Prevention and treatment of erysipelas. Erysipelas of the skin. Erysipelas disease

The first stages are characterized by the development of symptoms of general intoxication, which manifests itself:

severe headache;
chills;
general weakness;
nausea, vomiting;
increase in body temperature to 39-40°C;
constipation or loose stools.
muscle soreness.

Other symptoms of the disease are:

appearance bright red spot on the surface of the skin. The affected area is hot to the touch, painful, swollen. The spot quickly increases in size, taking on the shape of flames at the periphery. Sometimes several spots appear on the affected area, connected by red stripes. The affected area differs from the healthy one by a raised ridge-like edge, while the center appears slightly sunken. Swelling and redness are mild in areas with poor loose tissue subcutaneous tissue, for example, in the area of the nasolabial fold, at the border with the scalp, in the forehead, cheekbones, eyebrows, ankles and, conversely, in areas rich in loose subcutaneous tissue, for example, on the eyelids, scrotum (in men), labia ( among women). The swollen skin becomes tense, shiny, acquires a bluish tint, and sometimes hemorrhages are observed in the affected area. When palpated (feeling) at the periphery, the affected area is more painful than in the center. Most often the lower extremities, face, and head are affected. Erysipelas occurs mainly in areas with circulatory problems, for example, on the legs due to thrombosis.
The multiplication of the pathogen in the lymphatic vessels is accompanied by enlargement and pain of the lymph nodes.
Defeat nervous system It is noted from the first days in the form of headaches, sleep disturbances, and in severe cases, convulsions and delirium are possible.

Incubation period

From several hours to 3-5 days.

Forms

Erythematous form:
- a burning sensation, fullness in the affected area;
- redness and swelling at the site of inflammation;
- lesions with clear boundaries, scalloped (in the form of jagged edges, flames) edges, prone to peripheral growth;
- the skin in the area of the outbreak is hot to the touch, tense;
- this form is usually characterized by a mild course (from 5 to 8, sometimes 12-14 days), then the inflammation goes away, and slight pigmentation or peeling remains on the affected areas.
If pinpoint hemorrhages appear against a background of redness, erythrimatous-hemorrhagic form diseases.
Bullous form characterized by the fact that with significant swelling, detachment of the epidermis occurs ( upper layer skin), which rises, and small or large bubbles (bullas) filled with liquid contents form. Large blisters are usually located on the face, genitals, and lower extremities. When the bubbles burst, their contents turn into yellow crusts. The opening of the blisters and their further healing is accompanied by itching. When the course is complicated, erosions (a superficial defect of the skin without scar formation) and trophic ulcers (long-term non-healing festering wounds) can form at the site of the blisters. This form characterized by a longer course and a period of rising body temperature. After the lesions dry out, dense crusts remain.
In case of minor hemorrhages, the contents of the vesicles may contain blood impurities, and bullous-hemorrhagic form.
Phlegmous form characterized by the formation of blisters containing pus and damage to the subcutaneous fatty tissue. This form develops with additional infection of the affected tissue with staphylococcus. There is sharp pain in the center of the lesion.
Gangrenous form characterized by tissue death in the affected areas. It is most often localized in areas rich in loose subcutaneous tissue (for example, in the eyelid area, scrotum (in men)). The form occurs in severe cases in weakened persons suffering from serious pathologies, persons with chronic alcoholism. After the necrotic (dead) areas are rejected, scars remain. Severe pain is noted.

According to the distribution of the lesion there are:

local localized erysipelas– a specific area limited by the anatomical boundaries of one organ is affected;
wandering face– the process covers a wide area, the pathogen spreads through the lymphatic tract;
metastatic erysipelas– occurs extremely rarely, represents separate isolated foci in areas distant from each other; characterized by hematogenous (that is, along the bloodstream) spread of infection.

Causes

Sources of infection are people suffering from various streptococcal infections, as well as its carriers. The carrier of streptococcal infection himself does not get sick, since he the immune system capable of suppressing the development of the pathological process. However, the carrier can be a source of infection for people with weak immune systems.

The disease can develop against the background of:

injuries and microtraumas (violation of the integrity of the skin, mucous membranes);
under poor material, living and sanitary conditions;
stress;
poor nutrition;
hypothermia or overheating.

Very often, erysipelas occurs against the background of predisposing diseases - foot fungus, diabetes mellitus, varicose veins, lymphostasis (damage to the lymphatic vessels, etc.).

People over 50 years of age are most susceptible to the disease (this is explained by the fact that the bactericidal properties of the skin in older people are less pronounced than in people young, and the vulnerability of the skin is significantly increased).

Women get sick more often than men.

People who work outdoors, in conditions of hypothermia and sudden temperature changes, get sick more often.

Infection can occur when using contaminated instruments and dressings.

In this case, a person’s immune status and susceptibility to streptococcal infection are of decisive importance.

Diagnostics

Analysis of the medical history and complaints of the disease (when headaches appeared, fever, redness on the skin, whether there was previous damage to the skin at the site of the lesion (for example, an abrasion, scratch), etc.).
Analysis of life history (childhood infections, chronic diseases, injuries, surgeries, etc.).
General examination (localization of redness, nature of the lesion, severity of swelling, etc.).
Inspection of the affected area (when palpated, the peripheral area in the affected area is more painful than in the center).
Coagulogram analysis (determination of the main indicators of the blood coagulation system): in acute period The disease may reveal increased blood clotting and a tendency to form blood clots or a reverse reaction - bleeding.
A general urine test is performed to detect albuminuria (the presence of protein in the urine) and erythrocytes (red blood cells in a portion of urine). These changes are characteristic of the acute period of disease development.
Examination of ulcers and the contents of vesicles in order to isolate the pathogen, and the collected material is inoculated on nutrient media and determination of the sensitivity of this flora to antibiotics.
Express blood diagnostics based on latex agglutination and ELISA methods ( enzyme immunoassay). These are methods of testing blood to determine the pathogen antigen and antibodies to it.
Consultation is also possible.

Treatment of erysipelas

Within drug treatment Antibiotics are prescribed (in the form of tablets for oral administration and in the form of ointments for treating affected areas of the skin). For repeated episodes of erysipelas, antibacterial therapy combines well with cryotherapy (short-term freezing of the surface layers of the skin with a stream of chlorethyl until they turn white).
General strengthening therapy (taking vitamin and mineral complexes).
In some cases, blood/plasma transfusion is indicated.
Physiotherapeutic procedures include ultraviolet irradiation (impact on the skin ultraviolet rays), also UHF (a therapeutic method based on the principles of influencing the patient’s body with high-frequency magnetic field), quartz, laser.
For bullous forms, lotions are prescribed with a solution of furatsilin.
Hospitalization in the infectious diseases department (severe course, frequent relapses, presence of severe concomitant diseases, old age).

Complications and consequences

On the background timely treatment antibiotics, severe complications and consequences are rare.

However, in elderly people and people with weakened immune systems, the following are possible:

circulatory disorders due to cardiovascular diseases;
in older people, transient toxic bronchitis (inflammation of the bronchi) occurs;
very rarely (with the addition of a staphyloccal infection and the development of sepsis) inflammatory processes develop in the kidneys (pyelonephritis or glomerulonephritis);
erysipelas against the background of inflammatory kidney disease can lead to the development of renal failure;
thrombophlebitis (inflammation of the vein wall, accompanied by the formation of blood clots);
lymphostasis and the development of elephantiasis (impaired blood circulation and lymphatic drainage, the formation of lymphedema and an increase in the size of the affected part of the body). Sometimes a lymphatic fistula forms (a pathological channel connecting the source of inflammation in the area of the lymphatic vessels with the surface of the skin). From the fistula there may be discharge in the form of chyle (lymph mixed with absorbed digestive products) and fat.
ulcers and necrosis of the skin, abscesses and phlegmon, impaired lymph circulation leading to elephantiasis (enlarged limbs).

It should be noted that there is no immunity after erysipelas; the disease can occur again, and it may be impossible to determine whether the disease occurred as a result of the activation of a dormant infection or as a result of a new infection.

Prevention of erysipelas

Maintaining skin hygiene (timely treatment of abrasions, diaper rash, wounds, cracks, pustules).
Strict compliance with sanitary and hygienic standards when medical manipulations, processing of medical instruments.
Timely treatment of edema, thrombophlebitis (inflammation of the vein wall with the formation of blood clots that block the lumen of the vessel).
Timely and sufficient treatment of lesions chronic infection(elimination of carious lesions in the oral cavity, treatment of chronic sore throats).
In some cases, with a chronic recurrent course of erysipelas, long-acting antibiotics are used for a long time.

RCHR (Republican Center for Health 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 Healthcare Quality
Ministry of Health and social development Republic of Kazakhstan
dated June 9, 2016
Protocol No. 4

Erysipelas(English erysipelas) is a human infectious disease caused by β-hemolytic streptococcus of group A and occurs 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 ICD-10 and ICD-9 codes (in the case of more than 5 codes, add to the appendix to the clinical protocol):

ICD-10		ICD-9
Code	Name	Code	Name
A46.0	Erysipelas	035	Erysipelas

Date of development of the protocol: 2016

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

Level of evidence scale:

A	A high-quality meta-analysis, systematic review of RCTs, or large RCTs with a very low probability (++) of bias, the results of which can be generalized to an appropriate population.
IN	A high-quality (++) systematic review of cohort or case-control studies, or a high-quality (++) cohort or case-control study with a very low risk of bias, or an RCT with a low (+) risk of bias, the results of which can be generalized to an appropriate population .
WITH	Cohort or case-control study or controlled trial without randomization with low risk of bias (+), the results of which can be generalized to the relevant population or RCT with very low or low risk of bias (++ or +), the results of which cannot be directly distributed to the relevant population.
D	Case series or uncontrolled study or expert opinion.

