Fungal foot infections used to be so common that few people could avoid getting infected. Fortunately, starting in the 1960s and 1970s, drugs became available that actually cured patients rather than just providing relief. However, to this day, mycosis of the feet remains the most common fungal skin disease, followed by ringworm in terms of prevalence.
The skin folds between the toes and the surface of the feet (especially the soles) are most commonly affected, but in rare cases even the hands may be involved. The appearance of the disease on the hands is explained mainly not by direct infection, but by the action of fungal toxins circulating in the bloodstream. On the other hand, when combing the soles, microorganisms end up under the fingernails, from where they can be transferred to other parts of the body, incl. and on the scalp. This simplest and most common way of spreading infection must be taken into account by people susceptible to mycoses. The risk group includes athletes and people who frequently visit swimming pools and public showers, and people who do not follow basic hygiene rules.
Mycoses of the feet are caused by several types of parasitic fungi. These microorganisms are found in abundance on the floors of swimming pools and baths, as well as in public showers at sports complexes. A person who walks barefoot in such places is simply asking for infection.
Wearing other people's shoes and sharing towels and other hygiene products is the second common way of transmitting infection.
If a person has once suffered a fungal disease, then re-infection occurs very easily.
The growth of the fungus is supported by a lack of proper foot hygiene: putting socks and boots on wet feet, reusing dirty socks, and not properly airing shoes between uses.
Mycosis of the feet manifests itself in a very diverse manner. The first signs of a fungal disease may be the appearance of cracks, painful or itchy blisters, diaper rash, and roughening of the skin such as corns. Then the affected areas of the skin soften, turn white and begin to peel off in flakes. Sometimes, due to bacterial infection, existing blisters turn into ulcers or ulcers.
Itching and burning sensations are an almost constant symptom of mycosis; sometimes patients complain of pain and unpleasant odor of the feet.
If signs of a fungal infection appear, you should consult a dermatologist. It is the doctor who must prescribe treatment. We are simply providing general guidelines and advice.
If you are already sick, remember that athlete's foot is a fungal infection, and fungi thrive and reproduce only in moist environments. By eliminating humidity, you will prevent these parasites from multiplying and spreading.
Try to protect your family members from infection. To do this, explain to them that they are no longer allowed to walk barefoot in the apartment, especially in the bathroom. If you have such an opportunity, use a shower stall rather than a bathtub. After taking a shower, be sure to treat the bathtub or shower tray, as well as the bathroom floor, with a disinfectant.
Every day before going to bed, wash your feet with regular soap and warm water, making sure that the skin does not get too wet and soft. Use a napkin to collect and wipe off all the loose pieces of skin, being careful not to get any of them under your nails.
Using toilet paper or a hair dryer, dry your feet thoroughly, especially between the toes. Then apply antifungal cream (if the blisters break or ooze) or ointment (if the affected areas are dry). Continue treatment for four weeks even if external symptoms disappear earlier.
If your skin is very inflamed, avoid using antifungal cream or ointment. Use powder in the morning. If the antifungal powder also causes irritation, use a starch- or talc-based powder. It is also good to pour this powder into your shoes every day.
Remember that antifungal creams and ointments themselves are irritating and should only be applied to dry skin. If your feet are prone to sweating, shoes should not be worn until the medicine has been absorbed.
Wear cotton socks, preferably white, and wear clean ones every day. When washing, soak socks in a chlorine bleach solution (not soap) or boil for 10 minutes. This will kill fungi on your clothes. Otherwise, cure is almost impossible, since re-infection will constantly occur. Shoes should also be disinfected with antifungal sprays and then left to air for a couple of days (preferably in the sun).
If your hands are affected, do not use antifungal agents until you have had your skin examined and diagnosed. Since if there are no microorganisms there, antifungal agents will be ineffective. When the disease on the feet passes, the manifestations on the hands will also disappear.
If necessary, the doctor can prescribe a strong and specific medicine, as well as write a prescription for a powder mixture to prepare a disinfectant solution for the feet.
In severe cases, it may be recommended to use combination therapy, which also includes physiotherapeutic procedures, as well as oral medications.
