Problem description:
What happened?
Analysis:
Erysipelas is an acute skin inflammation caused by group A β hemolytic streptococcus. Chinese medicine is called fire bravery and six fires.
[Clinical Features]
1. Etiology: Group A is caused by β hemolytic streptococcus.
Second, pioneer symptoms: chills, general malaise, high fever, 39 ~ 40℃
Third, the most common parts: calf and face.
Characteristics of skin lesions: bright red edema spots, tense and bright surface, clear boundary, and blisters Fig 1 in severe cases.
Systemic symptoms: local lymphadenopathy, fever, etc.
Sixth, conscious symptoms: obvious tenderness, high local skin temperature.
7. Prognosis: Repeated erysipelas can cause chronic lymphedema, and repeated attacks of lower limbs can lead to elephantiasis.
Experimental examination: the total number of white blood cells and neutrophils increased.
[Differential diagnosis] Contact dermatitis, cellulitis and tinea rash
[Prevention and treatment]
Treatment principle: active antibacterial, early, sufficient and effective antibiotic treatment.
First, systemic treatment: antibiotic treatment, penicillin is the first choice, 4.8 ~ 80 thousand units/day static point, allergic patients can use erythromycin.
Second, actively treat local diseases such as beriberi and rhinitis, and raise the lower limbs.
Third, supportive therapy and symptomatic treatment.
Fourth, local treatment: nitrofurazone liquid wet compress, topical antibiotic ointment: such as Baiduobang ointment.
Physical therapy: ultraviolet radiation, audio electrotherapy, ultrashort wave, infrared ray, etc.
Although erysipelas is named after poison, it is not caused by virus infection, but by acute purulent dermal inflammation caused by bacterial infection. The pathogen is group A hemolytic streptococcus, which invades through skin or mucosal injury, but can also be infected through blood.
The disease can recur in the original site, which is called recurrent erysipelas. Chronic lymphedema can be caused by long-term diseases. Chronic lymphedema of the leg, also known as elephant skin leg.
The typical pathological changes of erysipelas are high dermal edema, dilatation of blood vessels and lymphatic vessels, and extensive purulent leukocyte infiltration in dermis, reaching subcutaneous tissue.
According to the typical clinical manifestations and the increase of white blood cells in the blood, erysipelas can be diagnosed. But it should be differentiated from contact dermatitis and cellulitis. Contact dermatitis has a history of contact with foreign objects, without systemic symptoms and itching; Cellulitis is a diffuse and infiltrating flush with unclear boundary, obvious sunken edema, no softening and ulceration, and scars after healing.
Patients with erysipelas should pay attention to rest, avoid overwork and be properly isolated. If the lower limbs are sick, stay in bed and raise the affected limbs. Penicillin is the first choice for drug treatment, oral or intravenous drip. Those who are allergic to penicillin can take erythromycin or sulfonamides orally. Topics can be coated with 20% ~ 30% fish fat cream, or wet-packed with 0. 1% Rafnuel solution.
Who is susceptible to erysipelas?
(1) erysipelas on the face related to chronic diseases on the body surface are mostly caused by diseases in the nose, pharynx and ears. Especially rhinitis patients and people who often pick their noses by hand are prone to erysipelas. Erysipelas of lower limbs are mostly caused by tinea pedis or lower limb trauma.
(2) Malnutrition, alcoholism, gamma globulin deficiency, and renal edema related to decreased immunity are all inducing factors of this disease.
Therefore, even rhinitis and beriberi should be treated actively, and don't get into the habit of picking your nose with your nails. When the body's immune function declines or suffers from renal edema, more attention should be paid to keeping the skin clean and intact.
How does Chinese medicine treat erysipelas?
Traditional Chinese medicine believes that the main cause of erysipelas is fire poison, which can be caused by the evil of rheumatic fever turning into fire. Among them, what happens on the face is also called "fire bravery" or "big head writing"; What happens in the lower limbs is called filariasis; Erysipelas that occur in newborns or children are called red swimming Dan or swimming fire. Syndrome differentiation and treatment can be divided into four types.
