Boils and

carbuncles of the
face and neck
 Furuncle- acute purulent-necrotic inflammation of the hair follicle, sebaceous
gland and the surrounding connective tissue.

Boils often occur in adolescence, which is related to

the presence of acne vulgaris.
.
 Carbuncle-spilled necrotic inflammation several hair follicles adjacent
subcutaneous fat,
passing to mimic, at least the chewing muscles.
Carbuncles mostly observed in middle and old age, which predispose concomitant
somatic
the disease in the patient.
 etiology
• inflammation caused by streptococci and
staphylococci (Staphylococcus and
Staphylococcus white)

• The infection of a hair follicle, sebaceous gland and

surrounding tissues occurs through the ducts and
skin with the damaged epidermis.
 Factors contributing to the development
disease
• Skin condition
- pollution
- cracks
- excoriation
- reduction in skin barrier function As well as:

• - adverse weather conditions,

- cooling, hyperthermia,
- disorders of the nervous ,,
- avitaminosis,
- intoxication.
- violation of carbohydrate metabolism (more than 20% of patients suffer from diabetes
furunculosis).
• ^ Y p y n and y n e s - plural, often recurrent appearance of boils that occurs, generally at
PARTICULAR weakened and malnourished patients, the presence of hypo and avitamino
call.
 pathogenesis

formation of pustules (purulent bubble) in the hair follicle

implementing infection deeper into the hair follicle

the development of inflammation of the hair follicle

forming shaft and perifocal inflammatory tissue reaction

purulent fusion and necrosis in the center of the follicle

rejection opening and purulent rod and hair of the deceased

replacement tissue defect with scar tissue

 Formation of boils,
carbuncle
• stage 1 - there are a limited
swelling and redness
accompanied by minor

soreness. Within 1 to 2 days in the

mouth of the hair follicle is formed
bounded nodule tissue to be
infiltrated, hyperaemia of the skin in
the region of infiltration is increased,
there is a sharp pain.
• 2 stadiya- accompanied by suppuration and
necrosis. After 3-4 days of onset occurs purulent fusion of
tissues clinically manifest fluctuation. After spontaneous or
artificial opening purulent center released a small amount
of pus mixed with blood. In place of the epidermis
defect visible necrotic core which, together with pus
spontaneously rejected or removed with tweezers.
Thereafter, in place furuncle formed small bleeding
ulcers, granulations fills. Infiltration and swelling of
the border with furuncle tissue decreases. When
timely therapy infiltration tissue gradually disappears
during the process comes abortifacient without
abscess formation.
3 stadiya- wound healing with the formation of small, slightly concave scar. In the
case of large accumulations of pus and melting necrotic rod there is the so-called
abscessed
furuncle.
 morbid anatomy
microscopic picture

• formation of blisters in the mouth of the follicle, consisting of

polymorphonuclear leukocytes accumulation of germs and the
surrounding fibrin
• the spread of inflammation of hair follicles to the papillary
body and then to the adjacent connective tissue

• formation of necrosis in the central part of the hair follicle /

sebaceous gland. necrosis surrounded by a zone of purulent
inflammation
• formation of purulent necrotic hearth with a central rod
located under the thinned epidermis

• skin perforation appearance

• yield outwardly necrotic rod fallen hairs and purulent
masses
• filling the cavity of granulation tissue
• scar formation
 The most frequent location of boils /
carbuncles:

- the upper lip (nasolabial

triangle)
- lower lip and
chin area of ​the nose

- mucous membrane of the

external nose

- a neck in the zone of skin folds and

areas of clothing rubbing (occipital
region, neck area)

- scalp
- alveary
 Clinical picture of boil
• appearance of papules or redness portion with the appearance of pain, tingling

• for 1-2 days in place papules / redness and painful produce dense infiltrate round shape, the
center of which raised above the skin accumulates serous or purulent fluid. flushed skin over
the infiltrate, soldered to the underlying tissues

