What distinguishes the carbuncle from the boil, gidradenita, abscess and phlegmon: the difference, photo

August 12, 2017 15:31 | Carbuncle

Purulent skin and fatty tissue disorders of the dietary fiber more often( up to 90% of the case histories) are caused by infection with staphylococcus.About what is the difference between a boil and a carbuncle, what are the differences of the latter from hydradenitis, skin abscess, and phlegmon, we will tell you today.

Importance of delineation

Key factors contributing to the development of pathologies:

  • reduction of local tissue resistance to the introduction of pathogens;
  • decreased immunity;
  • hypothermia, the spread of microbial flora with blood from the sites of inflammation.

More often patients face such kinds of suppuration, as a furuncle, a carbuncle, an abscess, phlegmon, appearing at different depths, in different types of tissues.Competent diagnosis and differentiation( distinction) of purulent pathologies contributes to the rapid appointment of the correct therapy regimen.

Often there are difficulties in diagnosing hydradenitis, which is confused with the maturing carbuncle.Therefore

, it is necessary to distinguish between carbuncle and furuncle, abscess, phlegmon and hydradenitis.

Pro removal carbuncle and its features, see in this video:

What is different from a boil carbuncle

Let's start razbremsya as distinguished from the boil carbuncle.

What boil

Boils called acute abscess that occurs around the hair follicle of the sebaceous gland, which is the causative agent of the most harmful Staphylococcus aureus. Furuncles appear only on the hair growth sites.Outwardly, the furuncle looks like a large dense abscess, red and painful.If the boil is large, the inflamed tissue around it is hot to the touch.

Causes Boils - the introduction of pathogenic microbes in the place of damage - erosion, abrasion, cracks in the background:

  • poor hygiene, skin contamination;
  • reducing local skin defenses and general resistance;
  • deficiency of vitamins, hypothermia;
  • of diabetes mellitus, autoimmune diseases( lupus erythematosus, rheumatoid arthritis, herpes infections, hepatitis).

Looks like boils and carbuncles( photo)

Boils of caruncle

Development and symptoms

  • around hair bulbs formed pustules( bubble) with pus and inflammation spreads, captures the subcutaneous tissue, getting kind of thick convex, A painful node up to 20 mm.In the middle of the pimple is a rod of dead cells.
  • Skin blushes, getting bluish shade, becomes hot and painful, and swelling captures the tissues surrounding the boil.
  • From the opened spontaneously boil liquid pours pus and Mete furuncle formed ulcer with exposure of greenish-yellow necrotic rod that is extruded healthy tissue for 1 - 2 days.
  • Pain ceases almost immediately after the expiration of pus, swelling dissolves gradually.The cavity, where the rod was located, is filled with granulations( a young tissue) and gradually tightens with the formation of a scar.Healing lasts up to 7 - 10 days, with large boils - up to 3 weeks.

Dangerous disturbances in the patient's condition do not usually occur.Note:

  • slight pain, more often - "pulling" character;
  • small puffiness, the degree of redness of the skin reaches a dark red color( rarely - with a slight cyanosis).

If you produce large or multiple boils arise:

  • pulsating pain, especially strong - the external auditory canal, on the upper lip under his nose, on his neck, fingers, legs;
  • symptoms of poisoning with Staphylococcus toxins - temperature, headache, weakness.
  • with furuncles on the face, in the scrotum - a massive swelling of the tissue, lymph nodes, due to the friability of the fiber in these areas.

Complications

Large furuncles on the head, face, occiput, neck are often severe and can be complicated:

  • purulent inflammation of blood vessels( thrombophlebitis) - especially in patients with diabetes mellitus;
  • by ingesting pus in veins and brain tissue and developing basal meningitis( inflammation of brain tissue with CNS damage, fever above 40 C, facial swelling, stiffness of the occipital muscles);
  • general infection of blood - sepsis.
  • when a large number of boils - furunculosis - bacteria often enter the valves of the heart, joints, spine, bones, kidneys( bacteremia).

About treatment of furuncles and carbuncles let's go further.