Classification

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

By flow rate:
· primary;
repeated (if the disease recurs two years or more after primary disease or at an earlier date, but with a different localization of the process);
· recurrent (relapses occur within a period of 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 relapses - after 6 months.

According to the nature of local manifestations:
· erythematous;
· erythematous-bullous;
· erythematous-hemorrhagic;
· bullous-hemorrhagic.

By localization of the local process:
· faces;
· scalp;
· upper limbs(by segments);
· lower extremities (by segments);
· torso;
· genital organs.

By severity:
· light (I);
· moderate (II);
· heavy (III).

According to the prevalence of local manifestations:
· localized (the local process affects one anatomical area (for example, lower leg or face));
· widespread (migratory) (the local process involves several adjacent anatomical areas);
· metastatic with the appearance of distant foci of inflammation (for example, lower leg, face, etc.).

Complications of erysipelas:
· local (abscess, phlegmon, necrosis, phlebitis, periadenitis, etc.);
· general (sepsis, ITS, pulmonary embolism, nephritis, etc.).

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

Examples of diagnosis formulation:
Primary erysipelas of the right half of the face, erythematous-bullous form, medium degree gravity.
Recurrent erysipelas of the left leg and foot, bullous-hemorrhagic form, severe. Complications: Phlegmon of the left leg. Lymphostasis.
Concomitant disease: Athlete's foot.

Diagnostics (outpatient clinic)

OUTPATIENT DIAGNOSTICS**

Diagnostic criteria

Complaints:
· increase in body temperature to 38 - 40°C;
· chills;
· headache;
· weakness, malaise;
· muscle pain;
· nausea, vomiting;
· paresthesia, feeling of fullness or burning, mild pain, redness in the skin area.

Anamnesis:
· acute onset diseases.

Provoking factors:
· Violations of the integrity of the skin (abrasions, scratches, scratches, injections, abrasions, cracks, etc.);
· bruises;
· sudden change in temperature (hypothermia, overheating);
· insolation;
· emotional stress.

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

Physical examination:

Erythematous form of erysipelas:
· erythema (a clearly demarcated area of hyperemic skin with uneven boundaries in the form of teeth, flames, “ geographical map»);
· infiltration, skin tension, moderate pain on palpation (more on the periphery), local increase temperature in the area of erythema;
· “peripheral ridge” in the form of infiltrated and raised edges of erythema;
· swelling of the skin extending beyond the erythema;
· regional lymphadenitis, pain on palpation in the area of regional lymph nodes, lymphangitis;
· predominant localization of the local inflammatory process on the lower extremities and face;
· absence of severe pain in the area of inflammation at rest.

Erythematous-bullousformfaces:
· blisters (bullas) against the background of erythema erysipelas (see above).

Erythematous-hemorrhagicformfaces:
· hemorrhages of various sizes (from small petechiae to extensive confluent hemorrhages) into the skin against the background of erythema erysipelas (see above).

Bullous-hemorrhagicformfaces:
· blisters (bulls) of various sizes against the background of erythema erysipelas, filled with hemorrhagic or fibro-hemorrhagic exudate;
· extensive hemorrhages into the skin in the area of erythema.

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

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

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

Severe (III) form:
· body temperature is 40°C and above, the duration of the febrile period is more than 4 days, symptoms of intoxication are expressed (adynamia, severe headache, repeated vomiting, sometimes delirium, confusion, occasionally meningismus, convulsions, significant tachycardia, hypotension);
· 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 a neutrophilic shift to the left, moderate increase in erythrocyte sedimentation rate (ESR);
· general urinalysis (UCA): in severe cases - oliguria and proteinuria, urine sediment - erythrocytes, leukocytes, hyaline and granular casts.

Instrumental studies: not specific.

Diagnostic algorithm:(scheme)

Diagnostics (hospital)

DIAGNOSTICS AT THE INPATIENT LEVEL**

Diagnostic criteria at the hospital level[ 1,2]

Complaints:
· fever (T 38-40 o C);
· chills;
· weakness;
lethargy;
· malaise;
· headache;
· sleep disturbance;
· decreased appetite;
body aches;
· nausea and vomiting;
· disturbance of consciousness;
· convulsions;
· paresthesia, feeling of fullness or burning, mild pain, redness, presence of rashes in the skin area.

Anamnesis:
Acute onset of the disease.
Presence of provoking factors:
· Violations of the integrity of the skin (abrasions, scratches, wounds, scratches, injections, abrasions, cracks, etc.);
· bruises;
· sudden 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), chronic (acquired or congenital) insufficiency of lymphatic vessels (lymphostasis), eczema, etc.;
· the presence of foci of chronic streptococcal infection: tonsillitis, otitis, sinusitis, caries, periodontal disease, osteomyelitis, thrombophlebitis, trophic ulcers (more often with erysipelas of the lower extremities);
· occupational hazards associated with increased trauma, skin contamination, wearing rubber shoes, etc.;
· chronic somatic diseases, as a result of which anti-infective immunity decreases (usually in old age).

Physical examination:
· Local process (occurs 12-24 hours from the onset of the disease) - pain, hyperemia and swelling of the affected area of the skin (in the face, torso, limbs 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 distribution, rises above intact skin. Its edges are irregularly shaped (in the form of “tongues of flame”, “geographical map”). Subsequently, peeling of the skin may appear at the site of erythema.

Erythematous-bullous form:
· Begins in the same way as erythematous. However, after 1-3 days from the moment of illness, epidermal detachment occurs at the site of erythema and blisters of various sizes filled with serous contents form. Subsequently, the bubbles burst and in their place form Brown crusts. After their rejection, young, delicate skin is visible. In some cases, erosions appear in place of the blisters, 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 blisters formed during the disease at the site of erythema are filled not with serous, but with hemorrhagic exudate.
· Regional lymphadenitis (enlarged and painful lymph nodes regional to the affected area of the skin).
· Lymphangitis (longitudinal changes in the skin, accompanied by hyperemia, thickening and pain).

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

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

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

Severe (III) form:
· body temperature is 40°C and above, the duration of the febrile period is more than 4 days, symptoms of intoxication are expressed (adynamia, severe headache, repeated vomiting, sometimes delirium, confusion, occasionally meningismus, 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
· CBC: leukocytosis, neutrophilia with band shift, thrombocytopenia, increased ESR.
· OAM: proteinuria, cylindruria, microhematuria (in severe disease as a result of toxic kidney damage).
· C-reactive protein: increased content.
· biochemical blood test (according to indications): determination of total protein, albumin, electrolytes (potassium, sodium), glucose, creatinine, urea, residual nitrogen).
· coagulogram: for disorders in the vascular-platelet, procoagulant, fibrinolytic links in patients with severe hemorrhagic forms of erysipelas - determination of blood clotting 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 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;
For disorders in the vascular-platelet unit: coagulogram - blood clotting time, activated partial thromboplastin time, prothrombin index or ratio, fibrinogen, thrombin time.
blood sugar (according to indications);
Immunogram (according to indications).

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

Differential diagnosis

Differential diagnosis and rationale additional research

Diagnosis		Surveys	Diagnosis exclusion criteria
Phlegmon	General symptoms: acute onset, severe symptoms of intoxication, fever, erythema with edema, changes in general blood count (neutrophilic leukocytosis, increased ESR)	Surgeon consultation	At the site of localization of the process, severe, sometimes throbbing pain and sharp pain on palpation occur. Hyperemia of the skin does not have clear boundaries, is brighter in the center, and develops against the background of an excessively dense infiltrate. Later, the infiltrate softens and fluctuation is detected. Characterized by hyperleukocytosis with a significant neutrophil 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, palpated in the form of painful strands. Often there is a history of varicose veins. Body temperature is usually subfebrile, intoxication and symptoms of regional lymphadenitis are absent.
Shingles	Erythema, fever		The appearance of erythema and fever is preceded by neuralgia. Erythema is located on the face, torso, 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 one-sided, within 1-2 dermatomes. Edema is not expressed. On the 2-3rd day, against the background of erythema, numerous blisters appear filled with serous, hemorrhagic, and sometimes purulent contents. In place of the bubbles, yellow-brown or black crusts gradually form; The disease often takes a protracted course and is accompanied by persistent neuralgia.
Anthrax (skin form)	Fever, intoxication, erythema, edema	Consultation with an infectious disease specialist	The boundaries of hyperemia and edema are unclear, there is no local pain; in the center - a characteristic anthrax carbuncle, “jelly-like” swelling, its trembling (Stefansky’s symptom). Epid. medical history: working with carcasses of slaughter animals or with secondary raw materials.
Erysipeloid (pig mug)	Erythema	Consultation with an infectious disease specialist or dermatologist	No intoxication, fever, regional lymphadenitis. Erythema is localized in the area of the fingers, hands, and is red, pinkish-red, or purplish-red in color. The edges of the erythema are brighter compared to the center, the swelling is insignificant. Vesicular elements sometimes appear against the background of erythema. Epidemiological data: skin microtraumas during processing of meat or fish, exposure to natural foci of erysipeloid.
Eczema, dermatitis	Erythema, skin infiltration	Consultation with a dermatologist	Itching, weeping, peeling of the skin, small blisters against the background of skin hyperemia. There is no regional lymphadenitis, fever, intoxication, or focal pain.
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, non-merging, dense, painful nodes, somewhat elevated above the surface of the skin, with local redness of the skin above them. The skin over the nodes is bright pink in color, later acquiring a bluish tint. Pain in the limbs, knee and ankle joints is typical.

