Blood tests for furunculosis

Medical Center for Immunocorrection named after. R.N. Khodanova has accumulated considerable experience in the treatment of furunculosis. Modern technologies, responsibility and professional qualities of specialists have helped more than one hundred patients cope with this disease. This reference material presents the course of the disease and time-tested methods of preventing and treating furunculosis.

A furuncle is an acute purulent-necrotic inflammation of the hair follicle and the surrounding connective tissue. The development of boils is caused by Staphylococcus aureus, less commonly white Staphylococcus. Exogenous and endogenous predisposing factors play an important role in the occurrence of furunculosis. Exogenous factors are skin damage (scratching, abrasions, dermatitis, etc.), contamination with particles of dust, coal, etc., pyoderma; endogenous - endocrine disorders (diabetes mellitus, obesity), metabolic disorders (hypovitaminosis, anemia), alcoholism, hypothermia, etc. Furunculosis is spoken of when there are multiple and recurrent appearance and development of boils. Furunculosis often occurs against the background of concomitant diabetes mellitus.

A boil can develop on any area of ​​the skin where there are hair follicles. The most common localization is the face, skin of the neck, back of the hands, and lower back. Initially, a dense, bright red inflammatory infiltrate appears, rising above the skin level in a small cone. Patients report mild itching and moderate pain. As the boil develops, the infiltrate increases, hyperemia increases, and peripheral edema occurs. On the 3rd - 4th day, necrosis and softening of tissues appear in the center of the infiltrate, which acquire a greenish color, and a necrotic core of the boil is formed. During this period, the pain increases sharply, especially when localized in a physiologically active area (for example, in the joint area), increased body temperature, headache, and malaise are possible. If the course is favorable, after 2 - 3 days the purulent-necrotic rod is independently rejected with the formation of a deep, moderately bleeding wound. After another 2 - 3 days, the wound heals. When the process is erased, a painful infiltrate is formed without suppuration and necrosis. With abscess furunculosis, the purulent-necrotic process spreads beyond the hair follicle with the development of a purulent cavity or phlegmon. Single boils usually do not cause a general reaction and do not give complications, however, in patients with diabetes mellitus, a severe course of the process is possible. Furunculosis can be complicated by lymphangitis, regional lymphadenitis, and thrombophlebitis.

Histology
In the dermis and subcutaneous base, an inflammatory infiltrate of round cell elements is detected, in the center - necrosis and destroyed leukocytes. Leukocytes, fibroblasts and sedentary macrophagocytes are found in the perifollicular infiltrate. The presence of a necrotic core helps to distinguish a boil from a pseudofuruncle and folliculitis.

Treatment of furunculosis consists of local and general treatment.

It consists of thoroughly cleaning the skin around the source of inflammation - wiping with a 70% solution of ethyl alcohol, a 2% alcohol solution of salicylic acid, or lubricating it with a 1 - 3% alcohol solution of methylene blue or brilliant green. The hair around the infiltrate on the scalp and neck is carefully cut off. At the very beginning of the process, sometimes it can be interrupted by lubrication with a 5% alcohol solution of iodine. They use injections of the infiltrate with solutions of antibiotics with novocaine or electrophoresis of antibiotics, which sometimes helps prevent abscess formation. Locally, crystalline salicylic sodium or salicylic acid is applied to the area of ​​the emerging purulent-necrotic rod in the center of the boil and fixed with a dry bandage, which promotes accelerated rejection of the rod (keratolytic effect). In case of abscess furunculosis, under local anesthesia, the abscess is opened and the purulent-necrotic masses are carefully removed. After rejection of the rod or removal of necrotic masses, the wound is treated with antiseptic solutions (hydrogen peroxide, furatsilin 1:5000) and a bandage with proteolytic enzymes or ointment (tetracycline, erythromycin, gentamicin, syntomycin) is applied.

After cleansing the wound from purulent-necrotic masses, ointment dressings (vinyline, 5% syntomycin emulsion) are used; dressings are changed every other day. Physiotherapeutic procedures are prescribed: UV irradiation, UHF therapy, solux, etc. If boils are localized on a limb (legs, arms), it is recommended to ensure its rest. It is dangerous and therefore strictly prohibited to squeeze out the contents of the boil and massage in the area of ​​inflammation.

