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Furuncle

The furuncle is an acute purulent-necrotic inflammation of the hair follicle and surrounding connective tissue . The causative agent is staphylococcus . To the occurrence of boils predispose: pollution, scratching and skin abrasions, increased sweating and sebum secretion of the skin, vitamin deficiency, metabolic diseases (diabetes).

boil photo
Fig. 6 and 7. Back neck furuncle

Symptoms Initially, a dense inflammatory infiltrate appears in the form of a bright red node, towering above the skin with a small cone. As the boil develops, infiltration, hyperemia, and peripheral edema increase. On the 3-4th day, a softening appears in the center of the infiltrate, which is opened with the release of a small amount of pus. In the place of the breakthrough, a necrotic tissue of a greenish color is revealed - the core of a boil (Fig. 6). After 2-3 days, together with pus and blood, the core is rejected with the formation of a deep moderately bleeding ulcer (Fig. 7). After 2-3 days, the ulcer heals, leaving a scar . The boil develops 8–10 days, rarely longer.

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A boil can develop on any part of the skin where hair is present. Most often the furuncle is localized on the skin of the neck, neck, face, back of the hands, lower back. Single boils usually do not cause a general reaction and do not give complications. In some cases, the development of boils is accompanied by fever and malaise. Sometimes the furuncle is complicated by furunculosis (see), lymphangitis (see), lymphadenitis (see), thrombophlebitis (see), phlegmon (see) or abscess (see). The most severe complications are observed with the localization of the boil on the face, especially on the upper lip, in the nasolabial triangle. Significant development of the venous and lymphatic network on the face predisposes to the so-called malignant course of the boil - the occurrence of thrombophlebitis of the facial veins, the spread of infection in the cranial cavity, which manifests itself in a serious condition, high fever, chills, severe headache, the occurrence of meningitis (see), septic syndrome , see. (see), sometimes fatal.

It is absolutely unacceptable to squeeze, pierce, cut off the top of the boil, as this may be the cause of these serious complications.

Treatment depends on the stage of the disease, localization and associated complications. Initially, before the appearance of pus, there is UV irradiation in erythemal doses (a full cure may occur in a day). In the stage of maturation of the boil, it is advisable to pierce the infiltrate with antibiotic solutions in novocaine (1–2 obkalyvaniya daily in compliance with the rules of asepsis); the use of pure ichthyol: a thick layer of ichthyol is applied to the skin and covered with a thin layer of cotton (1-2 times a day until the boil is opened), ichthyol is removed with warm water; apply crystalline salicylic sodium or salicylic acid (impose on the surface of the boil with a layer thickness of 0.5 cm, strengthen with a dry dressing); After 1-2 days, a necrotic rod forms in the center of the boil, which quickly rejects.

After opening the boil, the wound is carefully treated with hydrogen peroxide , furacilin - 1: 5000 or ethacridine ( rivanol ) - 1: 1000 and a dressing is applied with a hypertonic solution of sodium chloride. Ligation produced daily until complete cleansing of the wound . Removal of the rod with tweezers is allowed only after it is separated from the surrounding infiltrate - early removal, rupture of the rod leads to an exacerbation of purulent infection. With the same purpose during dressings it is recommended to lubricate healthy skin around the boil with 70% alcohol or camphor alcohol, brilliant green, methylene blue. Wipe the skin from the periphery to the center. Apply ointment dressings to a clean wound surface (5% syntomycin emulsion , 1% furacilin, 5% streptocidal ointment, etc.). To reduce the duration of treatment, along with the indicated therapy, it is advisable to use physical therapy ( UHF , quartz, and Solux).

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Surgical treatment is rarely used, only in the case of the formation of an abscess (a significant abscess in the skin) with delayed rejection of the boil rod. An abscess is opened by piercing the skin with a pointed scalpel (analgesia with chloroethyl or local infiltration anesthesia); it is impossible to forcibly remove the rod; no tampons are required.

A patient with a boil on his face is hospitalized; shows strict bed rest, intramuscularly penicillin 300 000 E every 3 hours, it is forbidden to talk; food is only liquid.

Prevention of boils - see Pyoderma .

Furunkul (furunculus) is an acute purulent-necrotic inflammation of the hair follicle and the surrounding connective tissue, caused by the introduction of pathogenic staphylococci from the outside. Predisposing causes for the development of single boils are most often external factors: skin contamination, especially chemicals, coarse dust particles, combined with friction, excessive sweating and skin greasiness, as well as microtraumatism and, in particular, combing of the skin. This is due to the frequent complication of boils of itchy skin diseases. Frequent recurrences of single boils can be explained by skin sensitization to staphylococcal infection.

