Furunculosis is a purulent–necrotic disease of the hair follicle and near-follicular connective tissue. The primary inflammatory element is the inflammatory node that forms around the hair follicle. The main cause is staphylococcal infections. A typical dermatological picture, signs of inflammation in a clinical blood test and the results of bacteriological seeding of the separated skin elements make it possible to diagnose furunculosis without much difficulty. Patients are treated by a dermatologist.
The cause of furunculosis is staphylococcal microflora, which under the influence of various factors is activated and provokes a purulent-inflammatory process. In the presence of immunodeficiency, short-term exposure to exogenous factors is sufficient for the development of furunculosis. The presence of foci of chronic infection, diabetes mellitus, hypovitaminosis, errors in diet, chronic intoxication both independently and collectively can provoke furunculosis. With localized furunculosis, traumatization of the skin, local hypothermia and its contamination are the main causes of the introduction of staphylococci into the follicle.
At the initial stage of the disease, a purulent-inflammatory infiltrate of a small size is formed around the hair sac, which resembles folliculitis. After a few days, the entire hair follicle is involved in the inflammatory process. With furunculosis, unlike folliculitis, not only the follicle is affected, but also the adjacent sebaceous gland and the surrounding connective tissue. Clinically, the elements of rashes with furunculosis resemble a cone-shaped congestive hyperemic node rising above the surface of the skin. As the focus of inflammation develops, soreness, swelling and pain of a pulsating or twitching nature increases.
If furunculosis affects the follicles of the face and neck, the process is accompanied by extensive swelling around the infiltrate. On the 3rd, 4th day, a fluctuation zone begins to form in the center of the infiltrate – when you click on such an element of furunculosis, a springy movement of purulent masses in the follicle cavity is felt, and a small focus of purulent melting of tissues and the formation of a fistula is noted around the hair.
After the elements of furunculosis are opened, a small amount of thick pus is released, which has accumulated on the surface and a small ulcer is formed. At the bottom of the ulcer, you can see a necrotic rod of a greenish color, the presence of such a rod is a diagnostic symptom of furunculosis. After a few days, the rod is rejected along with a small amount of blood and purulent masses. After the rejection of the rod, the inflammatory phenomena of furunculosis begin to decrease. The affected area becomes less painful when touched, the swelling of the tissues subsides.
After the resolution of the elements of furunculosis, a deep crater-shaped ulcer is formed with the remains of pus and necrotic masses, which are gradually rejected or form a chronic furunculosis. The ulcer is filled with granulation tissue and a retracted scar is formed, the depth and size of the scar depend on the size of the necrosis zone in the center of the boil.
Furunculosis has no favorite localizations, but more often elements of inflammation occur on the forearms, face, back of the neck, buttocks and thighs, that is, where areas of oily problem skin are located. If the elements of furunculosis are of a single nature, then the general well-being of the patient does not suffer, the body temperature remains normal, patients lead the same lifestyle.
When furunculosis affects the area of the nasolabial triangle, the wings of the nose, the area of the external auditory canal, even with single rashes, the body temperature rises, symptoms of intoxication and headaches are observed. The skin on the face becomes purple, tense, puffiness and soreness are pronounced. The work of facial muscles, a high risk of injury to the elements of furunculosis during shaving and washing, attempts to squeeze them out on their own can lead to thrombophlebitis of the veins of the face and to the dissemination of staphylococcal infection into internal organs and tissues.
Due to the peculiarities of venous blood flow on the face, facial furunculosis in some cases leads to meningitis and meningoencephalitis. Sepsis with the formation of multiple abscesses in the internal organs is one of the most severe complications of furunculosis.
In the acute course of furunculosis, many boils of the same resolution stage are present on the skin. Untreated acute furunculosis, the presence of immunodeficiency and neglect of personal hygiene rules lead to the chronization of the process. The chronic course of furunculosis is characterized by the presence of boils of varying degrees of resolution, at the same time there are granulation changes of elements and recurrent boils on the skin, the process in which is activated several times a year or more often.
With localized furunculosis, certain areas of the skin are affected, whereas with disseminated the process takes on a widespread character. Furunculosis of the extremities, especially when the elements are located near the joints, is complicated by regional lymphadenitis. Sometimes with furunculosis, complications in the form of glomerulonephritis are possible.
Clinical manifestations, the presence of a fluctuation zone, the presence of signs of an infectious process make it possible to make a diagnosis. In clinical blood analysis, there is a noticeable increase in the rate of erythrocyte sedimentation, a shift of the leukocyte formula to the left and pronounced leukocytosis. Cultural diagnostics confirms the staphylococcal nature of the disease. Together with cultural diagnostics, the sensitivity of the microorganism to antibiotics is determined. Accurate identification of the pathogen helps to identify the source of infection, for example, often nosocomial infection manifests itself in the form of pyoderma and furunculosis.
Treatment of furunculosis should be carried out by a dermatologist. Self-treatment with Vishnevsky ointment can lead to the spread of the process and to phlegmon, since Vishnevsky ointment will be applied only after the purulent capsule is resolved at the granulation stage. Squeezing out the rods during furunculosis with hands or with the help of vacuum cans leads to premature opening, when nearby areas of healthy skin are seeded with pathogenic microflora, and part of the rod remains inside and thereby leads to the chronization of the process.
During the treatment of furunculosis, it is necessary to limit or completely exclude water procedures, but with extensive furunculosis, slightly warm baths with potassium permanganate disinfect the skin. As hygienic procedures, they resort to wiping healthy skin with non–aggressive antiseptic solutions – salicylic alcohol or furacilin solution.
Great attention should be paid to personal hygiene, minor scratches and cuts are treated with a solution of diamond greens, frequent changes of underwear and bed linen are mandatory. The exclusion of fatty, spicy foods from the diet and the presence of foods rich in vitamins and protein in it help to improve tissue regeneration.
At the stage of maturation, the skin around the elements is treated with antiseptics, pricking the affected area with a solution of novocaine with antibiotics relieves pain and prevents the spread of the purulent process to healthy tissues. Electrophoresis with antimicrobial drugs helps to prevent complications of furunculosis in the form of abscesses and phlegmon.
After the fluctuation zone has been outlined, crystalline salicylic sodium is applied to the center of the furunculosis elements and fixed with a dry bandage. Such applications have a keratolytic effect and contribute to accelerated rejection of the rod.
In the abscessing course of furunculosis, the opening of the furuncle under local anesthesia and the removal of purulent necrotic masses is indicated. After an independent or forced opening, the wound is thoroughly washed with 3% hydrogen peroxide and bandages with proteolytic drugs, syntomycin and erythromycin ointments are prescribed. Bandages are changed every other day, and after the transition of the process to the granulation stage, Vishnevsky liniment and ichthyol-based ointments are used for better healing.
Ultraviolet irradiation and UHF therapy are dosed at all stages of furunculosis. The internal administration of antibiotics is resorted to in cases of chronic furunculosis and abscessed elements. In the presence of common diseases, exhaustion of the patient and a reduced immune status, antibiotics are prescribed in the form of intramuscular injections. To increase the body’s resistance, gamma globulin and ozone therapy are used, vitamin therapy, autohemotransfusions, UVI and restorative drugs are prescribed.
Prevention of furunculosis consists in observing personal hygiene, timely treatment of pustular diseases, in the treatment of systemic diseases and in maintaining a healthy lifestyle.