In the presence of large boils, with boils on the face, head, neck, as well as with developed furunculosis, along with local treatment, general specific and nonspecific therapy is carried out: injections of antibiotics, staphylococcal toxoid, autohemotherapy, protein therapy, vitamin therapy, etc.
Penicillin 800,000–1,000,000 units per day, 100,000 units every 3 hours.
Sulfonamide drugs are prescribed at a dose of 3–4 g per day for 5–6 days.
Combination therapy with antibiotics and immunological drugs is most effective.
Staphylococcal antifagin in increasing doses of 0.2–0.4–0.6–0.8–1.0–1.2–1.4–1.6–1.8–2.0 ml.
Vitamins are prescribed: retinol, ascorbic acid, thiamine or brewer's yeast (vitamin B group).
Patients with boils and furunculosis must adhere to a certain diet: limit the amount of carbohydrates in food, exclude alcoholic beverages, spicy seasonings, and sweets.

For furunculosis, the following blood tests are usually performed:

· Clinical blood test

· General urine analysis

· Biochemical blood test (total protein, total bilirubin, ALT, AST, blood glucose, alkaline phosphatase)

In case of possible immunodeficiency, it may be necessary

· Comprehensive assessment of immune status

For recurrent furunculosis, general restorative therapy and specific immunotherapy (antistaphylococcal gamma globulin and staphylococcal toxoid) are indicated. UHF therapy, UV irradiation, autohemotherapy, restorative treatment, gamma globulin, and staphylococcal toxoid are also used. Antibiotics and sulfonamide drugs are used for severe inflammatory infiltrate and elevated temperature.

Drug treatment methods for furunculosis are quite effective in treating single boils. In the case of numerous boils, frequent relapses, when the disease develops against the background of an immunodeficiency state or in cases of disorders of the innate immune system, the use of drugs, as a rule, is ineffective, since in this case it is necessary to use immunomodulators that eliminate the imbalance of the immune system.

The most effective immunomodulator of this spectrum of action is an autologous blood preparation obtained from the patient’s own blood according to the method of R.N. Khodanova. This drug is injected subcutaneously into reflexogenic zones.

Today it has been proven that one’s own blood cells in a state of hypoosmosis have a real immunomodulatory effect - they stimulate the fight against infection and suppress the autoimmune reaction. Activation of blood cells in a state of hypoosmosis occurs due to modification of the cell membrane. As a result of treatment, the rate of hematopoiesis (maturation of lymphocytes from bone marrow stem cells) increases 3–5 times, the phagocytic activity of macrophages, monocytes and neutrophils increases, the ratio of complement proteins (proteins of the innate immune system) is normalized, which increases the body's resistance to bacterial infections. In addition, the ratio of helper/suppressor cells of the immune system is normalized.

During treatment, after 4–5 procedures, even if new boils appear, the area of ​​infiltration and tissue necrosis will be small, and their maturation and rejection of the purulent-necrotic core will occur within 1–2 days. In the case of existing boils, they do not turn into abscess form.

For furunculosis of mild to moderate severity, a standard course of 9 procedures is sufficient for complete cure. In very severe forms of furunculosis (when new boils appear almost daily), a longer course of procedures is carried out or an individual course of treatment is used. However, in this case, almost 100% results are achieved.

The hemopuncture method has no side effects.

For more than 20 years of the center’s existence, our doctors received considerable practice in the treatment of furunculosis. The medical aspects of the course of the disease at various stages of the disease are well known to our specialists. All these developments and acquired experience have only one goal - alleviating the suffering of patients and returning them to a healthy and fulfilling life.

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Recurrent furunculosis is an inflammatory-purulent pathological process. It is characterized by damage to the deep layers of the epidermis. It is characterized by frequent, prolonged and sluggish exacerbations, the manifestations of which can be stopped with the help of antibacterial drugs.

Causes

Chronic furunculosis, which is prone to relapses, develops in the case of damage to the hair follicle, which is purulent-necrotic in nature. Boils in this case can be single or multiple.