• the reaction of regional lymph nodes in the form of serous lymphadenitis

• pustule erupts and dries up

• blisters formed in the center portion and necrosis are distinguished purulent masses

• After emptying the hearth inflammation have subsided, the swelling and infiltration
decreases slowly dissolves residual infiltration
 clinical picture carbuncle
• sharply painful infiltration, apply not only to all layers of the skin but also the
subcutaneous fat, the skin over the infiltrate has a blue-purple color, the
appearance of several necrotic "heads." Subsequently, in the central part
carbuncle occur softening and necrotic tissue rejection

• general state of moderate or severe

• body temperature is 39-40 * C

• chills, et al. intoxication symptoms (headache, loss of appetite, nausea, vomiting,

insomnia, delirium)

• skin is soldered to the underlying tissues

• swelling of the surrounding tissue

• regional lymphadenitis, nodes are often soldered into packages

• marked leukocytosis, leukocyte vle shift in the sharp increase in ESR

 differential diagnosis

• anthrax (malignant carbuncle) -for which use content hearth

bacteriological research, diagnosis is established at naozhdenii
sibiroyazvennoy batsylly.

• specific inflammatory skin lesions and pokozhnoy tissue

(actinomycosis, tuberculosis, etc.).
 treatment
A h e n e uncomplicated boils, especially in the first stage is carried out
conservative and usually on an outpatient basis. First of all it is necessary to remove any outer
irritate whether - shaving the slightest injury to the tissues in the area of ​local content policies
boil. Patients with carbuncles person must be observable with bed rest, not talk, eat through a
tube.
general treatment:
- antibiotics (Synthetic penicillins, cephalosporins etc.).
in combination with sulfonamides
- desensitizing therapy (Claritin, telfast, zirtek et al.)

- detoxification therapy (Intravenous infusions of saline solutions)

- restorative therapy (A multivitamin)

- phlebitis prevention (Disaggregants: aspirin Trentalum et al.)

- correction of immunity (Levamisole, T-activin, timalin et al.)

- physiotherapy (UHF, etc.)

- homeostasis correction

- metabolism correction
 treatment
topical treatment of boils:

• antiseptic skin treatment (70% ethyl alcohol, salicyl alcohol, 2%) followed by the application of antiseptic dressings

• 2-3 blockade circumference hearth (Novocaine infiltration with antibiotics, enzymes)

• ultraviolet irradiation region boils in the initial stage of development, UHF, hypothermia, a helium-neon laser,

• dressings with hypertonic sodium chloride solution, ointment Wisniewski

• after opening dressings furuncle with proteolytic enzymes, surface active agents, antibiotics in the form of
aerosols or gels

• when abscess - an abscess opening

• with good outflow eksudata- phonophoresis antibiotics Dimexidum, calcium chloride

 treatment
topical treatment carbuncle:

• section through the entire thickness of the tissue

• necrectomy

• opening burrowing pus

• local dialysis

• daily bandaging wounds washes with antiseptics, enzymes, chlorhexidine, al.

means

• in wound laid turundy with hypertonic sodium chloride solution, ointment Wisniewski,
streptomycin and emulsions sintomitsinovoy
Surgery
 complications:
• lymphadenitis

• contact spread to adjacent organs and tissues

(Abscesses, cellulitis etc.)

• Particularly severe clinical course is typical of the furuncles upper lip angle of the mouth, nose,
podglaz-boundary area, the nasolabial triangle. Because of The possibilities of the occurrence of
severe complications:

• Facial vein thrombophlebitis

• Cavernous sinus thrombosis
• Sepsis
• meningoencephalitis
 Prevention of boils and carbuncles
person

• preventing pustular diseases of a skin, brushing the oral cavity

and nose, which are a major reservoir of pathogenic
staphylococci in humans. Prevention of complicated forms flow
boils and carbuncles is to prevent attempts at squeezing
pustules on the face.