Military Medical Institute

Symptoms of erysipelas

The incubation period is about a day, the disease begins abruptly,

• from an increase in temperature to 39-40 degrees,
• general malaise with headache and muscle pain,
• weakness with nausea, vomiting, at the height of fever.

Lymph nodes are sharply enlarged, especially those that are closest to the affected area by streptococcus.

In the area of ​​the skin, which are affected by erysipelas, initially itching and burning of the skin occurs, as the disease progresses during the day, all signs of inflammation develop - redness, fever and pain, the lesion sharply spreads and increases in size.

In the classical course of the disease, the skin has a bright red color, clear boundaries with intact tissue, the edges of the lesion are uneven, resemble flames, the site of inflammation rises above the level of healthy skin.

The skin is hot to the touch, when palpating it can be extremely painful, blisters filled with transparent, sacral or purulent contents can form on the skin of the inflamed area. In the area of ​​inflammation, there may be minor hemorrhages in the form of bruises.

The main localizations of erysipelas are the nose and cheeks of the "butterfly" type, the area of ​​the external auditory canal and the corners of the mouth. This localization is usually characterized by severe swelling and pain. There may be foci in the scalp, on the lower extremities, less often inflammation occurs in other areas.

With erysipelas, even with adequate treatment, there may be a fever for up to 10 days, and skin manifestations last up to two weeks.

After recovery, relapses of the disease can occur up to two years, but with relapses, fever usually no longer occurs, and the diagnosis is made when red spots appear on the skin with slight tissue edema.

Diagnostics

The basis of diagnosis is the manifestation of a characteristic set of clinical symptoms of erysipelas:

• fever, toxicosis with a sudden onset of the disease,
• lesion with typical localization on the face or lower extremities,
• swollen lymph nodes
• typical red and painful spots with uneven edges, like a flame,
• at rest, the pain disappears.

Diagnostics is supplemented by the detection of antibodies to streptococcus, as well as the identification of the pathogen.

Differential diagnosis is carried out with many skin diseases - phlegmons and abscesses, dermatitis, shingles, eczema, erythema nodosum.

Treatment of erysipelas

The treatment is carried out by surgeons and therapists.

Hospitalization is not required, the disease is not contagious. It is necessary to increase fluid intake with fever, antipyretic drugs - nurofen or paracetamol. Bed rest and diet are required.

Treatment includes taking antibiotics (erythromycin, ciprofloxacin, penicillins, cephalosporins) for at least 7-10 days. Supplement the treatment with anti-inflammatory drugs (chlotazol, butadion), in case of intoxication, systems with glucose, isotonic solution are shown.

Local therapy is necessary for a bullous form - dressings with furacillin and rivanol, for hemorrhages - dibunol. Shown ultraviolet irradiation, in the stage of recovery ozokerite, paraffin, calcium chloride.

Complications and prognosis

The main complications of erysipelas include sepsis, phlebitis and thrombophlebitis, damage to the lymph nodes and blood vessels, and infectious toxic shock.

The prognosis with a timely start of treatment is favorable, on average, the condition improves on days 7-10, complete recovery occurs in 2-3 weeks, but relapses may occur within two years.