When eczema develops on the face, it is sometimes difficult to refrain from erasing it. Most of us are not aware, however, that it can have health-threatening consequences.
- The death triangle is the area between the corner of the mouth of the upper lip and the top of the nose pyramid
- Manipulating pimples in this area can lead to inflammation that will spread rapidly to the inside of the skull
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If you draw straight lines between the corners of the upper lip and the top of the nose pyramid, a triangle is formed, what clinicians call the triangle of death. There is no exaggeration in this name, as manipulating the pustules that appear in this area can lead to inflammation that will spread rapidly to the inside of the skull. Believe me, a seemingly harmless pimple or boil on the nose or upper lip, if not properly treated, can lead to intracranial complications. It is related to the specific arrangement of the venous vessels in this area.
A bit of anatomy
To understand why you shouldn’t squeeze the pimples that have formed in the death triangle, it’s important to understand the anatomy of this part of our body. The venous vascularization of the death triangle is unique due to the existence of two venous outflows at this site. One leads through the facial vein to the internal jugular vein, the other through the angular vein and the superior and inferior ophthalmic veins to the cavernous sinus. The angular vein is the initial segment of the facial vein. It is located in the medial corner of the eye and is formed from the junction of the supra-orbital vein with the nasofrontal vein, i.e. the initial inflow of the superior ophthalmic vein. These veins do not have valves, and this promotes backflow of the venous blood.
The cavernous sinus, which collects venous blood from the upper lip, nasal cavities, paranasal sinuses, nasopharynx, pharynx, and eye sockets, is irregular in shape. It has a spongy structure formed by multiple connective tissue trabeculae. It is they that slow down blood flow, which promotes the formation of clots during the inflammatory process.
Dangerous boils
The boil is most often formed around the nose or upper lip. It is acute, limited, and deep necrotizing inflammation of the hair follicle, sebaceous or sweat gland and the surrounding dermis. Boils usually form when the skin is infected with staphylococcus. The development of infection is favored by: mechanical and chemical injuries, metabolic disorders, hormonal disorders, hidden infection foci and improper hygiene.
Boils develop very quickly. Within a few hours, a high temperature and painful swelling develops, which can spread to the upper lip, the wings of the nose, the cheek and even the eyelids. The boil can be compared to a mole built by a mole. A purulent pustule is visible on its top, and a plug of necrotic tissue inside. If the sick person does not receive proper treatment promptly, their condition will worsen and the ulcers will widen. The infection will travel through the veins to the cavernous sinus, where it will cause thrombosis.
In order to prevent this from happening in the case of facial soft tissue inflammation, manipulation, squeezing lesions or surgical drainage are strictly prohibited.
In the initial period, when the lesion is limited to the hair follicle, topical antibiotic ointment or 3% compresses are used. baking soda or Rivanol solution at a concentration of 1: 1000. Rapid hospitalization is required if a boil is formed or swelling is spreading within the face, but doctors have been able to prevent intracranial complications. Patients are also given broad-spectrum antibiotics against staphylococci. The treatment lasts for two weeks. It is also recommended to limit speaking so that vibrations of the tip of the nose do not contribute to the flow of infected blood into the cavernous sinus.
Neglecting such procedures, and above all squeezing the contents of the boil, may lead to thrombophlebitis of the face and orbital veins, orbital tissue inflammation or the aforementioned cavernous sinus thrombosis.
The most serious of these and requiring a separate discussion is cavernous sinus thrombosis.
Cavernous sinus thrombosis
Cavernous sinus thrombosis is the most severe complication of nasal or upper lip boils. This severe intracranial complication may also be associated with inflammation around the teeth, middle ear, sphenoid, frontal and ethmoid sinuses, and nasal septum abscess.
Infections most often develop after being infected with staphylococcus or other aerobic and anaerobic bacteria.
The disease develops rapidly, within 1-2 days. Local symptoms include increasing pain in the depths of the eye socket, conjunctival hyperaemia, eyelid edema, exophthalmos with immobilization of the eyeball, dilation of the pupils with no reaction to light, gradual loss of vision, photophobia, swelling of the skin around the eye, and facial skin hyperesthesia. There are also facial nerve paralysis. The symptoms appear symmetrically.
The general symptom is hectic fever (several days of very high temperature, then its significant decrease, the phases repeat) with chills, increasing headache, vomiting, disturbed consciousness, variable heart rate and the so-called septic enlargement of the spleen. Gradually, meningeal symptoms also appear, which indicate that the central nervous system is involved. Patients die of meningitis and sepsis.
Both the diagnosis and treatment of cavernous sinus thrombosis require the cooperation of many specialists. It is also necessary to perform many tests that will give the answer about the patient’s condition.
The great art is the almost immediate introduction of intensive parenteral antibiotic therapy, anticoagulant therapy, corticotherapy and general intensive care. The administered antibiotics must have a very broad spectrum of activity. They are usually given for two weeks. Surgical treatment, i.e. cleansing drainage, is used only when the infection comes from the paranasal sinuses, nasal septal abscess, orbital abscess or retrobulbar abscess.
Self-removal of smaller or larger pimples from the face, especially in the death triangle, can have serious consequences. Therefore, people with serious skin problems, prone to acne or the formation of boils, should be under the care of dermatologists who, by selecting appropriate ointments and preparations for washing the face, will protect them from the unpleasant consequences of infections of the soft tissue of the face.
You can make an appointment with a dermatologist via Medonet Market.
Text: Anna Jarosz