Auricular dew

Erysipelas of the auricle is an infectious disease, widespread throughout the world, characterized by acute serous-exudative inflammation of the skin or (less often) mucous membranes, severe intoxication and contagiousness. The disease was known to Hippocrates; Galen developed its differential diagnostics, and T. Syndenham in the 17th century was the first to note the similarity of erysipelas with general acute exanthemas.

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Causes of erysipelas of the auricle

The causative agent of erysipelas is beta-hemolytic streptococcus group A (Str. pyogenes) or other serological types vegetating in the given area. These microorganisms were first discovered

The outstanding German surgeon T. Billroth in 1874. According to the observations of I.I. Mechnikov, the greatest accumulation of microorganisms can be found in the peripheral zone of the skin area affected by erysipelas.

Erysipelas is often preceded by acute streptococcal infections in the form of tonsillitis or catarrhal inflammation of the upper respiratory tract. Recurrent erysipelas of the head or face is usually associated with the presence of foci of chronic streptococcal infection (chronic purulent sinusitis, dental caries, periodontitis, etc.). The occurrence of erysipelas is facilitated by specific sensitization of the body to streptococcus and the absence of antimicrobial immunity, as well as vitamin deficiency and the consumption of food poor in animal proteins.

The source of the pathogen are patients with various streptococcal infections (tonsillitis, scarlet fever, streptoderma, erysipelas, etc.). Infection with erysipelas can occur by contact through damaged skin and mucous membranes. Airborne transmission of the infection is also possible, with the formation of its focus in the nasopharynx, tonsils, and subsequent transfer of the microorganism to the skin by hand. The infection can also spread through the lymphogenous and hematogenous routes.

Pathogenesis of erysipelas of the auricle

Erysipelas of the face most often begins at the tip of the nose. A limited, sharply hyperemic focus appears, which soon turns into a compacted, painful, sharply delimited from the surrounding tissues erysipelas plaque, characterized by serous inflammation localized in the dermis, subcutaneous tissue, along its lymphatic vessels. As a result, serous inflammation spreads to all elements of the skin and its nearest subcutaneous elements. Subsequently, the erysipelas plaque darkens, and along its periphery, a rapid spread of the inflammatory process begins, characterized by the fact that the zone of hyperemia and edema of the skin is sharply delimited from normal skin.

Erysipelas of the face (and other areas of the body) can manifest itself in several forms, often occurring simultaneously on different areas of the skin - erythematous, erythematous-bullous, bullous-hemorrhagic, pustular, squamous (crustular), erythematous-hemorrhagic and phlegmonous-gangrenous. According to the prevalence of local manifestations, the following forms of erysipelas are distinguished: localized, widespread (wandering, creeping, migrating), metastatic with the development of distant, isolated from each other lesions. According to the degree of intoxication (severity of the course), mild (I degree), moderate (II) and severe (III) forms of the disease are distinguished. There is also a recurrent form, characterized by long-term, over a number of months and years, recurring diseases.

Symptoms of erysipelas of the auricle

The incubation period ranges from several hours to 3-5 days.

Prodrome: general malaise, moderate headache, more pronounced when localized in the face, slight pain in the area of regional lymph nodes, paresthesia at the site of infection, turning into a burning sensation and increasing pain.

Initial and peak periods: fever up to 39-40°C, severe chills, increased headache and general weakness, nausea, vomiting. In isolated cases in the initial period - loose stools. Myalgic syndrome is an early sign of intoxication. In places of future erysipelas (especially with facial erysipelas) - a feeling of distension, burning; pain in regional lymph nodes and along the lymphatic vessels appears and increases. On the skin in the erythematous form, a small reddish or pinkish spot initially appears, which within a few hours turns into a characteristic erysipelas - a clearly demarcated area of hyperemic skin with jagged edges; the skin is infiltrated, edematous, tense, hot to the touch, moderately painful on palpation, especially on the periphery of the erythema. In some cases, a demarcation ridge can be detected in the form of infiltrated and elevated edges of erythema. In other forms of the disease, local changes begin with the appearance of erythema, against the background of which vesicles are formed (erythematous-bullous form), hemorrhages (erythematous-hemorrhagic form), effusion of hemorrhagic exudate and fibrin into vesicles (bullous-hemorrhagic form). In extremely severe clinical course of the disease, necrosis of the skin and phlegmon of the underlying tissues develop in the areas of bullous-hemorrhagic changes (phlegmonous-necrotic form).