Most often, this form of pathology is diagnosed in children and young people.

The development of a recurrent form of furunculosis is due to a number of provoking reasons. These include the following:

1. Infection with Staphylococcus aureus. This pathogenic pathogen is the cause of the described disease in 60-97% of cases. Much less frequently, chronic furunculosis develops due to Staphylococcus epidermidis.
2. Affected by group A and B streptococci.
3. Infection of the skin when wounds and abrasions appear on them.
4. A general decrease in the level of the body's immune defense, which may be due to the presence of infectious processes, congenital or acquired immunodeficiencies.
5. Long-term therapy with hormone-containing drugs, especially if the drug was selected incorrectly.
6. Diabetes.
7. Chronic damage to the skin (for example, from friction with clothing, regular contact with chemicals).
8. The presence of foci of chronic infection, the localization of which can be varied. In most cases, these include infectious diseases of the ENT organs: chronic sinusitis and tonsillitis, as well as pharyngitis.
9. Diseases of the urinary system.
10. Diseases of the gastrointestinal tract.
11. Pathologies of the thyroid gland.

This is not a complete list of possible pathologies that can provoke the development of furunculosis, which occurs in a chronic form. This is due to the fact that the disease is complex and has not yet been fully studied.

The boil in this case occurs as a result of purulent-necrotic inflammation of the hair follicle and surrounding tissues. Most often, these tumors are located on the skin of the thighs, buttocks, neck, and shoulders.

Signs of exacerbation of pathology

Exacerbation of chronic furunculosis can be determined by the following characteristic signs:

1. The appearance of boils that look like a knot. This is an area above the skin, a kind of protrusion. Over the course of several days, the boils mature and then open. When this happens, pus leaks out. After this, an ulcer forms on the skin area, which scars quite quickly. The entire process, from the beginning of formation to the scarring stage, takes an average of 14 days.
2. Enlargement of regional lymph nodes.
3. Symptoms of general intoxication: increased body temperature, headaches, general weakness, increased sweating. These manifestations are characteristic of severe and moderate degrees of recurrent furunculosis.

Periods of exacerbation during this inflammatory process last about 14-21 days.

In persons with impaired immune status, in the case of lymphogenous spread of infection, osteomyelitis, phlegmon, and ulcerative pyoderma may develop.

One of the most dangerous complications of mechanical action on boils that have formed in the area of ​​the nasolabial triangle is purulent meningitis. That is why you should never try to squeeze out these skin growths on your own.

In addition to purulent meningitis, the dangerous consequences of this disease include sepsis, in which ulcers form in various internal organs, inflammation of the lymph nodes located next to the affected area, and the formation of a rough colloidal scar.

Laboratory diagnostics

To diagnose the inflammatory process, you need to contact a medical facility.

The first thing you need to do is get tested. Stool, blood and urine are collected for further research of these materials.

Laboratory diagnostic methods include:

1. clinical blood test;
2. blood test for the presence of hepatitis;
3. general urine analysis;
4. blood testing for HIV and RW;
5. assessment of the level of hormones synthesized by the thyroid gland;
6. sowing the contents obtained from the boil for sensitivity to antibiotics;
7. bacteriological examination of stool.

If necessary, repeat examinations may be scheduled.

Instrumental diagnostic methods

Other methods that allow identifying the disease and are instrumental in nature include the following:

1. X-ray examination of the paranasal sinuses and chest organs;
2. Ultrasound of the abdominal organs;
3. ECG;
4. Ultrasound of the thyroid gland.

Also, if there are clinical manifestations of an unclear nature, additional measures may be prescribed to examine the patient.

Treatment methods for recurrent furunculosis

The nature of therapy for chronic furunculosis depends on the severity of the pathological process that was detected.