Differential diagnosis for localization of erysipelas on the face

Diagnosis	Rationale for differential diagnosis	Surveys	Diagnosis exclusion criteria
Quincke's edema	General symptoms: erythema, edema	Allergist consultation	Sudden onset, hyperemia and dense swelling, when pressed, a hole does not form. History: connection with the use of certain foods, medications, etc.
Periostitis of the upper jaw.	Erythema, swelling, local tenderness	Consultation with a dentist/oral and maxillofacial surgeon	Formation of a subperiosteal abscess, swelling of the perimaxillary soft tissues, pain in the area of the affected tooth with irradiation to the ear, temple, and eye.
Abscessing furuncle of the nose	Erythema, edema, fever	Consultation with an ENT doctor	After 3-4 days, an abscess may appear at the top of the infiltrate, which is the core of a boil.

Treatment

Drugs (active ingredients) used in treatment

Azithromycin
Amoxicillin
Benzylpenicillin
Vancomycin
Warfarin
Gentamicin
Heparin sodium
Dextrose
Diclofenac
Ibuprofen
Imipenem
Indomethacin
Clavulanic acid
Clindamycin
Levofloxacin
Loratadine
Mebhydrolin
Meglumine
Meropenem
Sodium chloride
Nimesulide
Paracetamol
Pentoxifylline
Prednisolone
Roxithromycin
Spiramycin
Sulfamethoxazole
Teicoplanin
Trimethoprim
Quifenadine
Chloropyramine
Cetirizine
Cefazolin
Cefotaxime
Ceftriaxone
Cefuroxime
Ciprofloxacin
Enoxaparin sodium
Erythromycin

Groups of drugs according to ATC used in treatment

Treatment (outpatient clinic)

OUTPATIENT TREATMENT**

Treatment tactics.
IN outpatient setting mild forms of erysipelas are treated.

Non-drug treatment

Bed rest
Diet: common table (No. 15), plenty of drink. If there is a concomitant pathology (diabetes mellitus, kidney disease, etc.), an appropriate diet is prescribed.

Drug treatment

Etiotropic therapy. When treating patients in a clinic, it is advisable to prescribe one of the following antibiotics:
· 1,000,000 units x 6 times/day, IM, 7-10 days [UD - A];
or
· amoxicillin/clavulanate orally 0.375-0.625 g 2-3 times a day for 7-10 days [UD - A];
or macrolides:
· erythromycin orally 250-500 mg 4 times a day for 7-10 days [UD - A];
· azithromycin orally - on the 1st day, 0.5 g, then for 4 days - 0.25 g once a day (or 0.5 g for 5 days) [UD - A],
or
· spiramycin orally - 3 million IU twice a day (course of treatment 7-10 days) [UD - A]
or
· roxithromycin orally - 0.15 g twice a day (course of treatment 7-10 days) [UD - A] or others.
or fluoroquinolones:
· levofloxacin orally - 0.5 g (0.25 g) 1-2 times a day (course of treatment 7-10 days) [UD - A].

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

Symptomatic therapywith fever,

or
paracetamol 500 mg, orally [UD - B].

Desensitization therapy:
· mebhydrolin orally 0.1-0.2 g 1-2 times a day [UD - C];
or
hifenadine orally 0.025 g - 0.05 g 3-4 times a day [UD - D];
or

or

or
Loratadine 0.01 g orally once a day [EL-B].

Antibacterial therapy:
· benzylpenicillin sodium salt, powder for preparing a solution for intramuscular administration in a bottle of 1,000,000 units [UD - A];
or
· amoxicillin/clavulanate 375 mg, 625 mg, orally [UD - A];
or
· azithromycin 250 mg, orally [UD - A];
or
· erythromycin 250 mg, 500 mg, orally [UD - A];
or
· spiramycin 3 million IU, orally [UD - A];
or
· roxithromycin 150 mg, orally [UD - A];
or
Levofloxacin 250 mg, 500 mg, orally [UD - A].

or

or
nimesulide 100 mg orally [UD - B];
or
ibuprofen 200 mg, 400 mg, orally [UD - A];
or
· paracetamol 500 mg, orally [UD - A];
or

or

or

or

or
cetirizine 5-10 mg, orally [UD - B].

Drug comparison table

Class	INN	Advantages	Flaws	UD
Antibiotic,			Not resistant to beta-lactamases. "-" m/o.	A
Antibiotic, combined penicillin	amoxicillin/clavulanate	Has a wide spectrum of antibacterial action.	Side effects (very rare and mild): dysfunction of the gastrointestinal tract (nausea, diarrhea, vomiting), allergic reactions (erythema, urticaria)	A
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.	A
	azithromycin	Active against gram “+”. It is quickly absorbed from the gastrointestinal tract, which is due to its stability in an acidic environment and lipophilicity.	Low activity against anaerobic pathogens	A
	spiramycin	Active against Streptococcus spp. (incl. Streptococcus pneumoniae)		A
	roxithromycin	Active against gram “+”, gram “-” m/o.	low activity against anaerobic pathogens	A
Fluoroquinolones	levofloxacin	Active against gram “+”, gram “-” m/o.	low activity against anaerobic pathogens.	A
Antihistamines	mebhydrolin		absolute contraindication- peptic ulcer of the stomach, duodenum, hyperacid gastritis, nonspecific ulcerative colitis.	WITH
	hifenadine	Antihistamine and antiallergic effect.		D
	chloropyramine			C
	loratadine			B
	cetirizine			IN
NSAIDs	indomethacin	Strong anti-inflammatory activity	Frequent development adverse reactions can lead to the development of aspirin-induced bronchial asthma	IN
	diclofenac	Strong anti-inflammatory activity	Increased risk development of cardiovascular complications.	IN
	nimesulide			IN
	Ibuprofen		Increased risk of toxic amblyopia.	IN
	Paracetamol		Hepatotoxic and nephrotoxic effects (with long-term use in large doses)	IN

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

Preventive actions:

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

Secondary prevention (relapses and complications):
· timely and complete etiotropic and pathogenetic therapy primary disease and relapses;
· treatment of pronounced residual effects - erosion, persistent swelling in the local area, consequences of erysipelas (persistent lymphostasis, elephantiasis);
· treatment of long-term and persistent chronic diseases skin, leading to disruption of its trophism and the appearance of entrance gates for infection;
· treatment of foci of chronic streptococcal infection (chronic tonsillitis, sinusitis, otitis, etc.);
· treatment of disorders of lymph and blood circulation in the skin as a result of primary and secondary lymphostasis and elephantiasis; chronic diseases peripheral vessels; treatment of obesity, diabetes mellitus (frequent decompensation of which is observed with erysipelas);
Bicillin prophylaxis.
Prophylactic administration of bicillin-5 is carried out in a dose of 1,500,000 units once every 3-4 weeks to convalescents after complete therapy for erysipelas in the acute period of the disease. Before its administration, 15-20 minutes before its administration, an injection of desensitizing drugs is recommended to prevent allergic complications.
The following methods of bicillin prophylaxis exist:
· year-round (with frequent relapses) for 2-3 years with an interval of drug administration of 3 weeks (in the first months the interval can be reduced to 2 weeks);
· seasonal (for 4 months, three seasons). The drug begins to be administered a month before the start of the morbidity season;
· one-course to prevent early relapses for 4-6 months after the illness.

Monitoring the patient's condition: carried out by KIZ doctors/general practitioners with the involvement of doctors of other specialties through medical examination.

The following are subject to medical examination:
· Group 1 - persons who experience frequent, at least 3 Last year, recurrence of erysipelas;
· Group 2 - persons with a pronounced seasonal nature of relapses;
· Group 3 - persons with prognostically unfavorable residual effects upon discharge from the hospital.

For 1st group:
· Regular, at least once every 3 months, medical examination of patients, which allows timely detection of deterioration of their condition, increase in lymphostasis, exacerbation of chronic concomitant skin diseases and foci of chronic streptococcal infection, which contribute 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. Preventive year-round (continuous) administration of Bicillin-5 for 2-3 years, 1.5 million units once every 3-4 weeks, intramuscularly (1 hour before the administration of Bicillin-5, antihistamines must be prescribed).
· Repeated physiotherapeutic treatment in the presence of persistent lymphostasis.
· Sanitation of foci of chronic ENT infection.
· Treatment of skin intertrigo, mycoses and other related skin diseases.
· Treatment in specialized medical institutions chronic vascular diseases, endocrine diseases.
· Employment of patients under unfavorable working conditions. Clinical observation of patients in this group is advisable for 2-3 years (in the absence of relapses). The maximum period of observation (3 years) is required for patients with particularly aggravated concomitant diseases (trophic ulcers, other skin defects, lymphorrhea, deep skin cracks with hyperkeratosis, papillomatosis, who have undergone operations for elephantiasis).

