Vulvar abscess

　　1. Etiology: Due to the moist and sweaty vulvar area, the skin is prone to friction and damage, and bacteria enter and cause abscesses. In addition, vitamin deficiency, patients with vulvovaginitis, diabetes, nephritis, and those with long-term use of glucocorticoids and low body immune function are prone to disease; patients with vulvar pruritus and those who do not pay attention to cleaning the vulva are also prone to infection.

　　2. Pathophysiology: Most Staphylococcus aureus can produce coagulase, hemolysin, enterotoxin, and epidermal desquamation toxin, which have strong resistance to external factors, can survive for several months in a dry environment, and can only be killed by heating to 80℃ for 30 minutes. Staphylococcus aureus has strong virulence and often forms abscesses locally. The inflammation can also spread to the subcutaneous tissue.

　　3. It is an acute diffuse inflammation of the subcutaneous, fascial, muscle gap, or deep蜂窝组织. The causative bacteria are mainly hemolytic streptococcus, followed by Staphylococcus aureus and anaerobic bacteria. The inflammation is caused by skin or soft tissue injury.

　　If vulvar abscess is not treated in time, there may be metastatic abscesses, and invasion into the blood can cause sepsis, and scars may also remain. Abscesses can also bring inconvenience to the daily life of women, so it is necessary to treat them in time.

　　At first, the skin around the hair follicle opening is slightly congested and painful, gradually forming a purple-red hard nodule higher than the surrounding skin. The skin surface is tense, with tenderness, unclear edge of the nodule, often accompanied by swelling of the inguinal lymph nodes. Later, the abscess center becomes soft, the surface skin becomes thin, and there is a fluctuating sensation. Subsequently, a yellowish-white dot appears at the central apex, and soon it breaks open, and the pus is discharged. After the pus is discharged, the pain decreases, the redness and swelling disappear, and it gradually heals.

　　Prevention:The main way to prevent the recurrence of abscess disease is to prevent auto-inoculation. Nasal carriage of bacteria is an important factor in the recurrence of abscess disease, followed by the carriage of bacteria around the perianal area and adjacent areas. Therefore, these parts should be cleaned with antibacterial soap every day, change underwear and pants frequently, and wash hands often. Apply antibiotic ointment to the wings of the nose, 2 times a day; apply bacitracin or mupirocin ointment to the nasal cavity, 2 times a day. Take systemic oral antibiotics, rifampin 0.5g combined with cloxacillin sodium 0.5g, 4 times a day, for a total of 10 days. In addition, polyvalent staphylococcal vaccine or autogenous vaccine can be used for subcutaneous or intramuscular injection. Patients with abscess disease often have low serum zinc levels. After taking zinc sulfate oral solution, the serum zinc level returns to normal, which helps to prevent abscess disease.

　　Patients with vulvar abscess need to undergo gynecological examination and skin examination, as well as laboratory tests for elevated white blood cells and neutrophils in the blood. Carry out pus pathogen culture and drug sensitivity test.

