Ugly face

Description:

Ugly face or erysipelatous inflammation - a serious infectious disease which external displays is defeat (inflammation) of an integument of hemorrhagic character,  temperature increase and the phenomena of endointoxication.
The name of a disease came from the French word rouge which is translated as "red".
The ugly face is very widespread infectious disease, statistically taking the 4th place, conceding only to a SARS, intestinal infections and infectious hepatitises. The ugly face is most often diagnosed for patients of the senior age groups. Aged from 20 up to 30 years men whose professional activity is connected with frequent microtraumatization and pollution of skin, and also with sharp changes of temperature suffer from an ugly face generally. These are drivers, loaders, builders, military etc. In the senior age group the most part of patients of the woman. Localization of an erysipelatous inflammation is quite typical – in most cases the inflammation develops on integuments of upper and lower extremities, is more rare on a face, is even more rare on a trunk, in a crotch and on generative organs. All these inflammations are well noticeable to people around and cause feeling of acute psychological discomfort in the patient.
The ugly face is widespread everywhere. Incidence of it in various climatic zones of our country makes 12 — 20 cases on 10 thousand population a year.  Now considerably the percent of an erysipelatous inflammation of newborns decreased though earlier this disease had very big lethality.

Ugly face reasons:

The causative agent of an erysipelatous infection is  the beta and hemolitic streptococcus of group A which can be in a human body in active and inactive, so-called,  a L-form. This type of a streptococcus is very steady against action of the environment, however perishes when heating to 56 C within half an hour that is of great importance in an antiseptic agent. The beta and hemolitic streptococcus is a facultative anaerobe, i.e. can exist both in oxygen conditions, and in without the oxygen environment.
If the person has any disease of a streptococcal etiology, or just is the carrier of this microorganism in any form, he can become an infection source. According to statistical data, carriers of a streptococcus of this look makes about 15% of people, at the same time they have no clinical signs of a disease. The main way of transfer of the activator — contact and household. Infection occurs through the injured skin – in the presence of scratches, grazes, attritions, etc. In transmission of infection the airborne way of transfer (has less significant role especially at emergence of an erysipelatous inflammation on a face). Patients are a little infectious.

Developing of infection with an ugly face is promoted by the contributing  factors, for example, permanent disturbances of a lymphokinesis, long stay in the sun, chronic venous insufficiency, fungus diseases of skin, a stressful factor. Aestivo-autumnal seasonality is characteristic of an erysipelatous inflammation.
Very often the ugly face arises against the background of associated  diseases: a fungus of foot, a diabetes mellitus, alcoholism, obesity, a varicose vein disease, a lymphostasis (a problem with absorbent vessels), the centers of a persistent streptococcal infection (at an ugly face of the person tonsillitis, otitis, sinusitis, caries, a periodontal disease; at an ugly face of extremities thrombophlebitis, trophic ulcers), the chronic somatopathies reducing the general immunity (is more often at advanced age).

Pathogeny:

Classify  primary, repeated (with other localization of process) and a recurrent erysipelatous inflammation. On the pathogeny, primary and repeated ugly face is an acute streptococcal infection. The exogenous nature of infection and the cyclic course of infectious process are characteristic. These causative organisms are in lymphatic capillaries of papillary and mesh layers of a derma where there is a center of the infectious and allergic inflammation having serous or serous and hemorrhagic character. In implementation of an inflammation an essential role is played by immunopathological processes with formation of cell-bound immune complexes in a derma, including and perivaskulyarno. The recurrent erysipelatous infection is a  persistent streptococcal infection, with formation of the characteristic endogenous centers in skin and regional lymph nodes. At the same time the mixed infection of an organism of patients bacterial and a L-form of a streptococcus is observed. A L-form it is long persistirut in the interrecurrent period of a disease in macrophages of skin and bodies of macrophagic system. At a recurrent ugly face heavy disturbance of the immune status of patients, their sensitization and an autoserotherapy takes place.
Also it was noticed that the ugly face most often arises at people with  III (In) a blood group. Obviously, genetic predisposition to an ugly face finds itself only at advanced age (more often in women), against the background of a repeated sensitization to beta hemolytic streptococcus of group A to both its cellular and extracellular products (virulence factors) at the certain morbid conditions including connected with involutional processes.