Histopathologically, necrosis of the hair follicle, sebaceous gland and connective tissue is noted in furuncles, around which a wide shaft of neutrophils and macrophages is formed. In the surrounding connective tissue of the dermis - swelling and expansion of the blood and lymphatic vessels.

Clinic The beginning of the furuncle is ostiofollikulit, or a small nodule in the thickness of the dermis. After 1-2 days, a painful inflammatory infiltrate forms in the dermis in the form of an unsharply delimited node that quickly grows and reaches the size of a hazelnut. The skin over the infiltrate is colored crimson-red. On the 3-4th day, a slight fluctuation is found in the center of the node and a pustule forms at its apex. Soon the boil is opened and a small amount of pus is secreted, after removal of which necrotic tissue of green color is revealed - the so-called necrotic core. In the following days, the amount of pus increases and along with it the necrotic rod subjected to demarcation is rejected. The resulting small bleeding ulcer is quickly filled with granulations and in 2–3 days heals with a small scar. Most often, boils are localized on the skin of the forearms, back of the hands, neck, face, lower back. Boils of the skin are usually accompanied by a sharp swelling. Single boils do not cause a general reaction and only in some patients are accompanied by fever and malaise. When localized on the extremities (rear of the hand, fingers), boils may be complicated by lymphangitis and lymphadenitis. The most severe complication observed with the localization of boils on the face (upper lip, nasolabial triangle) is the formation of the so-called malignant furuncle, characterized by the occurrence of purulent thrombophlebitis of the facial veins followed by the development of meningitis, sepsis or septicopyia with abscesses with the help of the absents of the patients who have an organization, the countries of the dismigrants of the dismigrants of the dismigrants of the dismigrants of the dismigrants of the dismigrants of the dismigrants of the dismigrants of health departments of the Ministry of Education and Discriminals of Artsists and Discriminals of Dissectors of Dissectors and Dissectors of Dissectors of Dissectors of Dissectors of Dissectors and Disorders of Dissets and Disorders of Dis Naisme disease will also have a good chance of getting rid of facial veins and other people who have abscesses.

Malignant boils most often develop as a result of squeezing, cutting off the initial elements with a razor, irrational treatment. Clinically malignant furuncle is characterized by increased infiltration and edema; affected veins are often felt in the form of dense cords. The general reaction is manifested by high temperature, leukocytosis, and accelerated ESR. The occurrence of sepsis is accompanied by fever of the remittent type, stupefaction, profuse sweats, dryness of the tongue. Staphylococcus is sown from blood. Until recently, a large percentage of malignant boils on the face ended in death. With the introduction of antibiotics into therapy with their timely use, mortality is excluded. Single boils can cause metastatic abscesses in various organs and tissues.

Treatment . Locally, pure ichthyol is most often used in the form of so-called ichthyol flat cakes (the surface of a boil is smeared with ichthyol and covered with a thin layer of cotton), applied once a day and removed by wetting with warm water. Ichthyol cakes are used before the boil is opened; after opening - ointment (1% syntomycin, 2% white mercury, etc.) or hypertonic salt solution in the form of stickers, strengthened with cleol. Circular dressings should not be applied due to possible dissemination. At the same time it is advisable to apply dry heat (heaters, UHF); this reduces the duration of treatment and reduces pain. Warming compresses are contraindicated. When changing labels, the skin around the furuncle is wiped with 2% salicylic or camphor alcohol. In some cases, radiotherapy is indicated (furuncles of the skin of the face, scalp, large folds). General treatment for uncomplicated single boils (except for boils of the face) is optional.

To speed up the resolution of boils, autohemotherapy, sulfa drugs, and antibiotics are recommended. With a complication of lymphangitis and lymphadenitis, antibiotics or sulfa drugs are indicated. For uncomplicated and especially complicated malignant boils of the face, urgent treatment with penicillin of 100,000 IU every 3 hours is necessary; at the same time designate sulfonamides. In case of single, but often recurring boils, it is recommended to conduct a course of immunotherapy (staphylococcal vaccine, especially autovaccine, toxoid, etc.) or autohemotherapy for the purpose of desensitization.

Surgical treatment of boils is rarely used - in cases of formation of a significant abscess in the skin, around the rod, with a delay in rejection of the latter. An abscess is opened by piercing its wall with a pointed scalpel. Local (infiltration) anesthesia or freezing with chloroethyl can be used. Attempts to forcibly remove a necrotic rod are unacceptable. The introduction of tampons is not required.

Prevention of boils - see Pyoderma.

See also Furunculosis.