For group 2:
· Regular medical examination at least once every 6 months.
· Annual laboratory examination before the relapse season (clinical blood test, determination of C-reactive protein level).
· Preventive 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 the patient with a 3-week interval for 3-4 months annually 3 seasons.
· If there are appropriate indications - sanitation of foci of chronic ENT infections, treatment of concomitant chronic skin diseases, etc.

For the 3rd group:
· Medical examination 1-4 months later, if necessary, and 6 months after the illness.
· Laboratory examination at the beginning and end of clinical observation (clinical blood test, determination of C-reactive protein level).
· Physiotherapeutic treatment of prognostically unfavorable residual effects of 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 had erysipelas:
· preventing relapses of the disease, reducing their number;
· relief of edema syndrome, persistent lymphostasis, other residual effects and consequences of the disease.

Treatment (ambulance)

DIAGNOSIS AND TREATMENT AT THE EMERGENCY CARE STAGE

If possible outpatient treatment- transfer the asset to the clinic at the patient’s place of residence.

Hospitalization in a hospital according to indications.

Transport the patient by ambulance in a prone position, taking into account pain and signs of intoxication.
To reduce body temperature and relieve pain, administer 2.0 ml of a 50% analgin solution (can be combined with a 1% solution of diphenhydramine 2.0).

Treatment (inpatient)

INPATIENT TREATMENT**

Treatment tactics

Non-drug treatment

Bed rest- until the temperature normalizes, if the lower extremities are affected - during the entire period of the disease.
Diet No. 15 - complete, easily digestible food, drinking plenty of fluids. If there is a 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. IM, 10 days Reserve drug: Ceftriaxone 1.0 - 2.0g x 2 times/day, IM, IV, 7-10 days or cefazolin 2-4 g/day, IM, 7-10 days or cefuroxime 2.25-4.5 g/day in 3 doses IM, IV, 7-10 days or cefotaxime 2-8 g/day in 2-4 doses IV or IM, 7- 10 days.	Benzylpenicillin sodium salt 1,000,000 units x 6-8 times/day. IM, IV, 10 days + Ciprofloxacin 200 mg x 2 times/day. IV drip, 10 days ( single dose M.B. increased to 400 mg); or cefazolin 1.0 g 3-4 times a day, 10 days; ilaceftriaxone 2.0 - 4.0 g/day, IM, IV, 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 IV or IM, 10 days	Ceftriaxone 2.0 x 2 times/day, IM, IV, 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. IM, 10 days + Gentamicin sulfate 80 mg x 3 times a day IM, 10 days.	Benzylpenicillin sodium salt 1,000,000 units x6-8 times/day. IM, 10 days + Clindamycin 300 mg x 4 times a day. i/m, i/v (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 (macrolides, tetracyclines, sulfonamides and co-trimoxazole, rifimycins) is used.
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 - 2.0g x 2 times/day, IM, IV, 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, IV, IM, 10 days.
For frequently recurrent erysipelas, 2 courses of treatment:
1 course: cephalosporins (10 days), break 3-5 days,
2 course: bacteriostatic antibiotics (the drug of choice is antibiotics of the lincosamide series: 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 should be strictly controlled based on daily diuresis, the volume of fluid administered taking into account the degree of severity) :
With an average severity of the infectious process, patients should drink plenty of fluids at the rate of 20-40 ml/kg.
In case of severe infection, parenteral administration of isotonic (0.9% sodium chloride solution, 400; 0.5% dextrose solution, 400.0, etc.) and colloidal (meglumine sodium succinate, 400.0) solutions in a ratio of 3- 4:1 in a total volume of 1200-1500 ml for 3-5 days.

Nonsteroidal anti-inflammatory drugs(simultaneously with antibiotic therapy, taking into account contraindications, course 7-10 days):
· indomethacin 0.025 g 2-3 times a day, orally [UD - B];
or
Diclofenac 0.025 g 2-3 times a day, orally, for 5-7 days [UD - B];
or
nimesulide 0.1 g 2-3 times a day, orally, for 7-10 days [UD - B];
or
ibuprofen 0.2 g, 2-3 times a day, orally for 5-7 days [UD - B].

Desensitization therapy:
· mebhydrolin orally 0.1-0.2 g 1-2 times a day [UD - C];
or
hifenadine orally 0.025 g - 0.05 g 3-4 times a day [UD - D];
or
· chloropyramine orally 0.025 g 3-4 times a day [UD - C];
or
cetirizine orally 0.005-0.01 g 1 time per day, 5-7 days [UD-B];
or
Loratadine 0.01 g orally once a day [EL-B].

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

To improve microcirculation and rheological properties of blood, for antiplatelet purposes(taking into account coagulogram indicators):
· 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 IU/kg/day for 5-7 days [UD - A];
or
Warfarin 2.5-5 mg/day, orally;
or
· enoxaparin sodium 20-40 mg 1 time/day s.c.

Symptomatic therapy

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

List of essential medicines
· benzylpenicillin sodium salt, for intramuscular administration 1,000,000 units;
· or ceftriaxone, for injection for intramuscular and intravenous administration 1g.
· or ciprofloxacin, for infusion 0.2%, 200 mg/100 ml; 1% solution, 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, IV and IM administration, 750 mg, 1.5 g.
· or cefotaxime, IV and IM administration, 1.0 g.

List of additional medicines
sodium chloride 0.9% - 100, 200, 400 ml
· dextrose 5% - 400 ml;
meglumine succinate for infusion 400.0
· indomethacin 25 mg, orally [UD - B];
or
Diclofenac 25 mg, 100 mg, orally [UD - B];
or
nimesulide 100 mg orally [UD - B];
or
ibuprofen 200 mg, 400 mg, orally [UD - B];
or
· paracetamol 500 mg, orally [UD - B];
· mebhydrolin, 100 mg, orally [UD-S];
or
· quifenadine, 25 mg, orally [UD-D];
or
· chloropyramine 25 mg, orally [UD - C];
or
Loratadine 10 mg, orally [LE - B];
or
cetirizine 5-10 mg, orally [UD - B];
Prednisolone 5 mg, orally [UD - A];
· pentoxifylline 2% solution 100 mg/5 ml, 100 mg in 20-50 ml 0.9% sodium chloride, ampoules.
· heparin, 1 ml/5000 units, ampoules 1.0 ml, 5.0 ml, 5.0 ml each.
or
Warfarin 2.5 mg, orally;
or
· enoxaparin sodium 20-40 mg, syringes for subcutaneous injection.

Drug comparison table:

Class	INN	Advantages	Flaws	UD
Antibiotic, biosynthetic penicillins	benzylpenicillin sodium salt	Active against gram “+” cocci (streptococci)	Not resistant to beta-lactamases. Low activity for most grams "-" m/o.	A
Antibiotic, third generation cephalosporin	ceftriaxone	Active against gram “+”, gram “-” m/o. Resistant to beta-lactamase enzymes. Penetrates well into tissues and liquids. The half-life is 8-24 hours.	Low activity against anaerobic pathogens.	A
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 of Proteus spp., M. tuberculosis, anaerobic microorganisms	A
Antibiotic, II generation cephalosporin	cefuroxime	Has a bactericidal effect. Highly active against grams “+” and some grams “-” m/o.	Inactive regarding Clostridium difficile, pseudomonas spp., Campylobacter spp., Acinetobacter Calcoaceticus, Listeria monocytogenes, staphylococcus aureus, staphyloco strains resistant to methicillin CCUS EPIDERMIDIS, Legionella spp., Streptococcus (Enterococcus) Faecalis, Morganella Morganii, Proteus Vulgaris, Enterobacter spp. Citrobacter spp., Serratia spp., Bacteroides fragilis.	A
Antibiotic, III generation cephalosporin	cefotaxime	Antibiotic wide range actions. 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	Active against some grams “+”, grams “-” m/o. antipseudomonas drug	Moderate activity to Str.pn. If you suspect or have an infection caused by Pseudomonas aeruginosa	A
Antibiotic, aminoglycoside	gentamicin sulfate	Potentiates the effect of b-lactam antibiotics	Low activity against anaerobic pathogens. Oto-nephrotoxic effect	A
Antibiotic, lincosamide	clindamycin	Bacteriostatic, active against gram “+”, gram “-” m/o (Strept., Staph.)	Low activity to Clostridium sporogenes and Clostridium tertium	A
Antibiotic, lincosamide	lincomycin	Bacteriostatic, active against gram “+”, gram “-” m/o (Strept., Staph.), Corynebacteriumdiphtheriae, anaerobic bacteria Clostridium spp., Bacteroidesspp., Mycoplasmaspp.	Low activity to most gram-negative bacteria, fungi, viruses, protozoa.	A
Antihistamines	mebhydrolin	Antihistamine and antiallergic effect	Side effects: increased fatigue, dizziness, paresthesia; when using high doses - slower reactions, drowsiness, blurredness visual perception; rarely - dry mouth, nausea, heartburn, irritation of the gastric mucosa, pain in the epigastric region, vomiting, constipation, difficulty urinating. granulocytopenia, agranulocytosis.	WITH
	hifenadine	Antihistamine and antiallergic action.	Has a moderate antiserotonin effect.	D
	chloropyramine	It does not accumulate in the blood serum, therefore, even with prolonged use it does not cause an overdose. Due to its high antihistamine activity, a rapid therapeutic effect is observed.	Side effects - drowsiness, dizziness, inhibition of reactions, etc. - are present, although 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	Highly effective in the treatment of allergic diseases, does not cause addiction or drowsiness.	Occurrences 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, and does not have anticholinergic or antiserotonin effects.	Improper use of the drug can lead to dizziness, migraines, drowsiness, and allergic reactions.	IN
NSAIDs	indomethacin		Frequent development of adverse reactions. may lead to the development of aspirin-induced bronchial asthma	IN
	diclofenac	Strong pronounced 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 may develop: drop in pressure, disruption of heart rhythm, breathing, acute renal failure.	IN
	ibuprofen	Analgesic and antipyretic effects predominate	Increased risk of toxic amblyopia.	IN
	paracetamol	Mainly “central” analgesic and antipyretic effect	Hepatotoxic and nephrotoxic effects (with long-term use in large doses)	IN

