Purulent inflammation of the skin and subcutaneous tissues, such as boils, carbuncles, cellulitis, acute lymphangitis and abscesses, are common.
Boils are acute purulent inflammation of individual hair follicles or cortical glands, often spreading to subcutaneous tissues.
1. Etiology.
Causing bacteria: Commonly staphylococcus.
2. Causes: They occur on parts of the body that are often rubbed, such as the neck, back, armpits, buttocks, etc. Diabetes, kidney disease and people with poor health are prone to occur.
3.Diagnostic points.
(1) A small pustule appears at the root of the hair at the beginning, and a few hours later there is a deep red swelling, fever and pain around it.
(2) After 2-4 days, the swelling protrudes significantly and a grayish-white pus head is formed in the center. 6-7 days later, the necrotic tissue in the center falls off, the pus is discharged, and the swelling and pain are reduced.
(3) Boils on the face often cause severe swelling, fever, pain and various degrees of systemic symptoms such as high fever, rapid pulse, shortness of breath, mental irritability, loss of appetite and increased white blood cells.
4.Treatment.
(1) Do not squeeze the needle to pick.
(2) The initial local cold compress can be used, and when the swelling is obvious, the hot compress is used instead.
(3) Systemic and local antibiotics.
(4) If you have diabetes, you must treat it at the same time.
Carbuncle is a multi-headed boil or a group of boils fused together.
1. Etiology: Same as boils.
2. Diagnostic points
(1) Local: Initially, it is a red, swollen, hard and painful area with many small pus heads. After spreading to the surrounding area, the central part of the carbuncle becomes necrotic and depressed downward, and there are still pus heads and redness around the depression. The periphery of the redness and swelling is hard and edematous, with no obvious boundary with normal tissue.
(2) Systemic symptoms: fever, chills, headache, fatigue, and anorexia are often present.
(3) Total white blood cell count increases, and the percentage of neutrophils increases.
3.Treatment.
(1) Non-surgical treatment is the same as that for boils.
(2) Incision and drainage: If the inflammation is limited and necrotic tissue is formed, the incision should be incised and drained at an early stage, and the incision can be used as “+” or “*”. Cross incision is more commonly used. The incision should be deep to the fascia and all pus compartments should be opened to make a single cavity for drainage.
Acute cellulitis is an acute inflammation of the subcutaneous tissue caused by purulent bacteria.
1. Etiology.
(1) Pathogenic bacteria: Streptococcus haemolyticus, Staphylococcus aureus, anaerobic or corrosive bacteria, etc.
(2) route of infection: bacteria can enter the subcutaneous tissue by tiny wounds, or infected by blood circulation. For example, poorly drained infected wounds, boils, carbuncles, etc. can cause cellulitis.
2. Diagnostic points.
(1) Local: Redness, swelling, heat and pain of the skin and subcutaneous tissues are significant. The inflammation area is not clearly demarcated from the normal tissue. In severe cases, extensive subcutaneous tissue necrosis may occur. Local lymph nodes are painful and enlarged.
(2) Systemic symptoms: obvious or not and bacterial virulence and the patient’s health condition. Usually there is fever, chills, fatigue, etc.
(3) Signs: There is obvious tenderness and sunken edema in the inflamed area. In later stages, there is skin blister formation, subcutaneous accumulation of dilute pus or necrosis. If the extremities or neck are involved, there is often dysfunction.
3.Treatment.
(1) Braking: the affected limb should be elevated to rest.
(2) Hot compress: moist hot compress is better.
(3) Incision and drainage: If abscess has formed, early incision and drainage should be performed. Cellulitis caused by poor wound drainage should be expanded as early as possible.
(4) Systemic treatment: increase nutrition and use antibiotics intravenously.
(4) Acute lymphangitis (dancunculosis)
1. Etiology.
(1) the causative agent: the same as cellulitis.
(2) Complications of trauma or other acute soft tissue infections, such as boils, infections of the hands and feet.
2. Diagnostic points.
(1) Site: Mostly occurs in the extremities, often with infected lesions, such as after trauma to the hands or feet.
(2) Superficial lymphangitis presents with obvious punctate, patchy or striated redness on the skin, and its proximal lymph nodes are often enlarged and painful to the touch.
(3) In deep lymphadenitis, in addition to puffiness of the skin and subcutaneous tissues, there may be hard cords on palpation.
(4) Systemic symptoms: the patient may have fever and fatigue.
3.Treatment.
(1) Remove the primary lesion or actively control the infected lesion.
(2) Local and systemic treatment: the same as cellulitis.
V. Acute abscess
The result of local purulent inflammatory changes can be healed or tissue necrosis and liquefaction into abscesses
1. Etiology.
(1) Acute purulent inflammatory lesions such as boils, cellulitis, osteomyelitis, can become abscesses.
(2) Complications of systemic septic infection, such as metastatic abscess due to sepsis.
2.Diagnostic points.
(1) Local: early with throbbing pain, fever, redness and swelling hardness. After abscess formation, shallow ones may have fluctuating sensation, and deep abscesses, if the tension is high or the wall of abscess is thick, the fluctuation is not obvious.
(2) Systemic symptoms: small abscesses may have no obvious systemic symptoms. Larger abscesses often have fever, chills, general malaise, loss of appetite, etc. Leukocytosis and the percentage of neutrophils is increased.
3.Treatment.
(1) Incision and drainage: once an abscess is formed, it should be incised and drained in time. Superficial abscesses are often discharged after incision of the skin or subcutaneous tissue. For deeper abscesses, the fascia should be incised, and all intervals should be opened by hand or vascular clamp into the abscess cavity so that the pus can flow freely. The incision should be large enough to facilitate drainage. The abscess cavity is filled with petroleum jelly gauze and then bandaged.
(2) Systemic treatment: see skin and subcutaneous infection.