For patients suffering from this pathology, the following drugs are recommended:

1. Immunomodulators. Since the risk of relapse of the disease increases several times against a background of weakened immunity, the patient requires immunotherapy. Usually, with such a diagnosis, administration of a staphylococcal vaccine is recommended. During periods of remission, immunomodulatory drugs such as Likopid, Polyoxidonium can be prescribed.
2. Antibacterial drugs in tablet dosage form. The type of medication is determined in each case individually, in accordance with the characteristics of the pathogen and its sensitivity to certain types of antibiotics. For recurrent furunculosis, Azithromycin, Augmentin, Ceftriaxone are prescribed. The tablets should be taken orally for 7-10 days. Antibiotics are rarely used in the form of solutions for intramuscular or intravenous administration.
3. Medicines for topical use. If the pathological process during an exacerbation is accompanied by a moderate inflammatory reaction, it is recommended to treat boils on the skin with antiseptic substances - brilliant green, iodine or ethyl alcohol at a concentration of 70%.

Treatment for recurrent furunculosis should be started only after consultation with a specialist.

Prevention of exacerbations

To reduce the risk of relapse of furunculosis in a chronic course, you should:

1. strengthen immunity; This can be done through systematic hardening, playing sports, walking in the fresh air;
2. use local skin care products;
3. observe the rules of personal hygiene;
4. avoid hypothermia;
5. Be sure to treat the skin with antiseptics when damage appears;
6. in case of diabetes mellitus, monitor its course;
7. Avoid contact with chemicals and other irritants.

At the first manifestations of the disease, it is necessary to consult a doctor so as not to start the process and not cause complications that are dangerous to health and life.

General recommendations for promoting health

Strong immunity is the key to the body’s resistance to pathogens of various pathologies. To improve your health, you should:

1. to refuse from bad habits;
2. eat properly, maintaining a balance of fats, proteins and carbohydrates;
3. control weight, as well as blood pressure, blood sugar and cholesterol levels;
4. spend more time in the fresh air;
5. harden the body;
6. protect yourself from stress and other negative factors;
7. engage in feasible physical activity;
8. take vitamin complexes, especially in the autumn-spring periods;
9. carry out procedures to cleanse the body. Fasting days will do an excellent job of this task.

Recurrent furunculosis is an inflammatory process that is characterized by damage to the deep layers of the skin. Externally, the disease is expressed in the formation of ulcers. During periods of exacerbation, it is necessary to use specific medications. Preventative measures will help prolong the period of remission.

Currently, there is a tendency towards an increase in chronic bacterial and viral diseases, which are characterized by a continuously relapsing course and low effectiveness of antibacterial and symptomatic therapy. One of these diseases is chronic recurrent furunculosis. A furuncle develops as a result of acute purulent-necrotic inflammation of the hair follicle and surrounding tissues. As a rule, a boil is a complication of osteofolliculitis of staphylococcal etiology. Boils can occur either singly or multiple times (so-called furunculosis).

In case of recurrent furunculosis, chronic recurrent furunculosis is diagnosed. As a rule, it is characterized by frequent relapses, long-term, sluggish exacerbations that are tolerant to antibiotic therapy. Depending on the number of boils, the prevalence and severity of the inflammatory process during furunculosis, it is classified according to severity.

Severe degree of furunculosis: disseminated, multiple, continuously recurrent small foci with a weak local inflammatory reaction, non-palpable or slightly visible regional lymph nodes. Severe furunculosis is accompanied by symptoms of general intoxication: weakness, headache, decreased performance, increased body temperature, sweating.

Moderate severity of furunculosis - single or multiple large boils, occurring with a violent inflammatory reaction, with relapses from 1 to 3 times a year. Sometimes accompanied by enlarged regional lymph nodes, lymphangitis, a short-term increase in body temperature and minor signs of intoxication.

Mild severity of furunculosis—single boils, accompanied by a moderate inflammatory reaction, with relapses 1 to 2 times a year, well palpable regional lymph nodes, without symptoms of intoxication.

Most often, patients suffering from furunculosis receive treatment from surgeons; at best, on an outpatient basis, they undergo a blood test for sugar, autohemotherapy, some are prescribed immunomodulatory drugs without a preliminary examination, and in most cases they do not receive a positive result from the therapy. The purpose of our article is to share the experience of managing patients with chronic furunculosis.