Surgical intervention

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

For extensive weeping erosions:
· local treatment - manganese baths for the extremities, then applying a bandage with liquid antiseptics.

For purulent-necrotic complications of erysipelas:
· surgical treatment of the wound - excision of necrotic tissue, application of a bandage with liquid antiseptics.
Ointment dressings (ichthyol ointment, Vishnevsky balm, antibiotic ointments) are strictly contraindicated during the acute period of the disease.

Other treatments

Physiotherapy
Suberythemal doses of ultraviolet radiation to the area of inflammation and ultrasonic frequency currents to the area of regional lymph nodes (5-10 procedures);
A method of low-intensity laser therapy for anti-inflammatory purposes, to normalize microcirculation in the source of inflammation, restore the rheological properties of blood, enhance reparative processes from 2 to 12 sessions, at intervals of 1-2 days.

Indications for consultation with specialists:
· consultation with a surgeon: for differential diagnosis with abscess, phlegmon; at severe forms erysipelas (erythematous-bullous, bullous-hemorrhagic), surgical complications (phlegmon, necrosis);
· consultation with 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 with a resuscitator: determination of indications for transfer to the ICU;
· consultation with an endocrinologist: for concomitant diseases - diabetes, obesity.
· consultation with an otorhinolaryngologist: for diseases of the ENT organs;
· consultation with a clinical pharmacologist for correction and justification of therapy;
· consultation with a physiotherapist: to prescribe physiotherapy;
· consultation with an allergist for differential diagnosis with Quincke's edema.

Indications for transfer to the intensive care unit:
If complications develop:
· infectious-toxic encephalopathy;
· infectious-toxic shock;
· secondary pneumonia and sepsis (in persons suffering from immunodeficiency).

Indicators of treatment effectiveness:

Clinical indicators:

With primary erysipelas:

· relief of local inflammatory process;
· restoration of working capacity.
For 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;
· reducing 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;
- age of patients over 70 years of age, regardless of the degree of intoxication, the nature of the local process and its location;
- the course of erysipelas against the background of persistent lymph circulation disorders and diseases of the peripheral vessels 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 location;
- complications of erysipelas.

Information

Sources and literature

Minutes of meetings of the Joint Commission on the Quality of Medical Services of the Ministry of Health of the Republic of Kazakhstan, 2016
1. 1) Infectious diseases: national leadership/Ed. N.D. Yushchuka, 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. pp. 135–150. 3) Amireev S.A., Bekshin Zh.M., Muminov T.A. etc. Standard definitions of cases and algorithms of measures for infectious diseases. Practical Guide, 2nd edition, updated. - Almaty, 2014 - 638 p. 4) Erovichenkov A.A. Erysipelas. Streptococci and streptococcosis /Ed. IN AND. Pokrovsky, N.I. Brico, L.A. Ryapis. M., 2006. P.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. Briko. M., 2009. 196s. 6) Erysipelas, a large retrospective study of aetiology and clinical presentation/Anna Bläckberg, Kristina Trell, and Magnus Rasmussen. BMC Infectious Disease. 2015. 7) A systematic review of bacteremias in cellulitis and erysipelas/ Gunderson CG1, Martinello RA. Journal of Infection 2012 Feb.4. 8) Glukhov A.A. Modern approach to the complex treatment of erysipelas/Basic research.-No.10.-2014.P. 411-415.

Information

Abbreviations used in the protocol:

ITS	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
SRB	C-reactive protein
Ultrasound	ultrasonography
Ural Federal District	ultraviolet irradiation
ECG	electrocardiogram

List of developers:
1) Kosherova Bakhyt Nurgalievna - Doctor of Medical Sciences, Professor, RSE at the Karaganda State Medical University, Vice-Rector for Clinical Work and Continuing Professional Development, Chief Freelance Adult Infectious Diseases Specialist of the Ministry of Health of the Republic of Kazakhstan.
2) Kulzhanova Sholpan Adlgazyevna - Doctor of Medical Sciences, Astana Medical University JSC, head of the department of infectious diseases and epidemiology.
3) Kim Antonina Arkadyevna - Candidate of Medical Sciences, RSE at Karaganda State Medical University, Associate Professor, Head of the Department of Infectious Diseases and Dermatovenereology.
4) Mukovozova Lidiya Alekseevna - Doctor of Medical Sciences, RSE at the State Medical University of Semey, Professor of the Department of Neurology and Infectious Diseases.
5) Nurpeisova Aiman Zhenaevna - Municipal State Enterprise “Polyclinic No. 1” Health Department of the Kostanay region, head of the department, infectious disease doctor, chief freelance infectious disease specialist of the Kostanay region.
6) Khudaybergenova Mahira Seidualievna - JSC "National science Center oncology and transplantology", doctor - clinical pharmacologist.

Conflict of interest: absent.

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

Conditions for reviewing the protocol: review of the protocol 3 years after its publication and from the date of its entry into force or if new methods with a level of evidence are available.

Attached files

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Content

A common infectious disease of the mucous membranes and skin is called erysipelas (erysipelas). Both healthy carriers of infection and chronically ill individuals are sources of pathology, so disease is one of the most pressing problems for modern healthcare. The doctor decides how to treat erysipelas in each individual case, because this skin disease has many symptoms and forms, and therefore develops differently.

What is erysipelas

Erysipelas have been known to people since ancient times. Descriptions of skin pathology were found in the works of ancient Greek authors. The causative agent of the pathology, group A beta-hemolytic streptococcus, was isolated in 1882. Erysipelas is a skin infection characterized by symptoms of intoxication, fever, and the appearance of red foci of inflammation on the epidermis and mucous membranes. Complications of the disease are characterized by severe infectious lesions of soft tissues, which rapidly progress, accompanied by severe intoxication of the body.

Group A streptococci are not only the cause of erysipelas, but also other skin diseases (osteomyelitis, boils, cellulitis, abscesses). Bacteria penetrate the skin from the outside. Wounds, abrasions, abrasions, cracks or minor injuries are the gateway to streptococcal infection. The two main routes of infection for erysipelas are airborne and contact. The inflammatory process affects the dermis - the framework of the skin. The disease is localized on the mucous membranes, torso, arms, legs, face, perineum or scrotum.

What does a mug look like?

Women suffer from erysipelas more often than men. In 60% of cases, the disease develops in people over 40 years of age. What does the mug look like? First, a small red spot appears on the mucous membrane or skin. Within a few hours it turns into a clearly limited inflammation with jagged edges. The epidermis in the affected area is hot to the touch and moderately painful on palpation. Along with redness, it develops lymphedema, extending beyond the spot.

Next, blisters develop at the site of inflammation, which spontaneously burst after a certain time. Fluid leaks out of them, after which superficial wounds occur. If the blisters retain their integrity, they gradually dry out, forming brown or yellow crusts. Residual effects of erysipelas, which are observed for weeks and even months, are pigmentation, swelling of the skin, dry dense crusts in place of the blisters.

Treatment of erysipelas of the leg with medication

Erysipelas is usually treated with medication. Immunomodulatory and/or desensitizing therapy is carried out simultaneously with antibiotics. Since harmful microorganisms produce toxins during their life, they can cause allergies in the patient. To prevent the development of allergic reactions during the treatment of erysipelas, patients are prescribed antihistamines.

Often the pathology develops in the lower extremities. How to treat erysipelas on the leg? If the disease affects a limb, then the acute onset of the disease may occur only after a week. A person may suddenly develop symptoms of the disease such as muscle aches, migraines, high fever (up to 40°C), general weakness. Often the diagnosis is made without analysis based on a combination of visual signs. Treatment of erysipelas of the leg is carried out with medication, both inpatient and outpatient.