If a secondary bacterial infection occurs (it enters the skin through cracks and wounds), your doctor will prescribe antibiotics for local or systemic use.
Maintain hygiene: never walk barefoot, especially in public showers and locker rooms, wear fresh socks every day, after washing and thoroughly drying your feet and the spaces between your toes, and air your shoes well between uses.
Be sure to shower before and after swimming in the pool, and put on rubber slippers as soon as you get out of the water. In addition, you can consult with your doctor about the use of various preventive measures.
“The condition without which infection cannot occur is a violation of the integrity of the skin . Obesity and foot pathologies: calluses, flat feet and various deformities are factors that cause chronic trauma to the skin and nails of the foot when wearing shoes. The load on the foot due to obesity, friction of the skin of the deformed foot when walking, reduced trophism and skin regeneration in angiopathy predispose to the development of mycosis due to disruption of the unity of the epidermal barrier. The development of mycosis of the feet in patients with diabetic foot is considered a natural phenomenon.
The source of infection is a person suffering from mycosis of the feet or onychomycosis. The source of rubrophytosis of the feet, as a rule, should be sought in the patient’s family. Transmission factors include shared shoes, underwear, carpets, etc. Mycosis of the feet in one of the older family members, which is hidden by him or ignored, can serve as a source of skin infection, and then nails for the rest.
The following forms of mycosis of the feet are distinguished:
This form is also called plantar, or hyperkeratotic, with pronounced hyperkeratosis. Peeling of the arches of the feet on a slightly hyperemic background is characteristic. For the initial stages of the squamous form, moderate peeling of the sole and interdigital folds, small cracks are typical. Subsequently, the lesion spreads to the lateral surfaces of the feet, flexor and lateral surfaces of the fingers, where a border of exfoliated epidermis is noticeable.
This widespread form is characterized by the appearance of maceration and cracks in the fourth, less often in the third, interdigital and subdigital folds. Due to its frequent resemblance to diaper rash, the interdigital form is also called intertriginous.
The dyshidrotic form is manifested by numerous blisters located on the skin of the arch and inferolateral surface of the foot, as well as in the interdigital folds. The process usually begins from the area of interdigital folds.
Acute dermatophytosis of the feet is manifested by erythema, swelling, severe maceration with the formation of vesicles and blisters, abundant desquamation with the formation of erosions and ulcers.
Possibilities and means of treatment of mycoses of the feet
In the treatment of mycoses of the feet, both external and oral preparations can be used. External agents include antiseptics and antimycotics of almost all classes, produced in forms for application to the skin. Systemic antimycotics also include almost all classes, with the exception of those used only for deep mycoses.
Antimycotics and antiseptics are produced not only as the only active ingredient in external dosage forms. They are part of multicomponent preparations. These usually contain an antimycotic or antiseptic in combination with some other agent, usually an anti-inflammatory.
Principles and standards for the treatment of foot mycoses
Only external treatment is recommended if:
1. Nails are not changed
2. No damage to hands, folds or smooth skin
3. Medical history is not great
4. The patient has not previously been treated
Systemic therapy is recommended in all cases of dyshidrotic and widespread squamous form, with simultaneous involvement of acidic or smooth skin. When choosing a method of therapy, the doctor has to take into account not only the clinical features of the disease, but also the condition of the patient as a whole, the history of the present and concomitant conditions, and other factors.
Factors influencing the choice of external monotherapy for mycosis of the feet
The most common causative agents of mycosis of the feet are Trichophyton rubrum and Trichophyton mentagrophytes var interdigitale. Much less commonly, mycosis of the feet can be caused by Epidermophyton floccosum, as well as yeast and mold fungi. At the same time, cases of mixed lesions have increased significantly. The frequency of foot lesions caused by various dermatophytes varies widely: 70-95% of cases occur with Tr. rubrum, from 7 to 34% - on Tr. interdigitale and only 0.5-1.5% on E. floccosum.
Infection with mycosis of the feet usually occurs in showers, swimming pools, baths, and when using household items shared with a sick person (towels, sponges, shoes, socks, etc.). Predisposing factors are excessive sweating of the feet, flat feet, and wearing tight shoes.