(1) wind-heat syndrome is found in the head, ears and arms. , burning red, serious eyes closed, unable to open. With thirst, dry stool, red tongue, thin yellow fur and slippery pulse. The treatment is mainly to dispel wind, clear heat and detoxify, and the prescription is modified by Huaban Jiedu Decoction.
(2) Syndrome of stagnation of fire in liver meridian is more common in chest and abdomen, waist and back, ribs and umbilicus. Red tongue, thin yellow fur and rapid pulse. The treatment is mainly to clear liver, promote diuresis and reduce fever, and the prescription is Chaihu Qinggan Decoction.
(3) Damp-heat fire syndrome often occurs in lower limbs, calves, thighs, instep and other parts. , redness and burning, upward spread, swollen inguinal lymph nodes, difficulty walking. Accompanied by anorexia, thirst, red tongue, yellow greasy fur and slippery pulse. The treatment is mainly to clear away heat, promote diuresis and detoxify, and the prescription is modified by Lishui Runzao Decoction.
(4) The syndrome of heat toxin entering the camp has a wide range of syndromes, and the syndrome is heavy, and various bad syndromes such as delirium, restlessness, nausea and vomiting can be seen. The treatment is mainly to cool blood and detoxify, clear heart and enlighten the mind, which can be modified by Qingwen Baidu Decoction. Decoct with water, daily 1 dose. For those who are unconscious, choose one of Jiaangong Niuhuang Pill, Zhibaodan, Zixuedan or Niuhuang Qingxin Pill.
It can be externally applied with traditional Chinese medicine for clearing away heat and toxic materials. At first, cactus, purslane, hibiscus leaves and mung beans were used. Choose one, mash it and apply it externally, and then change it when it is dry. In the middle and late stage, the redness and swelling recede slightly, and you can apply it with golden cream or Ruyi gold powder and honey water.
For recurrent erysipelas, you can take medicine to prevent it: raw barley 30g. Decoct 1 time every day.
Pay attention to rest and drink plenty of warm water during treatment. And isolated from healthy people, avoid contact. Avoid spicy, fishy and greasy products, and eat more fruits and vegetables.
erysipelas
(erysipelas)
Etiology and pathogenesis
The disease is an acute infectious skin disease caused by hemolytic streptococcus type B, which is called "Huo Dan" in Chinese medicine.
clinical picture
Before the onset, there were symptoms such as general malaise, chills and nausea. And then edema fresh erythema appeared locally at the boundary, which quickly spread around. Blisters appear on the surface of skin lesions with burning sensation, accompanied by lymphangitis and lymphadenitis, which are more common in the face and legs. Nasal vestibulitis or otitis externa usually exists before facial injury, and leg injury is usually related to tinea pedis. And often have a tendency to relapse, and the symptoms are often mild when they recur. Infants are more common in abdominal and umbilical infections. There is still pigmentation after healing.
It should be differentiated from contact dermatitis and cellulitis.
treat cordially
Systematic therapy
Patients should stay in bed and receive timely treatment. Penicillin is the best antibiotic. Generally, the body temperature often returns to normal after 2-3 days of medication, but it takes about 2 weeks to continue medication, and sulfonamides can also achieve better curative effect. If necessary, it can be combined with penicillin. People who are allergic to penicillin can use tetracycline and erythromycin. If the patient has recurrent chronic erysipelas, it is necessary to check whether there is tinea pedis in toes and other parts, check whether there is infection in nasal vestibule and external auditory canal, and give corresponding treatment. The application time of antibacterial drugs for recurrent erysipelas should be appropriately extended. You can also use low-dose X-ray irradiation, each time 50- 100r(0.5- 1Gy), every two weeks 1 time, ***3-4 times.
Local treatment
The affected limb is elevated, and external use of antibiotic ointment is of little significance. The hibiscus or dandelion leaves can be mashed and applied externally, or decocted with aluminum acetate solution, alum solution or purslane for wet application, which can reduce congestion and pain. When lymphedema occurs in limbs, try intradermal injection with hyaluronidase or corticosteroid mixture.