Antibiotics for erysipelas

According to statistics, erysipelas ranks fourth in the prevalence of infectious diseases. How to treat erysipelas? Antibiotics have been and remain the priority in the fight against infection. The course is calculated by the doctor, depending on the form of the disease and the antibacterial drug. Immediately after starting to take antibiotics for erysipelas, the development of infection decreases and body temperature returns to normal. To treat erysipelas, 1st or 2nd generation antibacterial agents are used - cephalosporins (Cedex, Suprax, Vertsef) and penicillins (Retarpen, Benzylpenicillin, Ospen).

Ointment for erysipelas of the leg

When treating erysipelas on the leg, which is at an early stage, pastes for external use are not used. When the form of the disease becomes cystic, then Ichthyol ointment or Vishnevsky is prescribed. Excellent results Naftalan gives the remedy during the recovery stage. Ichthyol ointment for erysipelas of the leg quickly helps get rid of itching, softens keratinization, and provides effective wound healing, provoking rapid skin regeneration.

The medicine has anti-inflammatory and antiseptic effects. For erysipelas, it is necessary to apply the product to the affected area, but not in its pure form, but in equal proportions with glycerin. The mixture is rubbed into a thin layer, then covered with gauze folded in 3-4 layers. The bandage is fixed with adhesive tape. It must be changed at least three times per day. The procedure is carried out until open wounds heal.

How to treat erysipelas with Vishnevsky ointment? The topical preparation is also called balsamic liniment. The product contains three components: xeroform, Birch tar and castor oil. Now the latter substance is often replaced fish oil. Vishnevsky ointment has a pronounced anti-inflammatory and antiseptic effect. During treatment skin pathologies it helps the epidermis to recover, accelerates the healing process, and has drying, antipruritic, and anesthetic properties.

In the absence of relapses, Vishnevsky ointment is prescribed for the treatment of erysipelas. The medicine promotes exudation and breakthrough of blisters. Apply the ointment to a gauze bandage in a thin layer, after which it should be applied to the affected area of the skin. The bandage is changed once every 12 hours. Since the drug can dilate blood vessels, doctors do not recommend using it for severe forms of erysipelas.

Treatment of erysipelas with folk remedies

During the initial period of erysipelas, as soon as bubbles begin to form, you can try to remove the infection with folk recipes, but after consultation with a specialist. Treatment of erysipelas of the leg at home is carried out with propolis or pork fat. These substances should be lubricated on the affected areas and another 2-5 cm of skin around them to stop the spread of the disease. Also, treatment of erysipelas with folk remedies includes the use of such remedies as:

Frogspawn. It has pronounced wound-healing and antimicrobial properties. During the breeding season of frogs in the spring, fresh eggs should be collected and dried on a clean cloth in the shade. To treat erysipelas, the dry substance must be soaked, put on a cloth, and applied as a compress at night. It is believed that the erysipelas will go away in 3 nights.
Kalanchoe juice. When treating erysipelas, the stems and leaves of the plant are used. They must be crushed until a homogeneous rare mass is formed, then squeeze out the juice. It is left to stand in the cold, filtered, and preserved with alcohol to a strength of 20%. To treat erysipelas, a napkin is moistened in Kalanchoe juice, diluted equally with a solution of novocaine (0.5%), then applied to the inflammation. In a week the symptoms will go away.
Plantain. The leaves of the plant should be finely chopped, mashed, then mixed with honey in a 1:1 ratio. Then you need to simmer the mixture over low heat for a couple of hours. During the treatment of erysipelas, apply a bandage to the inflamed area, changing it every 3-4 hours. Use the product until recovery.
Burdock. You need to pick fresh leaves of the plant, rinse in water room temperature, grease with fresh homemade sour cream, apply to the wound, bandage. The compress, regardless of the degree of intoxication, should be changed 2-3 times a day.

Prevention of erysipelas

Treatment of erysipelas becomes difficult if the patient has a disease such as diabetes mellitus, in which the death of small blood vessels, impaired circulation of lymph and blood. You can avoid getting and developing an infection if you adhere to the rules of personal hygiene, especially when treating skin pathologies. Prevention of erysipelas includes:

Timely treatment of foci of inflammation. When spread through the bloodstream, bacteria can weaken the immune system and cause erysipelas.
Shower frequently. It is recommended to apply a contrast douche at least once a day with a large temperature difference.
Use shower gel or soap with a pH of at least 7. It is advisable that the product also contains lactic acid. It will create a protective layer on the skin that is harmful to pathogenic bacteria and fungi.
Avoid diaper rash. If the skin in the folds is constantly damp, you need to use baby powder.

Photo of erysipelas on the leg

Content

The disease erysipelas owes its name to the French word rouge (red), because it is characterized by severe redness of the skin, swelling, pain, and fever. The source of inflammation quickly grows, suppuration begins, pain and burning intensify. Why does erysipelatous inflammation of the skin and mucous membrane occur? Find out about the etiology of this disease, methods of its treatment, and possible complications.

Causes of the disease

The root cause of the disease (ICD-10 code) is infection with the most dangerous looking streptococcal family of bacteria - beta-hemolytic streptococcus group A. It occurs upon contact with a patient or carrier of this infection, through dirty hands, by airborne droplets. Whether inflammation is contagious or not depends on the general condition (immunity), contact and other factors. Contribute to the penetration and development of infection and skin damage:

abrasions, cuts;
bedsores;
injection sites;
bites;
chickenpox (ulcers);
herpes;
shingles;
psoriasis;
dermatitis;
eczema;
chemical irritation;
boils;
folliculitis;
scarring.

The risk of infection increases in people with thrombophlebitis, varicose veins, lymphovenous insufficiency, fungal infections, constantly wearing rubber clothes and shoes, and bedridden patients. Complications after ENT diseases and immunosuppressive factors contribute to the penetration and development of infection:

taking certain medications;
chemotherapy;
endocrine diseases;
cirrhosis of the liver;
atherosclerosis;
AIDS;
anemia;
smoking;
oncology;
addiction;
exhaustion;
alcoholism.

In what areas does it develop most often?

Erysipelas is a local inflammation affecting individual areas of the skin. The following parts of the body are most susceptible to outbreaks:

Legs. Inflammation occurs as a result of infection with streptococci through skin damage from calluses, fungus, and injuries. Development is facilitated by impaired lymph flow and blood circulation caused by thrombophlebitis, atherosclerosis, and varicose veins. Bacteria, having entered the body through skin lesions, begin to multiply in the lymphatic vessels of the lower leg.
Hands. This part of the body in women is susceptible to erysipelas due to stagnation of lymph after mastectomy. The skin of the hands becomes infected at the injection sites.
Face and head. Erysipelas as a complication is possible during and after ENT diseases. For example, the ear (pinna), neck and head become inflamed with otitis media. Streptococcal conjunctivitis provokes the development of inflammation around the eye sockets, and sinus infections cause the formation of a characteristic butterfly-shaped erysipelas (nose and cheeks).
Torso. Here skin inflammation occurs in the area surgical sutures when a streptococcal infection is introduced into them. In newborns - the umbilical opening. Possible manifestations of skin lesions with herpes and herpes zoster, in areas of bedsores.
Genitals. Appears in the area of the female labia majora, scrotum in men, develops in the area anus, perineum, in places of diaper rash, scratching, skin abrasions.

Characteristic signs and symptoms

Skin inflammation begins with sudden increase temperature (up to 39-40 degrees!) and severe chills shaking the body. The fever lasts about a week, is accompanied by clouding of consciousness, delirium, convulsions, severe weakness, muscle pain, dizziness. These signs are characteristic of the first wave of intoxication. 10-15 hours after infection, bright redness of the skin occurs, caused by vasodilation under the influence of staphylococcal toxins. After one or two weeks, the intensity weakens and the skin begins to peel off.

The source of infection is limited to a noticeable ridge (thickening of the skin), has uneven edges, and grows quickly. The skin begins to become shiny, the patient experiences severe burning and pain at the site of the lesion. The complicated form of erysipelas is characterized by:

blisters with pus;
hemorrhages;
bubbles with transparent contents.

Which doctor should I contact?

Diagnosis of the disease is not difficult. The symptoms of inflammation are so obvious that a correct diagnosis can be made based on the clinical picture. Which doctor treats erysipelas of the skin? The initial examination is carried out by a dermatologist. Based on the survey and identifying visual signs of erysipelas of the skin, the doctor makes a preliminary diagnosis and prescribes a general blood test. If necessary, the patient is referred to a therapist, infectious disease specialist, immunologist, surgeon, and bacteriological diagnostic methods are used.

How and with what to treat erysipelas

Antibacterial therapy is prescribed to destroy the pathogen. To eliminate skin damage caused by inflammation, physiotherapeutic methods are used, in complicated cases - chemotherapy and surgical treatment. Facilities traditional medicine, which have an antiseptic, anti-inflammatory, calming effect, are used as an additional healing effect for the regeneration of damaged skin tissue and restoration of immunity after treatment.

Drug therapy

The basis for the treatment of erysipelas, like other infectious diseases, is antibiotic therapy. These drugs (along with other antibacterial agents) destroy the pathogen, stopping the development of inflammation, stopping destructive processes in tissues. In addition to them, antihistamines are prescribed to help the body fight allergies to streptococcal toxins.