Causes of furunculosis

The main etiological factor of chronic furunculosis is considered to be Staphylococcus aureus, which, according to various sources, occurs in 60–97% of cases. Less commonly, furunculosis is caused by other microorganisms - Staphylococcus epidermidis (previously considered apathogenic), streptococci of groups A and B and other types of bacteria. An outbreak of furunculosis of the lower extremities was described in 110 patients who were patients of the same pedicure salon. The causative agent of this outbreak was Mycobacterium fortuitium, and this organism was identified in foot baths used in the salon. In most cases of CRF, antibiotic-resistant strains of Staphylococcus aureus are cultured from purulent lesions. According to N.M. Kalinina, St. aureus is resistant to penicillin and ampicillin in 89.5% of cases, resistant to erythromycin in 18.7% of cases, and sensitive to cloxacillin, cephalexin and cotrimoxazole in 93% of cases. In recent years, there has been a fairly wide distribution of methicillin-resistant strains of this microorganism (up to 25% of patients). According to foreign literature, the presence of the pathogenic strain St. on the skin or nasal mucosa. aureus is considered an important factor in the development of the disease.

Chronic furunculosis has a complex and still insufficiently studied pathogenesis. It has been established that the onset and further recurrence of the disease are caused by a number of endo- and exogenous factors, among which the most significant are considered to be a violation of the barrier function of the skin, pathology of the gastrointestinal tract, endocrine and urinary systems, and the presence of foci of chronic infection of various locations. According to our research, foci of chronic infection of various locations are detected in 75–99.7% of patients suffering from chronic furunculosis. The most common foci of chronic infection of the ENT organs (chronic tonsillitis, chronic sinusitis, chronic pharyngitis), intestinal dysbiosis with an increase in the content of coccal forms.

In patients with chronic furunculosis, gastrointestinal pathology (chronic gastroduodenitis, erosive bulbitis, chronic cholecystitis) is determined in 48–91.7% of cases. In 39.7% of patients, pathology of the endocrine system is diagnosed, represented by disorders of carbohydrate metabolism, hormone-producing functions of the thyroid and gonads. 39.2% of patients with persistent furunculosis have latent sensitization, 4.2% have clinical manifestations of sensitization to allergens of house dust, tree pollen and cereal grasses, and 11.1% have an increased concentration of serum IgE.

Thus, the majority of patients with furunculosis are characterized by a continuously relapsing course of the disease (41.3%) with severe and moderate severity of furunculosis (88%) and long-term exacerbations (from 14 to 21 days - 39.3%). Chronic foci of infection of various locations were identified in 99.7% of patients. In 39.2% of cases, latent sensitization to various allergens was determined. The main pathogen is St. aureus.

In the occurrence and development of chronic furunculosis, along with the characteristics of the pathogen, its pathogenic, virulent and invasive properties, the presence of concomitant pathology, a major role is played by disturbances in the normal functioning and interaction of various parts of the immune system. The immune system, designed to ensure the biological individuality of the body and, as a result, performs a protective function when in contact with infectious, genetically foreign agents, for various reasons can fail, which leads to a violation of the body’s defense against microbes and manifests itself in increased infectious morbidity.

Immune protection against bacterial pathogens includes two interrelated components - innate (predominantly nonspecific) and adaptive (characterized by high specificity to foreign antigens) immunity. When the causative agent of furunculosis enters the skin, it causes a “cascade” of protective reactions.

With chronic furunculosis, disorders of almost all parts of the immune system are detected. According to N. Kh. Setdikova, 71.1% of patients with furunculosis had impaired phagocytic immunity, which was expressed in a decrease in the intracellular bactericidal activity of neutrophils and defects in the formation of reactive oxygen species. Defects that impair granulocyte migration can lead to chronic bacterial infections, as demonstrated by Kalkman et al in 2002. Defects in the utilization of pathogens within phagocytes can have various causes and have severe consequences (for example, a defect in NADPH oxidase leads to incomplete phagocytosis and the development of a corresponding severe clinical picture).