Therapy

Phlegmon carbuncle Local( with one or a small number of ulcers):

  • alcohol( 70%) treatment of the skin over the abscess;Color solutions are not recommended because of burns and masking of the degree of inflammation;
  • application of salicylic acid in the form of powder, ointment 10% for softening the skin and ripening the head of the boil;
  • warm dry compresses( 15 minutes 4 times a day) - to relieve pain and ripening of the abscess head;
  • active ointments that accelerate the opening of the boil: Vishnevsky( liniment balsamic), Ichthyol, Bactroban, liniment synthomycin, Ilon, Ioddicerin;
  • ointments are antibacterial, cleansing, which are used after breakthrough of pus and wound treatment with hydrogen peroxide: Tetracycline, Gentamicin, Bactrian, Baneocin, Levomekol, Oxycort, Dimexid, Ioddicerin Levosin, Polcortolone.

General:

  • analgesic( analgesic) and inflammatory agents( paracetamol, Nice, Ketanol) with pronounced "jerking" of the furuncle;

For the prescription of a dermatologist:

  • antibacterial agents( in tablets and injectively);
  • short blockade with novocaine injections and antibiotics;
  • electrophoresis with antiseptics, UHF.

Surgical dissection of the boil is performed if medication is unsuccessful.At the dissection, pus and necrotic rod are removed, drainage is introduced to drain the remaining pus, applying bandages with NaCL solution and enzymes for complete cleansing and non-scarring tightening of the wound.

This video tells about the treatment of carbuncles and boils:

Carbuncle

Carbuncle is the union in a limited area of ​​several furuncles that merge around adjacent hair follicles and form a common infiltrate with necrosis of skin cells and fatty tissue.

Carbuncle usually grows with the drawing in the process of neighboring follicles and the spread of suppuration deep into the process.Inflammation occurs on the face, head, neck, buttocks, in the armpits.

Development and signs

For 4 - 5 days, a dark red convex seal is formed about 7-10 cm, extremely painful when palpated.After the formation of necrosis areas, the inflammatory focus acquires a dark blue-purple color.On the seal appear small holes, similar to the "sieve", out of which expires pus with the sugars and elements of dead cells.

After pouring out the main volume of pus, first separate ulcers are formed with a greenish-yellow necrotic stem, then they merge, forming a large ulceration with uneven edges, leaving into the thickness of the cellulose.

Recovery lasts up to 4 weeks, as rejection of a healthy stem tissue, filling the wound with a new connective tissue and scarring is slow enough.

Other than furunculous symptomatology

Furuncle and carbuncle

  • Skin tension in an inflamed area with a gloss effect;
  • more massive necrosis( necrosis) of tissues, due to violation of blood supply to cells in the carbuncle zone;
  • intense bursting pain;
  • seal has a more pronounced coloration( to blackness), the color of pus is greenish-gray;
  • is characterized by multi-chamber abscesses in adipose tissue, cutaneous pustules( pus with pus) and "honeycomb" - very small holes, from which the purulent liquid gradually swells;
  • strong intoxication, reaching fever, vomiting, impaired consciousness, severe insomnia.

In the diagnosis of carbuncle must necessarily differentiate with anthrax carbuncle, which is distinguished by the absence of pain and the emergence of a dense black scab from the dead tissue in the center.

Treatment of

Patients with carbuncle are treated in the hospital, where the following measures are carried out:

  • when the carbuncle is located on the neck, head, face - forbid talking and chewing solid foods;
  • enter bed rest.

For drug therapy, the following prescriptions are prescribed:

  • medications with antiplatelet action( preventing clotting of platelets and formation of blood clots);
  • means, softening the skin and helping tissues easier to tear off necrotic rods - Acriderm SK, Skinoren, Belosalik, Retasol;
  • medications to facilitate intoxication and excretion of poisons of pathogenic microbes - Polysorb MP, Zorex( allergen), Dyufalak, Agri, Legalon;
  • Locally - around inflammation - an injection blockade with antibiotics is used;
  • dressings with Vishnevsky ointment, shintomycin liniment, Dimexide solution( 20 - 30%);
  • UHF - to accelerate maturation of carbuncle and rejection of rods;
  • antibacterial drugs, mandatory for weakened patients, and also - when placing carbuncle on the face, complications, high temperature, strong increase in white blood cells, when using hormonal and cytotoxic drugs.