Antibiotics

Treatment with antibiotics is prescribed according to a specific scheme, which takes into account the mechanism of action of a group of drugs and the method of administration of the drug:

Benzylpenicillin. Intramuscular, subcutaneous injections for a course of seven to thirty days.
Phenoxymethylpenicillin. Syrup, tablets - six times a day, 0.2 grams, for a course of five to ten days.
Bicillin-5. Intramuscular monthly injections for two to three years for prevention.
Doxycycline. 100 mg tablets twice daily.
Levomycetin. Tablets 250-500 mg three to four times a day, for a course of one to two weeks.
Erythromycin. Tablets of 0.25 g four to five times a day.

Antihistamines

Medicines with antihistamine (antiallergic, desensitizing) action to prevent relapses are prescribed in tablet form. A course of therapy, lasting seven to ten days, is aimed at relieving swelling and resolving the infiltrate in areas of the skin affected by streptococcus. Prescribed medications:

Diazolin;
Suprastin;
Diphenhydramine;
Tavegil.

Local treatment: powders and ointments

When treating an area of skin affected by inflammation, local external treatment is effective, for which antiseptic, anti-inflammatory, analgesic, and wound-healing medications are used. Dry powders are made from crushed tablets, healing solutions, use ready-made aerosols, ointment (except for syntomycin, ichthyol, Vishnevsky!):

Dimexide. Gauze folded in six layers is saturated with 50% medicinal solution, apply for two hours to the inflamed area, capturing part of the healthy skin around it. Applications are carried out twice a day.
Enteroseptol. Tablets crushed into powder are used for powders - twice a day, on a dry and clean surface.
Furacilin. Bandages with the solution are applied to areas of skin inflammation as compresses and left for three hours. The procedure is carried out in the morning and before bedtime.
Oxycyclosol aerosol. The areas of inflammation are treated with the drug twice a day.

Nonsteroidal anti-inflammatory drugs

This group of drugs is prescribed in addition to antibacterial therapy in order to relieve manifestations accompanying skin inflammation (fever, pain, etc.) with persistent infiltration. In drug therapeutic treatment, NSAIDs are used such as:

Chlotazol;
Butadion;
Ortofen;
Ibuprofen;
Aspirin;
Analgin;
Reopirin and others.

Chemotherapy for severe forms of the disease

In complicated cases, the course of treatment is supplemented with sulfonamides, which slow down the growth and reproduction of bacteria, glucocorticoids (steroid hormones), immunomodulatory drugs, nitrofurans, multivitamins, thymus preparations, proteolytic enzymes:

Taktivin;
Dekaris;
Biseptol;
Streptocide;
Furazolidone;
Furadonin;
Prednisolone;
Methyluracil;
Pentoxyl;
Ascorutin;
Ascorbic acid.

Physiotherapy

The purpose of this type of care for patients with erysipelas is to eliminate the manifestations associated with skin inflammation (swelling, soreness, allergic reaction), will improve blood circulation, activate lymph flow:

Ultraviolet treatment (UVR) of the site of inflammation. A course consisting of 2-12 sessions is prescribed from the first days of treatment of inflammation, combined with taking antibiotics.
Magnetic therapy. Wave exposure high frequency area of the adrenal glands stimulates the release of steroid hormones, reduces swelling, relieves pain, and reduces allergic reactions. Assigned at the beginning complex treatment, includes no more than seven procedures.
Electrophoresis. Includes 7-10 procedures, prescribed a week after the start of treatment, reduces infiltration.
UHF course (5-10 sessions) is aimed at warming tissues and improving their blood supply. Prescribed a week after the start of treatment.
Laser treatment is used during the recovery phase. Infrared irradiation heals formed ulcers, improves blood circulation and tissue nutrition, eliminates swelling, and activates protective processes.
Paraffin treatment is carried out in the form of local applications. Prescribed 5-7 days from the onset of the disease, promotes better nutrition tissues, eliminating residual effects.

Surgical intervention

This type of treatment for erysipelas is indicated for its purulent forms and purulent-necrotic complications, the occurrence of phlegmon, abscesses. The surgical intervention is carried out in several stages:

opening of an abscess;
emptying its contents;
drainage;
autodermoplasty.

Folk remedies for treatment at home

Treatment of erysipelas of the leg and other parts of the body is effective only with the use of antibacterial medications, and before the discovery of antibiotics it was fought with spells and traditional medicine. Some are really effective, helping to cure erysipelas, as they have an antiseptic effect and relieve inflammation:

Wash the inflamed areas with a decoction of chamomile and coltsfoot (1:1). Prepare it from a spoon of the mixture and a glass of boiling water, heat it in a steam bath, leave for 10 minutes.
Lubricate damaged skin with a mixture of rosehip oil and Kalanchoe juice. The product is used at the healing stage, when the skin begins to peel off.
Rozhu and others skin diseases on the face and genitals is treated with a decoction of calendula or string.
Lubricate with cream made from natural sour cream and fresh mashed burdock leaf (morning and evening).
Make lotions with alcohol tincture of eucalyptus (two to three times a day).

Possible complications and consequences

The disease is dangerous not only due to possible relapses and repeated manifestations. At untimely treatment the infection can spread to internal organs, cause sepsis, and have consequences such as:

gangrene;
thrombophlebitis;
lymphadenitis;
trophic ulcer;
elephantiasis;
skin necrosis.

Video

Do you want to learn about the mechanism of occurrence and development of acute erysipelas of the skin? Watch the story of the program “Doctor and...” below. Using a real-life example, the presenters consider possible reasons diseases, methods of its treatment (medication, physiotherapy), possible complications, relapses. Doctors comment on the situation: dermatologist, phlebologist, infectious disease specialist.

Erysipelas (erysipelas) is an infectious-allergic disease that affects the mucous membranes, subcutaneous fat layer, and skin. It is caused by beta-hemolytic streptococcus, which is why it often recurs. A contagious infectious disease is accompanied by bright red swelling of the affected tissues, intoxication, fever, and high temperature. With improper or delayed treatment, erysipelas is complicated by an abscess, secondary pneumonia, purulent inflammation fiber (phlegmon).

Erysipelas disease - what is it?

Infectious pathology is provoked by pyogenic streptococcus, which affects:

mucous membranes;
skin;
subcutaneous fat tissue.

Erysipelas is popularly called erysipelas. The incubation period ranges from 5-6 hours to 5 days.

What does the lesion look like:

erythematous (red) spots form on the skin;
infected tissues swell;
Serous-hemorrhagic foci with vesicles are formed.

In terms of prevalence, erysipelas ranks fourth among other infectious pathologies.

Causes leading to erysipelas

Streptococcus pyogenes is the causative agent of erysipelas, which is classified as an opportunistic microorganism. It is a representative of the normal microflora of the hypopharynx and skin of more than 75% of people. The main source of infection is a carrier of pyogenic streptococci or a person with erysipelas.

Pathogenic microorganisms are transmitted by contact and aerosol, that is, by airborne droplets. The risk of erysipelas entering the body increases when the integrity of the skin is damaged. The entry gates for Streptococcus pyogenes are:

scratches;
abrasions;
ulcerations on the mucous membranes;
microcracks on the genitals, etc.

With proper timely treatment, erysipelas ends in complete recovery. But with complications, the prognosis is not so optimistic. The disease occurs when the immune defense is severely weakened. Provocateurs of erysipelas include:

vitamin deficiency;
chronic tonsillitis;
rheumatism;
scarlet fever;
myocarditis;
hypovitaminosis;
glomerulonephritis.

Streptococci secrete toxic substances (pyrogenic exotoxins, streptolysin) that destroy body cells. They increase vascular permeability, so severe swelling occurs in the affected areas.

Who is more susceptible to the disease?

The incidence of erysipelas is on average 20 cases per 10 thousand population. Women get sick much more often than men, which is associated with hormonal instability, consumption contraception. In 30% of cases, the pathology is caused by impaired lymph flow and blood flow in the lower extremities.

The risk group includes:

women after 55-60 years;
newborns with an umbilical wound;
those suffering from chronic diseases;
people with the third blood group.

Much more often, erysipelas occurs in people with varicose veins, pathologies of the ENT organs - tonsillitis, sinusitis, chronic rhinitis. Erysipelas enters the body through postoperative wounds, post-traumatic scars, etc.

Classification and symptoms of erysipelas

Modern clinical classification includes various shapes erysipelas, depending on the location, extent of the lesions, the nature of local manifestations, etc. According to the frequency of flow, the following types of erysipelas are distinguished:

primary – appears for the first time, affects mainly the skin of the face;
repeated – occurs 2-3 years after the initial infection, but with a different localization;
recurrent - the infection worsens every 3-4 months, sometimes more often.

Depending on the location, erysipelas can appear on the face, legs, back, and arms. In adults, the first two types of pathology are more common.

You can become infected with hemolytic strepococcus directly from a patient (erysipelas, scarlet fever, tonsillitis) or from a carrier of the infection. At the slightest damage to the skin, it is better to limit contact with carriers of streptococcal infection, since the disease is transmitted by contact. However, infection can also occur through microcracks, injections and insect bites that are scratched.