The process can be asymptomatic for a long time or manifest itself with minor symptoms in the form of mild peeling, maceration of the epidermis in the interdigital folds, peeling on the arch of the feet, and occasional minor itching.
This condition can last for many months and years without causing any particular discomfort to the patient. The chronic course and unsystematic short-term, and therefore unsuccessful, attempts at treatment lead to the unjustified conclusion that the disease cannot be cured. At the same time, a long asymptomatic course creates the illusion that the disease is not dangerous and does not cause any problems. Both of these conclusions are completely incorrect, since the infection continues to spread to the nails and smooth skin. The patient is a source of infection, especially for family members and for those with whom they use showers and swimming pools. In addition, violations of the integrity of the skin can become an entry point for bacterial infection. For example, the clinical manifestations observed in the intertriginous form of mycosis of the feet are the result of the interaction of fungi and bacteria. Allergization of the body increases significantly. According to many authors, mycoses of the feet are one of the main causes of sensitization, the occurrence of contact dermatitis, as well as the transition of the latter to allergic dermatitis and eczema. The attached secondary microbial flora aggravates the course of the fungal disease, further reducing the body's defenses. In contact with fungi, such flora acquires increased resistance to antibacterial agents.
Under the influence of provoking factors, an exacerbation of the disease may occur: redness, cracks, maceration of the skin, blisters and blisters in the arch and lateral surfaces of the feet appear, and pain occurs, which intensifies when walking. Periods of exacerbation of fungal foot diseases are more often observed in the warm season. The natural result of the development of mycosis of the feet is fungal infection of the nails - onychomycosis.
Predisposing factors for the development of fungal infections of the feet, especially in the case of complications with eczematization and/or secondary infection, are also vascular diseases of the extremities, diabetes mellitus, repeated microtraumas, and disorders of the nervous, endocrine and immune systems. The disease often develops against the background of long-term use of drugs that suppress the body’s defenses (glucocorticoids, cytostatics, broad-spectrum antibiotics), and complicates the course of the diseases for which these drugs are prescribed.
Clinical manifestations of mycoses of the feet differ depending on the type of pathogen. T. rubrum affects the skin, toenails (less often the hands), as well as any part of the skin; sometimes vellus and long hair are involved in the process. T. interdigitale affects the skin and nail plates of the feet only.
With mycosis of the feet caused by T. rubrum , the disease begins with the interdigital folds, then the skin of the soles, lateral and dorsal surfaces of the feet, palms, as well as the nail plates are involved in the process. The skin becomes dry, thickened, with a pronounced pattern of skin furrows and flour-like or lamellar peeling. Rubromycosis is characterized by multiple lesions of the nails of the feet and hands according to the normotrophic, hypertrophic, atrophic type and the type of onycholysis. Leukonychia is sometimes observed - the appearance of spots and stripes of white color.
Damage to the skin of the feet with rubromycosis can be in the following clinical forms: squamous, intertriginous, dyshidrotic, squamous-hyperkeratotic with single or multiple lesions of the nails or without it. The disease in some patients is accompanied by itching. The squamous form is characterized by the presence of peeling on the skin of the interdigital folds, soles, and palms. With the intertriginous form, slight redness and peeling on the lateral contacting surfaces of the fingers, maceration, the presence of erosions, superficial or deep cracks in the folds are observed. This form can become dyshidrotic, in which vesicles or blisters form in the area of the arches, along the outer and inner edges of the feet and in the interdigital folds. Superficial bubbles open with the formation of erosions, which can merge, forming foci with clear boundaries. In the case of a bacterial infection, pustules, lymphadenitis and lymphangitis occur, and secondary allergic rashes may develop on the lateral and palmar surfaces of the fingers, palms, forearms, shins, and less often in other areas. In some cases, the disease becomes chronic with an exacerbation in spring and summer. In the squamous-hyperkeratotic form, the skin of the soles (palms) becomes reddish-bluish in color, and pityriasis-like peeling is noted in the skin grooves, which extends to the plantar and palmar surfaces of the fingers. There may be ring-shaped or plate-like peeling on the palms and soles. In some patients, it is insignificant due to frequent hand washing. Sometimes, along with peeling, areas of skin thickening such as callus are noted.