Schemes of antibiotic therapy:

Description Description of symptoms
Typical general and local( local) Manifestations of acute purulent inflammation with intoxication poisoning that emit pyogenic microbes:
severe general weakness;Abnormal fatigue, loss of appetite;Pallor of the skin and mucous membranes;Paroxysmal vomiting.
Specific symptoms of renal inflammation blunt, drawing back pain;Tremendous chills in the background of fever( up to 40 - 41C);Plentiful cold sweat, dripping with drops;Oliguria( pronounced decrease in the volume of urine);Lowering blood pressure.
Local( not always shown) muscle tension defenses with pressure on the peritoneum and waist;Pronounced soreness with a slight tapping of the lumbar region in the kidney( Pasternatsky's symptom);A noticeable increase and soreness of the organ during palpation.
Abdominal Manifestations simulating the totality of symptoms of the "acute abdomen":
sharp pains in the stomach and stomach( spilled and localized);Nausea and frequent vomiting;Gas retention, constipation;Tension of the peritoneum when attempting to palpate( feel);And also:
soreness and swelling of the lumbar tissues in the area of ​​the location of the kidney( late symptom);High level of leukocytes: 10 - 20x109 / l, but when a carbuncle occurs for the first time - in the early stage of the disease urine, as a rule, sterile;Piuria of the middle degree( the appearance of pus in the urine).
Gastrointestinal Signs that simulate the development of dysentery:
spastic and dull pain in the stomach and abdomen;Frequent stool with pain and irritation of the anus area, false desires;Nausea, vomiting;Presence of feces in feces.
Cardiovascular pathology clinic tachycardia or, conversely, bradycardia( decrease in the frequency of myocardial contractions);Decreased or increased blood pressure;Symptoms of an acute disorder of blood supply to the tissues of the heart muscle;Failure of right ventricular function;Disturbance in conduction of the myocardium;Swelling of the extremities.
Neuropsychomorphous symptomatology In patients with renal carbuncle the actual clinical picture is "erased", and the signs of psychoneurological disorders dominate:
excessive activity, excitation;Insomnia, delirium, hallucinations are possible;Abnormal excitation of the subcortical layers of the brain accompanied by tonic( prolonged muscle spasm) and clonic( cyclic spasm) convulsions;Symptoms of dysfunction of the central nervous system trunks In this complex case, only an analysis of an experienced specialist in diagnosis allows us to establish the true origin of neurological signs caused by severe intoxication with suppuration in the kidney.
Hepatopathy and nephropathy There are cases when local signs of carbuncle are poorly expressed, the composition of urine is almost unchanged, and in the foreground there are symptoms of severe liver damage:
acutely developing jaundice with severe yellowing of the skin, mucous membranes, sclera;Blunt pulling pain in the right hypochondrium;An increase in the organ and soreness when feeling;Nausea with urge to vomit;Signs of acute violations of the liver and kidneys.Such symptoms are observed in elderly people, weakened, more often with the presence of multiple carbuncles in the kidney, and also with their localization in both kidneys.
Erased symptoms Observe absence:
pain and hyperthermia( fever);Changes in the pattern of blood or changes not characteristic of acute suppuration;Changes in the composition of urine.The general symptoms of undiagnosed disorders predominate in the functioning of the organism and in the preceding diseases.
Atypical symptomatology often causes an incorrect diagnosis and treatment tactics.
Pulmonary Sometimes there is thromboembolism of the vessels of the brain and lungs - clogging of the lumen of the vessel with a clot of pathogenic bacteria.With incorrect diagnosis, the patient dies, and the carbuncle of the kidney is detected only at the autopsy.
  • As well as additional antibiotics acting on Staphylococcus aureus: Minocycline, Ciprofloxacin, Vancomycin( in severe cases - intravenously).
  • If drug treatment is ineffective, an operation is performed under general anesthesia, in which dead tissues impregnated with pus are completely excised.Further - hemostasis, drainage and treatment according to the scheme of treatment of purulent wounds.
abscess

Abscesses occur not only in the subcutaneous tissue, but in the muscle and bone tissue, internal organs and cavities between them, often - when foreign tissue penetrates into the tissues,Injections.