Ugly face symptoms:

On the nature of clinical manifestations the erysipelatous inflammation is divided into several forms:  
- erythematic
- erythematic and violent
- erythematic and hemorrhagic
- violent and hemorrhagic forms.

Incubation interval — of several hours to 3 — 5 days.
On disease severity distinguish easy, medium-weight, heavy forms. Most often inflammatory process is shown on the lower extremities, is more rare — on a face, upper extremities, is very rare — in a trunk, generative organs. The beginning of development of a disease acute,  arises a headache, feeling of heat the general weakness, a fever, muscular pains. Critical fervescence of the patient to febrile figures - 38 — 39,5 ° is observed. Quite often the beginning of a disease is accompanied by nausea and vomiting. Very often described phenomena develop one day before skin manifestations.
The main sign of an erysipelatous inflammation are skin manifestations in the form of an erythema with the uneven edges which are accurately delimited from not affected skin in the form of the twisting line, arches and languages which are often compared to "tongues of flame".

Existence of the peripheral roller in the form of the towering edge of an erythema is characteristic of an erythematic ugly face. Skin in the field of an erythema has bright red color, at a palpation of pain are usually insignificant, generally on the periphery of an erythema. Skin is strained, hot to the touch. At the same time puffiness of skin which extends out of erythema limits is characteristic. Regional lymphadenitis is noted.

At erythematic and violent ugly faces against the background of an erythema appear bubbles (bulls). Contents of bulls -  transparent yellowish liquid.
At an erythematic and hemorrhagic erysipelatous inflammation there are hemorrhages of the different sizes — from punctulate to extensive and drain, extending to all erythema. In bubbles there is a hemorrhagic and fibrinous exudate, however they may contain also preferential fibrinous exudate, to have the flattened character and to have a dense consistence at a palpation.

The easy current of an ugly face is characterized by slightly expressed intoxication symptoms, temperature seldom increases higher than 38,5 °, the moderate headache can be observed. At heavy disease temperature reaches 40 ° above, the tremendous fever, vomiting, nonsense, disorders of consciousness, a meningeal syndrome (a so-called meningism) are noted. Increase of heart rate is observed, hemodynamics indicators fall.  
The increased temperature at patients keeps up to 5 days. Acute inflammatory changes in the center disappear in terms up to 5 — 7 days  at an erythematic ugly face, up to 10 — 12 days and more at a violent and hemorrhagic ugly face. The increased regional lymph nodes remaining during recovery, infiltration of skin on site of the inflammation center, subfebrile temperature are predictively adverse for development of an early recurrence.
The repeated ugly face arises 2 years later and more after the previous disease and has other localization.

Recurrent erysipelatous vospaleniyechashche all  it is observed at localization of the center of an inflammation on the lower extremities. There are contributing  factors for transition of primary ugly face in recurrent, in particular at accompanying chronic diseases of skin, especially fungal (an epidermophitia, a tinea), the previous venous insufficiency, a lymphostasis, existence of the centers of a persistent streptococcal infection. A recurrence develops in terms from several days and weeks to 1 — 2 years, the number them can reach several tens. A frequent recurrence leads to the expressed disturbances in lymphatic system.
Complications usually have local character: skin necroses, abscesses, phlegmons, thrombophlebitises, limfangiita, periadenites. At the accompanying serious illness and late begun treatment sepsis, infectious and toxic shock can develop. At a frequent recurrence lymphatic hypostasis (limfedema) and secondary elephantiasis are possible.

Treatment of the Ugly face:

Medical events at an erysipelatous inflammation  in most cases are held at home or in out-patient conditions. Plentiful drink, a balanced diet is shown to patients. Indications for hospitalization are heavy disease, widespread local process, its violent and hemorrhagic character and a recurrent ugly face.