Low levels of serum iron may possibly cause a decrease in the efficiency of oxidative killing of pathogenic microorganisms by neutrophils. A number of authors have identified a decrease in the total number of T-lymphocytes in peripheral blood. As a rule, in patients with CRF, the number of CD4 lymphocytes is reduced (in 20–50% of patients) and the number of CD8 lymphocytes is increased (in 14–60.4% of patients).
In 26–35% of patients suffering from chronic furunculosis, the number of B lymphocytes decreases. When assessing the components of humoral immunity in patients with furunculosis, various disimmunoglobulinemias are revealed. The most common are decreases in IgG and IgM levels. A decrease in the affinity of immunoglobulins was noted in patients with CRF, and a correlation was found between the frequency of occurrence of this defect, the stage and severity of the disease. The severity of laboratory abnormalities correlates with the severity of clinical manifestations of furunculosis.

From the above it follows that changes in indicators of the immune status in patients with CRF are of a diverse nature: in 42.9% there was a change in the subpopulation composition of lymphocytes, in 71.1% - in the phagocytic and in 59.5% - in the humoral part of the immune system. Depending on the severity of changes in immune status, patients with CRF can be divided into three groups: mild, moderate and severe, which correlates with the clinical course of the disease. With mild furunculosis, the majority of patients (70%) have immune status indicators within normal limits. In moderate and severe cases, changes in the phagocytic and humoral components of the immune system are predominantly detected.

Diagnosis of chronic recurrent furunculosis

Based on the above pathogenetic features of furunculosis, the diagnostic algorithm should include identifying foci of chronic infection, diagnosing concomitant diseases, and assessing laboratory parameters of the state of the immune system.

Mandatory laboratory testing for symptoms of furunculosis:

clinical blood test;
general urine analysis;
biochemical blood test (total protein, protein fractions, total bilirubin, urea, creatinine, transaminases - AST, ALT);
RW, HIV;
blood test for the presence of hepatitis B and C;
sowing the contents of the boil for flora and sensitivity to antibiotics;
glycemic profile;
immunological examination (phagocytic index, spontaneous and induced chemiluminescence (CL), stimulation index (SI) of luminol-dependent chemiluminescence LZHL), bactericidal neutrophils, immunoglobulins A, M, G, immunoglobulin affinity);
bacteriological examination of feces;
stool analysis for worm eggs;
sowing from the throat for flora and mushrooms.

Additional laboratory testing for symptoms of furunculosis:

determination of the level of thyroid hormones (T3, T4, TSH, AT to TG);
determination of the level of sex hormones (estradiol, prolactin, progesterone);
blood culture for sterility three times;
urine culture (if indicated);
bile culture (according to indications);
determination of basal secretion;
immunological examination (subpopulations of T-lymphocytes, B-lymphocytes);
total IgE.

Instrumental examination methods for symptoms of furunculosis:

gastroscopy with determination of basal secretion;
Ultrasound of the abdominal organs;
Ultrasound of the thyroid gland (according to indications);
Ultrasound of female genital organs (according to indications);
duodenal intubation;
external respiration functions;
ECG;
chest x-ray;
X-ray of the paranasal sinuses.

Consultations with specialists for symptoms of furunculosis: otolaryngologist, gynecologist, endocrinologist, surgeon, urologist.

Treatment of chronic recurrent furunculosis

Treatment tactics for patients with chronic recurrent furunculosis are determined by the stage of the disease, concomitant pathology and immunological disorders. In the stage of exacerbation of furunculosis, local therapy is required in the form of treating boils with antiseptic solutions, antibacterial ointments, and a hypertonic solution; in case of localization of boils in the head and neck area or the presence of multiple boils - antibacterial therapy taking into account the sensitivity of the pathogen. At any stage of the disease, correction of the identified pathology is necessary (sanitation of foci of chronic infection, treatment of gastrointestinal pathology, endocrine pathology, etc.).

If latent sensitization is detected in patients with furunculosis or in the presence of clinical manifestations of allergies, it is necessary to add antihistamines to treatment during pollination, prescribe a hypoallergenic diet, and perform surgery with premedication with hormonal and antihistamines.

Recently, in the complex therapy of patients with chronic furunculosis, drugs that have a corrective effect on the immune system are increasingly used. Indications for the use of immunomodulators have been developed depending on the dominant type of immune disorder and the degree of the disease. Thus, in the acute stage of chronic furunculosis, the use of the following immunomodulators is recommended.

In the presence of changes in the phagocytic component of immunity, it is advisable to prescribe polyoxidonium 6-12 mg intramuscularly for 6-12 days.
If the affinity of immunoglobulins decreases, Galavit 100 mg No. 15 intramuscularly.
If the level of B-lymphocytes decreases and the CD4/CD8 ratio decreases, the use of myelopid 3 mg intramuscularly for 5 days is indicated.
When the level of IgG decreases against the background of a severe exacerbation of furunculosis and the clinical ineffectiveness of the use of Galavit, immunoglobulin preparations for intravenous administration (octagam, gabriglobin, intraglobin) are used.
During the period of remission, the following immunomodulators may be prescribed.

Polyoxidonium 6-12 mg intramuscularly for 6-12 days - in the presence of changes in the phagocytic component of immunity.
Likopid 10 mg orally for 10 days - in the presence of defects in the formation of reactive oxygen species.
Galavit 100 mg No. 15 intramuscularly - with a decrease in the affinity of immunoglobulins.
The use of licopid is also advisable for sluggish, continuously recurrent furunculosis. In case of persistent recurrence of CRF against the background of changes in the humoral immunity, the administration of immunoglobulin preparations for intravenous administration (octagam, gabriglobin, intraglobin) is indicated. In some cases, the combined use of immunomodulatory drugs is advisable (for example, in case of exacerbation of furunculosis, polyoxidonium may be prescribed, in the future, if a defect in the affinity of immunoglobulins is detected, galavit is added, etc.).

Despite significant advances made in the field of clinical immunology, effective treatment of chronic furunculosis remains quite a challenge. In this regard, further study of the pathogenetic features of this disease is required, as well as the development of new approaches to the treatment of chronic furunculosis.

Currently, the search for new immunomodulatory drugs that can have a positive effect on the course of the inflammatory process in furunculosis continues. Clinical trials of new domestic immunomodulators, such as Seramil and Neogen, are being conducted. Seramil is a synthetic analogue of the endogenous immunoregulatory peptide - myelopeptide-3 (MP-3). Seramil was used as part of a complex treatment of patients with furunculosis both in the acute stage and in the remission stage, 5 mg No. 5 intramuscularly. After treatment with the drug, normalization of the level of B-lymphocytes was noted, as well as a decrease in the level of CD8-lymphocytes. A significant prolongation of the period of remission of the disease was revealed (up to 12 months in 30% of patients).

Neogen is a synthetic tripeptide consisting of L-amino acid residues isolecithin, glutamine and tryptophan. Neogen was used as part of complex therapy for patients with chronic furunculosis. Intramuscular injections of the drug Neogen were carried out in the amount of 1 ml of 0.01% solution once a day every day, the course was 10 injections.

The use of Neogen in complex therapy of patients with chronic furunculosis at the stage of remission of the disease causes a significant normalization of initially altered immunological parameters (relative and absolute number of lymphocytes, relative number of CD3+, CD8+, CD19+, CD16+ lymphocytes, the absorption capacity of monocytes in relation to St. aureus) and an increase indicators of spontaneous CL and the affinity of anti-OAD antibodies, the number of HLA-DR+ lymphocytes, and therefore allows to prolong the period of remission of the disease compared to the control group.

Thus, from the above it follows that chronic furunculosis occurs under the influence of a complex set of etiological and pathogenetic factors and cannot be considered only as local inflammation. Patients with chronic furunculosis need to undergo a comprehensive examination in order to identify possible foci of chronic infection, which are the source of septicemia and, if the elimination of microbes in the blood is impaired, as a result of a decrease in the immunological reactivity of the body, lead to the appearance of boils.

Since the prescription of immunocorrective drugs can cause an exacerbation of the underlying disease, we believe that treatment of patients should begin with the sanitation of identified foci of infection. The question of prescribing immunocorrective drugs should be decided individually, taking into account the stage of the disease, the presence of concomitant pathology and the type of immunological defect. If sensitization to various allergens is detected in a patient, treatment of furunculosis must be carried out against the background of anti-allergy therapy.