Abscess is an inflammation with accumulation of pus in a limited area, which is accompanied by cell death and purulent melting( destruction) of tissues. The peculiarity of the abscess is the formation of the so-called pyogenous granuloma from young cells and intensively expanded capillaries, which surrounds the purulent focus and limits it from healthy areas.

Development of

First a painful and hard knot with noticeable redness appears.After 4-7 days( acute form) or weeks( sluggish form) cells die, tissues are destroyed, and in the middle of the abscess a capsule with pus and elements of dead cells is formed.At this stage, when you feel the area of ​​the abscess, there is a fluctuation( sensation of movement of the tissue over the abscess).

Next - along the edges of the hearth, a red-pink pyogenous shell forms.Uncomplicated abscesses usually burst with outward outflow or into anatomical cavities of thick yellowish pus with an acid-sweet odor.Pus contained live white blood cells, but the microbes in it are completely destroyed.Cicatrization of the cavity takes 5 to 7 days, if the outflow of pus from the capsule is not difficult.

If the outflow of pus is disturbed, then, after the expiration of its main volume, a narrow channel is formed - a fistula that connects the purulent capsule with the place where there is an outlet for pus flow.

Signs of

Furuncle and carbuncle The main manifestations of the abscess coincide with typical symptoms of purulent inflammations: headache, fever( up to 41), chills, nausea, general weakness.

Visible edema, hyperemia over the abscess and fluctuation of the tissues over it are not determined if the abscess is located in the thickness of tissues or inside the organs.

Treatment

  1. More often, surgical intervention in the hospital is made, but small superficial suppuration is treated on an outpatient basis.
  2. If the abscess is formed in the liver, the lung is often punctured to remove pus from the capsule of the abscess( interventional sonography) and through the tube into the cleaned cavity of antibacterial solutions.
  3. In cases of extremely severe course, the organ is excised together with the abscess.
  4. After the capsule with pus is opened, the ulcer is also treated like an open carbuncle.Completely remove pus, applying bandages, impregnated with antibiotics and ointments for healing.
  5. In addition to local treatment, rational antibiotic therapy is used.

Hydraderitis or in common terminology - the bony udder - acute suppuration of the sweat glands located in the perineum, basins of the armpits, groin, around the nipples.Infectious agents( staphylococcus) through the lymphatic vessels or through skin erosions penetrate into the ducts of the sweat glands and actively multiply, which is facilitated by the abundant release of sweat and its alkaline environment.

Causes may also be violations in the metabolism of fats, the function of the gonads.

Development of and symptoms

In adipose tissue, painful pea-sized seals are formed, which are transformed into pear-shaped, tightly connected to the skin nodes of 30-40 mm.In the middle of the focus there is a softening of the tissue, accumulation of pus and the formation of a fistulous channel for the release of pus on the surface.But with hydradenitis there is no central necrotic stem, as in carbuncle.

Sometimes, several abscesses combine, creating a dense uneven formation with a lot of fistulas.Fused abscesses with hydradenitis resemble phlegmon, but unlike it - the surface of the skin above the purulent conglomerate is bumpy, similar to the nipples of the dog, where the name "bony udder" originated.The purulent masses that poured out during the rupture of hydradenite are thick, sometimes with an admixture of blood.

Recovery is long - up to 2 - 3 weeks, and in the case of the formation of bilateral abscesses - up to 2 - 4 months.With the "bough of the udder", when the abscesses "burst" in the thickness of the tissues, simultaneously there are new abscesses.