The main pathogenetic therapy of an ugly face is prescription of antibiotics. Most often use one of the given antibacterial agents: Oletetrinum on 0,25 g of 4 — 6 times a day, metacycline a hydrochloride on 0,3 g 2 — 3 times a day, erythromycin or Oleandomycinum the phosphate in daily doses to 2 g combined химиопрепарат Bactrimum (Biseptolum), Sulfatonum — on 2 tablets 2 times a day in the morning and in the evening after food. In the conditions of a hospital and at heavy disease intramuscular administration of benzylpenicillin is shown, at a recurrent ugly face — cephalosporins (cefazolin, клафоран, etc.), hypochloride lincomycin. Duration of reception of antibiotics – 8 - 10 days. Pathogenetic treatment also includes non-steroidal anti-inflammatory drugs, Ascorutinum for strengthening of a vascular wall, a complex of vitamins. At a frequent recurrence of a disease the nonspecific stimulating and immunocorrective therapy (pentoxyl, methyluracil, sodium nucleinate), and also Prodigiosanum, levamisole is shown. Two last drugs are appointed only in a hospital. At the recurrent nature of disease in some cases apply an autohemotherapy.
Topical treatment of an ugly face is carried out only at its violent forms and localization of process on extremities. Bubbles make an incision at one of edges and apply bandages with solution of Aethacridinum of a lactate the center of an inflammation (1:1000) or Furacilin (1:5000), changing them several times a day. In the subsequent bandages with Ectericidum, vinylother are applied. In the acute period of a disease it is possible to use physical therapy: UF-radiation and UVCh-therapy, and after subsiding of acute inflammatory process of a bandage with naftalanny ointment, applications with paraffin and ozokerite, radonic bathtubs, an electrophoresis of a lidaza or Calcium chloratum for the prevention of a resistant lymphostasis. Patients are written out not earlier than the 7th day after normalization of body temperature. Transferred an ugly face there are on the account in an office of infectious diseases within 3 months, and not less than 2 years suffering from a recurrent ugly face.
Surgical treatment of complications at an ugly face. At development of a necrosis to the patient the necretomy after stabilization of the general state is made. The wound is covered with daltseks-trypsin with an antiseptic agent, teralginy, algipory, ointment on a hydrophilic basis (левомеколь) or chemotherapeutic means (Dimexidum, йодопирон, etc.). At defects of the big sizes, after emergence of dense granular granulations and elimination of the acute phenomena perform repeated operation — an autodermoplastika which sense consists in closing of defect of an integument, at the same time the patient becomes the donor and the recipient. At phlegmons and abscesses the section is carried out on the shortest way, cut skin, hypodermic cellulose and open an abscess cavity. After evacuation of a detritis the cavity is washed out antiseptic agents, drained, part edges of a wound with hooks and carry out audit. Excise all impractical fabrics. The wound is not taken in, as a rule, apply a sterile bandage. At purulent lymphadenites, the abscessed phlebitis and paraphlebitis and other centers of pyoinflammatory character treatment of the surgical plan - opening of accumulations of pus, removal of nekrotizirovanny fabrics, drainage of a wound is shown.

Prevention:

Preventive actions for the prevention of development of an erysipelatous infection consists in careful respect for personal hygiene, the prevention of injuries and attritions of legs. If such injury arose, their processing is shown by antiseptic agents (for example, 5% spirit solution of iodine, solution of diamond green). Timely sanitation of the centers of a persistent streptococcal infection is necessary. Prevention of a recurrent ugly face provides treatment of the diseases (fungal infections of skin, limfovenozny insufficiency) contributing to a recurrence. Medicamentous prevention of an ugly face is in certain cases justified. At a frequent, persistent recurrence with the preventive purpose enter Bicillinum-5 on 1 500 000 PIECES intramusculary each 3 — 5 weeks for two-three years. In cases of the expressed seasonality of a recurrence and at the considerable residual phenomena purpose of Bicillinum-5 is recommended by preventive courses lasting 3 — 4 months.