　　Boil abscess is a common disease, which generally does not threaten life, but it can be quite annoying when it occurs. From the perspective of Western medicine, boil abscess is merely an acute suppurative infection of the hair follicle and its associated sebaceous glands, often extending to the subcutaneous tissue. The causative bacteria are mostly Staphylococcus aureus, which is prone to occur on the neck, head, face, and other parts, as well as areas rich in hair follicles and sebaceous glands. Clinically, children are more susceptible to this disease, followed by the elderly and new mothers. It is more common in summer and autumn, and those occurring during the hot season are called 'summer boils' or 'heat boils'. According to its course, it can generally be divided into three stages. In the early stage, the patient's skin locally becomes red, hot, painful, with a shallow root and limited swelling, usually within 3 to 6 centimeters, and may be accompanied by varying degrees of thirst, constipation, and yellow urine, etc., symptoms of heat. It is advisable to take drugs with heat-clearing and detoxifying properties. Osmanthus flower and herba agastaches decoction: 3 to 5 withered osmanthus flowers, 15 grams of fresh herba agastaches, 30 grams of rock sugar. Wash the osmanthus flowers and fresh herba agastaches clean, add two cups of water, simmer over low heat until one cup remains, mix in rock sugar and stir well, cool, and take it all at once, twice or three times a day. Fresh dandelion fried eggs: 30 grams of fresh dandelion, two eggs, 50 grams of vegetable oil. Wash the fresh dandelion clean, cut into 1 to 2 centimeter long pieces, mix with the eggs, add a little salt, heat the vegetable oil and fry the eggs into a cake, and it is ready to eat. The formation of pus stage starts 3 to 7 days after onset, the local swelling increases, it is slightly hard around the edges when pressed, with yellowish-white pus heads in the middle, with pain and symptoms such as dry mouth, irritability, constipation, etc., it is advisable to eat food with detoxifying, reducing swelling, and cooling blood. Cold dish of purslane: 500 grams of fresh purslane, appropriate amounts of sugar, vinegar, sesame oil, etc. Wash and cut the purslane, blanch in boiling water, add sugar, vinegar, and sesame oil and mix well, serve as a side dish. Bitter melon mung bean rice soup: 150 grams of bitter melon, 250 grams of mung bean, 50 grams of Job's tears, 250 grams of lean pork. Wash and slice the bitter melon and lean pork, set aside. Boil the mung bean and Job's tears for 10 minutes, add the bitter melon and lean pork, and cook over low heat until the mung bean is soft. A little salt can be added, and the soup is drunk while eating the residue. Fresh lotus leaf and honeysuckle soup: 50 grams of fresh lotus leaf, 15 grams of honeysuckle, 100 grams of mung bean. Boil the mung bean in 1500 milliliters of water, remove the mung bean after boiling for 10 minutes, then add the washed honeysuckle and lotus leaf, boil again, cool, and drink. If constipation occurs, you can use 10 grams of rhubarb, infused with boiling water, as tea. In the late stage, 5 to 10 days after onset, the swelling is localized, pus is released, swelling subsides, pain stops, and the wound heals as the opening contracts. At this stage, generally no treatment is needed, but those with weak physical constitutions should eat some Qi-tonifying and Yin-nourishing foods for nourishment. Astragalus and red date porridge: 30 grams of Astragalus, 30 grams of red dates, 1 gram of dried tangerine peel powder, 3 grams of chrysanthemum, 100 grams of glutinous rice, 30 grams of brown sugar. Boil Astragalus, red dates, and chrysanthemum to extract juice, add glutinous rice and brown sugar to cook, add dried tangerine peel powder when the porridge is about to be done, and it is ready to eat after slight boiling. Silver ear porridge: 10 grams of silver ear, 10 grams of honeysuckle, 5 grams of Astragalus, 15 grams of rock sugar. Soak the silver ear in clean water for one hour, wash it, and add some clean water. Boil Astragalus and honeysuckle to extract juice and mix with the clean water, simmer over low heat until the silver ear is soft and the soup is thick, add rock sugar, dissolve, and it is ready to eat. Cordyceps braised chicken: 30 grams of cordyceps, 30 grams of Codonopsis pilosula, 30 grams of Chinese yam,One young chicken, a little salt, monosodium glutamate and other seasonings. Kill the young chicken clean, cut into 5 cm cubes, put into boiling water, blanch for a few minutes, take out, wash the blood water, and put it with the cut out polygonatum sibiricum, codonopsis pilosula, and houttuynia in a container, then put it into an electric rice pot with a certain amount of water and steam for three hours, eat on an empty stomach, suitable for those with weak spleen and stomach after boils.

　　1. Systemic treatment Those with severe lesions or systemic symptoms should take oral or intramuscular or intravenous anti-inflammatory drugs, and antibiotics can be selected according to the pus culture and drug sensitivity when necessary.

　　2. Local treatment can use potassium permanganate solution (1:5000) sitz bath, dry after wiping, and if there is no abscess head, 2% iodine tincture can be applied externally, or 10% ichthyol ointment and osmanthus leaf ointment can be applied externally every day. For those who have formed abscesses, immediate incision and drainage should be performed to remove pus, and do not squeeze to avoid causing blood spread.

　　3. Physical therapy In the early stage of the disease, hot water bag heat application, 75% ethanol moist heat application, ultraviolet, shortwave, diathermy therapy, etc., are all helpful to reduce pain, inflammation subsidence or promote abscess maturation and softening.

　　4. Keep the vulva clean. Early use of potassium permanganate solution (1:5000) warm water sitz bath, then apply antibiotic ointment to promote inflammation subsidence or limitation. Infrared ray can also be used to soften boils. Those with obvious inflammation or fever should take oral antibiotics. Some advocate using penicillin 200,000 to 400,000 units dissolved in 0.5% procaine 10-20ml for closed treatment, and injection should be made 2-3cm outside the edge of the boils. When the boils become soft and fluctuant, incision and drainage should be performed. The incision should be appropriately large to allow the smooth discharge of pus and necrotic tissue. But be careful not to squeeze to avoid the spread of inflammation.