The recovery period in the erythematous form usually begins on the 8th-15th day of the disease: improvement of the patient's general condition, decrease and normalization of body temperature, disappearance of signs of intoxication; local manifestations of erysipelas undergo reverse development: the skin turns pale, the ridge-like elevations of the edges of hyperemic areas of the skin disappear, peeling of the epidermis in flaps occurs. In erysipelas of the scalp - hair loss, which subsequently grows again, existing skin changes disappear without a trace.

In severe bullous-hemorrhagic form, the recovery period begins 3-5 weeks after the onset of the disease. Dark brown pigmentation of the skin usually remains at the site of blisters and hemorrhages. Complications in the form of phlegmon and necrosis leave behind scars and skin deformations.

In frequently recurring erysipelas, during the recovery period, pronounced residual effects in the form of infiltration, edema and pigmentation of the skin, and lymphostasis almost always persist.

Currently, the clinical course of erysipelas is changing towards its aggravation. A hemorrhagic form has appeared and is widely spread, the number of cases with a longer fever has increased, as well as the number of patients with a recurrent course, cases of comparatively slow reparation in the lesion have become more frequent.

Isolated erysipelas of the outer ear most often occurs against the background of weakened immunity as a complication of purulent infection of the external auditory canal, chronic otorrhea with purulent otitis media, damage to the integrity of the skin of the auricle and external auditory canal. With erysipelas of the external auditory canal, the process often spreads to the eardrum, causing its perforation, and moves to the tympanic cavity, provoking inflammation of its anatomical structures. Often, erysipelas of the auricle, face and scalp is complicated by otitis media, mastoiditis and sinusitis.

Diagnostics in typical cases does not cause difficulties, and the diagnosis is made on the basis of a characteristic clinical picture. In the blood - neutrophilic leukocytosis with a shift in the leukocyte formula to the left, toxic granularity of leukocytes, increased ESR.

Treatment of erysipelas of the auricle

Hospitalization and isolation of patients. The course of treatment with penicillin antibiotics (bicillin-5) is at least 7-10 days, even in the case of an abortive clinical course.

General treatment. Detoxification therapy: intravenous polyionic solutions (trisol, quartasole), as well as derivatives of polyvinylpyrrolidone (hemodez, polydez, neohemodez, etc.).

In hemorrhagic form - ascorution, ascorbic acid, for young people - calcium gluconate. In protracted forms with slow skin reparation - ascorbic and nicotinic acid, vitamins A, group B, multivitamin mixtures with microelements. Of the non-specific immunostimulating drugs - pentoxyl, yeast nucleic acid, methyluracil, pyrogenal, prodigiosan, preparations of greater celandine.

Local treatment is indicated only for the bullous-hemorrhagic form and its complications (phlegmon, necrosis). In the acute period, if there are intact blisters, they are carefully cut at the edge and after the exudate comes out, bandages with a 0.1% solution of rivanol, 0.02% aqueous solution of furacilin are applied. Tight bandaging is unacceptable. The duration of application of bandages should not exceed 8 days. In the future, if erosions persist in place of blisters, ointment and gel of solcoseryl, vinylin, peloidin, extericide, methyluracil ointment, etc. are used locally, which have a biostimulating effect and promote tissue regeneration.

After the acute inflammatory process has subsided, paraffin is applied to treat the residual effects of erysipelas, primarily its infiltration in the area of former erythema on the face and UR (the NSI is closed with a dense cotton plug) (up to 5 procedures or more).

Prevention of erysipelas of the auricle

Sanitation of infection foci (purulent ear diseases, sinusitis, CT, pyogenic diseases of the oral cavity), compliance with personal hygiene rules, prevention and timely disinfection of microtraumas, cracks, treatment of pustular skin diseases, prevention of hypothermia of the face and ears, exclusion of contact with patients with erysipelas.

Patients with recurrent erysipelas and with pronounced residual effects are subject to dispensary observation for 2 years, with the prescription of a prophylactic course of bicillin-5 injections, if indicated.

Prognosis for erysipelas of the auricle

In the pre-sulfanilamide and pre-antibiotic period, death, depending on the severity of the disease, was not an exception. At present, it is practically excluded and depends mainly on the existing lesions of the internal organs - diseases of the cardiovascular system, kidneys, liver, pancreas (diabetes), etc.