Symptoms:

  • inflammation in the form of tuberous painful nodes, similar to pears;
  • intense pain when pressed, moving, bursting - at rest;
  • red-cyanotic hot skin on the abscess site;
  • signs of poisoning with toxins - headaches, weakness, fever, increased ESR and leukocytes.

When diagnosed, the hydradenite is differentiated with phlegmon, lymphadenitis, sarcoma and tuberculosis of the lymph nodes, abscess, and lymphogranulomatosis. The difference is that the "bony udder" develops in the thickness of the tissues, and, for example, inflammation of the lymph nodes of different species - in adipose tissue.

Therapy

  1. The general treatment of hydradenitis is carried out using antibiotics( Doxycycline, Erythromycin).
  2. When the abscess ripens, the hair is removed from the site of inflammation and treated with antiseptics: iodine, ethyl alcohol( 96%), salicylic acid solution( 2%).With a major infiltration and intense pain, blockage of the focus is carried out by injecting antibiotics with novocaine 0.5-1%.
  3. The first 5 - 7 days impose fast drying bandages with alcohol( 50% solution).
  4. The use of ointments and compresses is contraindicated in order to avoid possible damage to the skin and increase inflammation.To mature the abscess, dry heat is successfully used: a heated towel, warming up with a "blue lamp"( 5 minutes), in summer - solar heating( 10 - 30 minutes).
  5. The ripe( softened) abscess is excised completely to healthy tissues.After removing pus and inflamed fiber.The usual opening of hydradenitis is not effective, because the abscess is a set of abscesses, which are at different stages of maturation.
  6. At the stage of infiltrate formation, UHF, UFO and CMV therapy, recommended at the stage of ripening, are often prescribed.

Difference between carbuncle and phlegmon

Furuncle and carbuncle in Phlegmon - diffuse acute suppuration of cellulose( subcutaneous, perineal, intermuscular, rectal, retroperitoneal), which extends actively to tissues, muscles, tendons and bones. The outline of phlegmon - unlike carbuncle - is not clear.The pyogenic shell, as with abscess, is also absent.

Phlegmon is purulent, putrefactive, gasy( anaerobic), which directly depends on the type of pathogen that has penetrated into the tissue - staphylococcus, Escherichia coli, anaerobic bacteria, streptococcus.The introduction of microbial flora comes from foci of inflammation of adjacent organs, through lesions on the skin, with blood from vessels from distant purulent foci.

Symptoms

Symptoms of phlegmon are similar to the development of any purulent-inflammatory process: fever, chills, thirst, soreness.

It is observed with phlegmon:

  1. Characteristic for diffuse form of inflammation - swift edema.
  2. Reddened skin redness in the shallow phlegmon area.

Development of and types

In the inflamed area, convex swelling( with subcutaneous phlegmon) rapidly builds up, the skin is red, hot, tense, glossy.When palpating, an immobile compaction is revealed - extremely painful without certain boundaries.As the suppuration is determined by softening in the place of compaction or the formation of a fistulous course with a deep deposition of the abscess.

  • With serous phlegmon, the fatty tissue resembles jelly, soaking with watery pus.
  • The putrefactive form is characterized by the development in the tissues of a multitude of necrosis zones with a large volume of fetid pus.
  • With a gas phlegmon, tissue suppuration with large areas of dead cells and the presence of many small gas bubbles are detected.
  • Chronic course occurs with the development of foci of suppuration of abnormal density of cyanotic color.Phlegmon Reclus, which develops when pathogenic bacteria is introduced into the nasopharynx, gives itself a painless and pronounced compaction on the neck, the inflamed tissues of which become hard as a tree.

Complications and treatment

Complications of phlegmon that develop without timely treatment: meningitis, purulent arthritis, osteomyelitis, erysipelas, pleurisy, tendovaginitis, peritonitis, thrombophlebitis of veins.

Treatment - surgical, is carried out in a hospital.The earlier the operation is performed, the more effectively the spread of pus is prevented.After the operation, local treatment and antibiotic therapy are necessary.

On the difference between carbuncle and similar ailments, the expert will tell in the video below: