Phlegmon – what is behind the infection?

Phlegmon - what is behind the infection

Phlegmon is a bacterial skin infection with severe consequences if left untreated. The phlegmon can be treated well with antibiotics, but the advanced phlegmon can lead to an operation. Fingers, hands, feet or legs are often affected, but phlegm can also appear on the face. Read here how the infection develops, its symptoms, and how the therapy is carried out.

Definition of phlegmon

Phlegmon is one of the so-called soft tissue infections. The skin and subcutaneous tissue (subcutis) are affected, in which the bacterial infection spreads extensively via the lymphatic gaps. A distinction must be made between phlegmonous inflammation or limited phlegmon, which does not go deeper than the subcutaneous tissue, and advanced or severe phlegmon. In this form, the connective tissue is involved, and the purulent inflammation can also affect the tendons, fascia, and muscles.


Causes: How do you get phlegm?

The cause of phlegmias is bacteria. Staphylococci are the most common, followed by streptococci or a mixed infection. So-called anaerobic bacteria are rarely responsible. The typical pathogens are part of the natural skin flora and penetrate the deeper skin layers as part of a minor injury. These can be cuts and tiny openings in the cuticles, which are initially not considered pathological. Often, the entrance gate cannot be seen from the outside.

Very often, phlegmias develop on the fingers and hands since these are most likely exposed to minor injuries in everyday life. But toes, feet, legs, eyes, and face can also be a portal of entry for the pathogens via skin lesions.

Sometimes phlegm can also spread after an insect bite, especially if you give in to the itching and scratching, which carries the bacteria from the superficial layer of the skin into the deeper layers.

Immunosuppressed particularly endangered by phlegmon

Our body’s defence system, with its various skin barriers, defence cells and immune messengers, normally prevents pathogens from penetrating or renders them harmless in good time. Above all, people with a weakened or, in extreme cases, failed immune system are particularly at risk from soft tissue infections. Diabetes mellitus, circulatory disorders, lymphoedema, chronic wounds and pre-existing ulcers ( ulcers ) are also risk factors.


Symptoms: What does phlegmon look like?

A phlegmon can cause different symptoms:

  • Starting from a minor injury, a flat, dark red to bluish discolouration and overheating of the skin develop in the early stages.
  • The area is painful, swollen and tender to touch.
  • If fascia and tendons are already affected, movement makes the pain worse.
  • Additional symptoms include a general feeling of illness, a high fever and swelling of the neighbouring lymph nodes (lymphadenitis).
  • If the infection progresses via the lymphatic system (lymphangitis), a red stripe, often incorrectly interpreted as “blood poisoning”, can become visible and spread towards the body’s trunk. However, lymphangitis occurs not only with cellulitis but also with other soft tissue infections.

Diagnosis of cellulitis

In addition to the clinical findings, the blood’s inflammation levels are recorded to make the diagnosis. In addition, attempts are made to determine the pathogen using blood cultures, biopsies or swabs.

In addition, imaging procedures such as sonography, CT or MRI can be used. This is particularly relevant to show the spread under the skin that is not externally visible and possible abscess formation.

Phlegmon or erysipelas?

Sometimes, it is challenging to distinguish cellulitis from erysipelas. This is also a soft tissue infection limited to the top layer of skin. Unlike cellulitis, the skin is flaming red and overheated, with a sharp boundary from healthy skin. Erysipelas can turn into cellulitis if the bacteria penetrate the deeper layers of the skin.


How dangerous is cellulitis?

Bei der Phlegmone handelt es sich um eine potenziell lebensbedrohliche Infektion. Die lebensgefährliche Ausbreitung der Bakterien in die Blutbahn (Sepsis) muss in jedem Fall verhindert werden.

Eine weitere mögliche Komplikation ist die Abkapslung der Bakterien in einem Abszess, welcher immer operativ behandelt werden muss.

Bei unbehandelter Erkrankung stirbt das betroffene Gewebe unweigerlich ab. Es entstehen Nekrosen, die zu einem Verlust des Körperglieds führen können.

Sonderformen der Phlegmone

Ebenso gefürchtet ist die sogenannte V-Phlegmone. Sie betrifft die Hand und beschreibt eine V-förmige Ausbreitung der Phlegmone über die miteinander verbundenen Sehnenscheiden des Daumens und des kleinen Fingers. Die Therapie ist schwierig, erfolgt immer operativ und die Komplikationsrate ist beträchtlich.

Auch die Orbitaphlegmone stellt ein gefährliches Krankheitsbild dar. Die Infektion der Augenhöhle (Orbita) entsteht durch die Ausbreitung einer Entzündung aus einem anderen Bereich des Kopfes, beispielsweise als Folge einer Nasennebenhöhlen- oder Zahnentzündung. Gefürchtet sind in diesem Zusammenhang die Sinusvenenthrombose (Verschluss der Hirnvenen) und auch die Erblindung durch Übergreifen der Phlegmone auf den Sehnerven.

Wie behandelt man eine Phlegmone?

Die Therapie der Phlegmone besteht aus der Bekämpfung der Bakterien mittels Antibiotika, der lokalen Behandlung und Spülung mit antiseptischen Lösungen und nicht selten der Operation.

Wird die Infektion rechtzeitig erkannt, kann sie gut antibiotisch behandelt werden. Das Antibiotikum wird zu Beginn oft intravenös verabreicht, sodass eine stationäre Behandlung erforderlich ist. Das betroffene Körperteil muss ruhiggestellt und hochgelagert werden, beispielsweise mit einer Gipslonguette (einer speziellen Form des Gipsverbandes).

Hat sich die Infektion in die Fläche oder Tiefe ausgebreitet, ist eine Operation vonnöten, um das befallene Gewebe chirurgisch zu entfernen (Débridement). Manchmal muss die Wunde offen weiterbehandelt werden und wird beispielsweise mit einer Vakuumversiegelung bedeckt. Mehrere operative Eingriffe sind dann keine Seltenheit. Auch das Einlegen einer Drainage zum Abfluss des Wundsekrets ist gängig. Ist die Wunde vollständig von Bakterien gereinigt, wird sie chirurgisch verschlossen. Bei großer Wundfläche kann eine sogenannte plastische Deckung nötig sein, also die Verpflanzung (Transplantation) von Gewebe.


Wie lange dauert die Genesung?

How long you are sick after cellulitis depends entirely on the extent of the infection. Mild forms can be overcome quickly with antibiotics in tablet form. If an inpatient stay or even an operation is necessary, the treatment can extend over several weeks. If cellulitis is suspected, it is advisable to see a doctor immediately to avoid life-threatening complications.

Home remedies for cellulitis?

Home remedies are not an option for true cellulitis. However, suitable home remedies can help prevent cellulitis from developing. If there is slight redness and itching after an insect bite, cooling quark compresses, for example, can help prevent those affected from scratching the bite.

Antiseptic gels are even better because they are more hygienic. When applying the gel, care should be taken to ensure adequate hygiene to prevent bacteria from entering the bite wound, which could lead to phlegmasia. If the redness worsens or there is pain, overheating and severe swelling, you must see a doctor immediately.

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