The nature local symptoms The following forms of erysipelas are distinguished:

Erythematous form. Begin with severe itching, redness and pain in infected tissues. The first signs appear within 5-6 hours after streptococcus penetrates the skin. A day later, a spot with uneven edges forms in the lesion. Because of severe redness and edema, pain and a feeling of fullness worsen. The patient feels unwell, fever, and weakness in the body. In the acute period, enlargement of the lymph nodes, which are located next to the focus of erysipelas, is possible.
Erythematous-bullous. Bubbles containing clear (serous) liquid appear on the skin and mucous membranes. The bullous form is characterized by ulceration of tissue against the background of the opening of vesicles. There are also symptoms of fever and lymphadenitis, that is, inflammation of the lymph nodes.
Erythematous-hemorrhagic. It is most often diagnosed in women over 50 years of age. Erysipelas often affects the perineal area, face and legs. Hemorrhages occur at the site of erythematous spots, which is associated with damage to the superficial vessels. The hemorrhagic form is characterized by prolonged fever (up to 14 days).
Bullous-hemorrhagic. The most severe form of erysipelas, in which vesicles with serous-bloody contents form in the lesions. When the cheeks become infected, areas of necrosis form. Because of this, noticeable scars and scars remain, which for a long time do not dissolve.

Erysipelas goes through four stages: redness, blistering, ulceration, and wound healing. The likelihood of complications depends on the severity:

Easy. Erythematous rashes are limited to small areas of skin, symptoms of intoxication are mild. A febrile state with subfebrile temperature (up to 38°C) lasts no more than 3 days.
Average. The fever lasts up to 5 days, and the temperature rises to 40°C. Other manifestations of erysipelas are pronounced: weakness, vomiting, headache. The lesions are represented by bullous-hemorrhagic or erythematous-bullous rashes.
Heavy. Intoxication is severe, which can cause loss of consciousness. High temperature lasts more than 5 days. In areas of tissue infection, complications arise - phlegmon, gangrenous changes.

If the focus extends beyond the anatomical zone, erysipelas is considered widespread (diffuse). They also distinguish a migratory form of erysipelas, in which inflammation subsides in one part of the body and worsens in another part of the body. The most dangerous is metastatic erysipelas. It is characterized by simultaneous damage to tissues distant from each other.

Possible complications

Hemolytic streptococcus provokes inflammation of damaged blood vessels and tissues. In this regard, erysipelas becomes more complicated:

purulent pustules;
phlebitis;
secondary pneumonia;
sepsis.

The recurrent form is accompanied by stagnation of lymph, which causes lymphedema. Possible consequences of erysipelas also include phlegmon, persistent skin pigmentation, hyperkeratosis (thickening of the outer layer of the epidermis), eczema. If left untreated, erysipelas leads to gangrenous changes in the skin and mucous membranes.

Diagnosis of erysipelas

At the first symptoms of erysipelas, contact a dermatologist or infectious disease specialist. The doctor pays attention to the acute onset of the pathology, intoxication, severe swelling, tissue redness, and regional lymphadenitis. To determine the causative agent of infection, the following is carried out:

PCR diagnostics;
blood chemistry;
general urine analysis.

The presence of beta-hemolytic streptococcus is indicated by a decrease in the level of antistreptococcal antibodies. Erysipelas should be distinguished from anthrax, scleroderma, dermatitis, Lyme disease, thrombophlebitis, lupus erythematosus.

How is erysipelas treated?

The first manifestations of erysipelas are a good reason to consult a doctor. In 73% of cases, the pathology is treated on an outpatient basis. In case of severe pathology, purulent-necrotic complications, patients are admitted to the hospital.

The therapeutic course for the treatment of erysipelas usually lasts from a week to ten days, and patients are recommended to be hospitalized in order to avoid consequences of varying severity and significant deterioration in well-being.

Specific therapy involves taking systemic antibiotics. In the bullous form, physiotherapeutic treatment is prescribed with the opening of the blisters and local treatment of wounds with antiseptics.

How to treat erysipelas with antibiotics

Treatment of erysipelas is carried out with antibiotics from the group of fluoroquinolones, macrolides, tetracyclines, penicillins, cephalosporins. The following medications are used to kill streptococcal infections:

Erythromycin;
Doxycycline;
Ciprofloxacin;
Benzylpenicillin;
Levomycetin;
Sulfadiazine;
Azithromycin.

For frequent relapses of erysipelas, antibiotics of two different groups are used simultaneously. Bullous erysipelas is treated with beta-lactams and lincosamides, which include Lincomycin, Clindamycin, Dalacin, etc. The course of antibacterial therapy ranges from 5 to 10 days.

Medicines to relieve symptoms

The pathology is accompanied by severe pain, nausea, itching, malaise, and fever. To relieve the main manifestations of erysipelas, the following are used:

antiallergic medications (Diazolin, Zyrtec) – reduce swelling, itching and burning;
nitrofuran antibiotics (Furadonin, Furazolidone) – inhibit the proliferation of streptococci, destroy their membrane membranes;
glucocorticosteroids (Betamethasone, Prednisolone) – eliminate swelling, normalize the outflow of lymph from the lesions;
proteolytic enzymes (Hyaluronidase, Trypsin) - improve tissue nutrition, resolve infiltrates.

Also, treatment of erysipelas involves taking biostimulants that accelerate tissue healing - Pentoxyl, Methyluracil, etc.

Treatment of the skin around the lesion

To prevent the spread of streptococcal infection, topical antimicrobial drugs are used. To treat the skin of the face and body during erysipelas, the following are used:

Enteroseptol;
Oxycyclosol;
Dimexide;
Microcide;
Furacilin.

Sterile gauze soaked in antiseptic is applied to the lesion so that the edges of the bandage cover 2 cm of healthy skin. The procedure is performed twice a day for 1.5-2 hours. Erysipelas on the legs and back are treated with a powder of crushed Enteroseptol tablets. If the lesion occupies more than 20 cm 2 of skin, use Oxycyclosol spray.

Local hygiene

During the period of exacerbation of erysipelas, the patient does not pose a danger to others. But to prevent the spread of infection, he must:

Change underwear and bed linen once a day;
wear clothes only made from natural fabrics;
take a shower every day without using washcloths;
wash the area of inflammation with a decoction of coltsfoot three times a day;
at the healing stage, treat ulcerations with Kalanchoe juice.

It is not advisable to wet damaged tissues with water until they are completely healed. If the erysipelas infection is localized in the groin area, wash the skin twice a day with a decoction of calendula.

Physiotherapy

The principles of physiotherapeutic treatment are determined by the stage of the disease. To combat erysipelas and local manifestations, the following are used:

UVR – irradiation of blood with ultraviolet light. It is used at the first signs of erysipelas to reduce inflammation, fever, intoxication, and swelling.
Magnetotherapy is irradiation of the adrenal glands with electromagnetic radiation. Accelerates the production of steroid hormones that eliminate inflammation.
Electrophoresis with Ronidase - introduction into the body medicinal product through electric current. Stimulates the outflow of lymph from the affected areas, reduces swelling.
UHF – tissue heating electromagnetic waves ultra high frequency. Prescribed on the 7th day of illness to improve blood circulation in superficial tissues.
Infrared therapy – exposure of the skin to an infrared laser. Stimulates local blood circulation, increases activity immune cells.

At the healing stage, paraffin applications are used. They eliminate residual effects and prevent the exacerbation of inflammation.

How to boost your immunity

The dermatological disease erysipelas is prone to recurrence. The speed of recovery and the risk of re-infection of tissues depends on the patient’s immune status.

To prevent the proliferation of streptococci, you must:

Identify and eliminate foci of low-grade inflammation. Antibacterial therapy is carried out for chronic tonsillitis, rhinorrhea, and sinusitis.
Restore intestinal microflora. It is recommended to take medications with lactobacilli and include fermented milk products in the diet.
Stimulate the activity of immune cells. To strengthen the immune system, take dietary supplements with echinacea and rhodiola rosea.

To restore strength, you need to normalize your sleep and wakefulness patterns. At least 8 hours a day are allocated for rest.

How to get rid of erysipelas using folk remedies

Alternative medicine stimulates tissue healing and inhibits the proliferation of streptococcus pyogenes. The following recipes are used to combat erysipelas:

Beans. The dried fruits are ground in a meat grinder. The powder is sprinkled onto weeping wounds on the body 2 times a day.
A mixture of herbs. Celery juice and chamomile infusion are mixed in equal proportions. 1 tsp. liquid is poured into 15 ml of melted butter. Leave the product in the refrigerator until completely hardened. The ointment is used to treat wounds with severe pain.
Celery. A bunch of greens are crushed in a blender. The pasty mass is wrapped in gauze and applied to the lesion for 1 hour. Perform the procedure twice a day.

It is not advisable to use folk remedies for purulent and hemorrhagic complications.

Treatment prognosis and prevention of erysipelas

Erysipelas with adequate antibacterial therapy ends in complete recovery. The prognosis worsens with weakened immunity - hypovitaminosis, HIV infection, chronic pathologies. Mortality from complications (gangrene, phlegmon, sepsis) does not exceed 4.5-5%.

To prevent recurrences of erysipelas, you must:

maintain personal hygiene;
avoid diaper rash;
avoid trophic ulcers;
wear loose clothing;
use shower gels with a pH of up to 7.

Personal prevention consists of timely disinfection of damaged mucous membranes and skin. Compliance with the rules of antiseptics when treating abrasions, eliminating foci of low-grade inflammation in the body prevents exacerbation of erysipelas.