T. rubrum often affects large folds: inguinal-femoral, axillary, intergluteal, under the mammary glands. When the process generalizes, rashes can occur on any part of the skin. In rare cases, the skin of the scalp and face is affected. Sometimes the disease occurs as a suppurative trichophytosis.
On smooth skin, the lesions are irregularly shaped, with an intermittent ridge consisting of small fused pink nodules, scales and crusts, with a bluish tint and peeling; in the center the skin is bluish-pink. There may be nodular lesions. On the lower legs, these elements are located mainly on the extensor surface, sometimes adjacent to the hair follicles, grouped into open rings and garlands, and vellus hair is often affected.
Manifestations of rubromycosis on smooth skin can be varied and resemble eczema, psoriasis, lupus erythematosus and other skin diseases.
In children, lesions of smooth skin on the feet are characterized by fine-plate peeling on the inner surface of the terminal phalanges of the toes, most often in the 3rd and 4th interdigital folds or under the toes, hyperemia and maceration. On the soles, the skin may not be changed or the skin pattern may be enhanced; sometimes ring-shaped peeling is observed. The disease is accompanied by itching. In children, more often than in adults, exudative forms of lesions occur not only on the feet, but also on the hands.
With mycosis of the feet caused by T. interdigitale , damage to the 3rd and 4th interdigital folds, plantar surface, lateral surfaces of the foot and toes, and arch of the foot is more often observed. The clinical forms of the lesion are the same as for rubromycosis, but the disease often occurs with more pronounced inflammatory exudative phenomena, the development of allergic rashes on the skin of the upper and lower extremities, torso, and face.
Mycosis of the feet is characterized by damage to the nails, and more often it is multiple in rubromycosis and single (I and V toes) if the mycosis is caused by T. interdigitale. Damage to the nails can be distal (changes in the nail begin from the free edge), distal-lateral and proximal. There are several forms of nail damage:
- hypertrophic (in most cases) - thickening of the nail throughout its entire length due to subungual hyperkeratosis; nails become dull, dirty gray in color, loosened at the free edge;
- normotrophic - the normal configuration of the nails is maintained, but they become dull, with a yellowish tint at the free edge, with thickening in the corners of the plate due to the accumulation of horny masses;
- atrophic - the nails are significantly destroyed, as if eaten away at the free edge, the bed is partially exposed, covered with a layer of loose and dry crumbling masses;
- onycholysis type lesion - the nail plate is separated from the bed, sometimes dirty gray in color, at the base the normal color of the nail remains.
may occur .
With onychomycosis caused by T. interdigitale, the nail damage is more superficial than with rubromycosis. Clinical manifestations in children differ in that the configuration of the nail may not be changed, but the surface is rough or exfoliated, subungual hyperkeratosis is rarely observed, the color of the nails may not be changed, or there are stripes of yellow or brownish-yellow color, sometimes merging into spots.
Mycosis of the feet is characterized by a chronic course with frequent exacerbations. Exacerbations and exudative clinical manifestations are characteristic of young and mature patients, while a monotonous course of the “dry type” is characteristic of elderly and senile patients.
Mycosis of the feet in the elderly is usually a long-term mycotic process (a disease acquired in youth lasts a lifetime). The soles and interdigital folds are mainly affected; their skin is pinkish-bluish in color, dry, covered with small scales, especially along the furrows. The lesion involves the skin of the fingers, the lateral (often the back) surfaces of the feet. In areas of pressure and friction with poorly fitting shoes, much more often than at a young age, foci of hyperkeratosis with cracks appear (sometimes deep and painful, especially in the heel and Achilles tendon). With mycosis of the feet in the elderly, especially with rubrophytosis, multiple lesions of the nails are observed, most often occurring as a total dystrophy. This is due to the fact that 40% of patients with onychomycosis are people over 65% of years of age.
Diagnosis of mycosis of the feet is based on clinical manifestations and detection of the fungus during microscopic examination of pathological material. The type of pathogen can be identified by culture.
It is necessary to differentiate mycosis of the feet from dyshidrotic eczema, psoriasis, Andrews pustular bacterid, keratoderma; when lesions are localized on the legs - with nodular vasculitis, papulonecrotic tuberculosis, limited neurodermatitis; on the skin of the body - with psoriasis, superficial and chronic trichophytosis, infiltrative and infiltrative-suppurative forms of zooanthroponous trichophytosis, inguinal epidermophytosis; on the face - with lupus erythematosus.
Skin mycoses, even at the earliest stages of development, require mandatory treatment, the leading role in which belongs to antifungal drugs for external use, acting directly on the lesion.
External antifungal drugs must meet the following requirements:
- have sufficient antifungal activity, taking into account the frequent occurrence of mixed infections, as well as in some cases the impossibility of an in-depth examination to identify the type of pathogen, the spectrum of antifungal action should be wide (this means activity against the maximum number of pathogens of skin mycoses found in the region and mucous membrane);
- ensure a sufficiently high concentration of the antifungal substance in the surface layers of the skin;
- combine antifungal and antibacterial effects;
- do not have a local irritating effect;
- do not have an allergenic effect;
- be easy to use, and also have no color or odor, do not make the skin “greasy”, provide sufficient effect when applied no more than 1-2 times a day;
- have an affordable price;
— uninterrupted presence in the pharmacy network.
In this regard, an important role in the fight against mycoses is played by mycological, treatment and advisory scientific centers, which, having trained specialists and appropriate laboratory and clinical facilities, have the opportunity to provide effective assistance to patients, not only introducing the latest achievements, but also developing new drugs in relation to various clinical forms of fungal infection.
Derivatives of azoles, undecylenic acid, allylamines, morpholines, etc. are used as active ingredients in external dosage forms.
For squamous manifestations of mycosis, antifungal drugs are prescribed externally until the clinical manifestations resolve. In case of significant hyperkeratosis in foci of mycosis on the feet, the stratum corneum of the epidermis is first detached using keratolytic agents. In case of acute inflammatory phenomena (wetting, the presence of blisters) and severe itching, desensitizing and antihistamine drugs are used in combination with external agents that have an anti-inflammatory, antiseptic effect (in the form of lotions).
In case of ineffectiveness of external therapy, for common and often recurrent forms, systemic antifungal drugs are prescribed:
Terbinafine orally after meals 250 mg/day for 3-4 weeks or
Itraconazole orally after meals 200 mg/day daily for 7 days, then 100 mg/day for 1-2 weeks or
Fluconazole orally after meals 150 mg once a week for at least 3-4 weeks.
Systemic therapy is carried out taking into account compatibility with other drugs (especially when prescribing azoles) and possible contraindications (primarily liver pathology).
Various approaches to the treatment of onychomycosis have been described. The most obvious, but not always effective, is the removal of the affected nail plates followed by external use of antifungal drugs.
Systemic therapy , the most common method of treating onychomycosis today, ensures the penetration of antifungal drugs into the nails through the blood. Indicated in the late stages of the distal-lateral form of onychomycosis, with total damage to the nail, proximal forms of onychomycosis, involvement of more than 50% of the nail plate in the process, damage to many nails, the nail matrix, long duration of the disease. Additional arguments in favor of such therapy have been the results of recent studies, which have shown that with total onychomycosis, not only the nail plate can be affected, but also the underlying tissues: epidermis, connective tissue and even bone structures, in particular the medullary canal. These data, from the author’s point of view, make it necessary for total and proximal onychomycosis to take a rather long-term use of a systemic antifungal drug on a continuous basis, since modern keratophilic antimycotics, accumulating in the stratum corneum, where fungi are exposed to their action even during breaks in treatment, do not affect this period on fungi located in deeper structures, which may contribute to their survival.
Dwelling in detail on the pathogenesis of onychomycosis, A.Yu. Sergeev (2001) comes to the conclusion that the area of articulation of the nail plate and bed is the one that most fully satisfies the requirements for the fungal habitat. Here are the softer, ventral layer of the nail plate and the upper layers of the nail bed, away from the vasculature. Moreover, the articulation of the bed and the plate occurs due to their longitudinal strands, represented by coinciding grooves and ridges. The space between them is a potential location for a fungal colony. According to the author, the exceptional conditions for the reproduction and vital activity of fungi in this zone explain the high frequency of the subungual form of the disease.
The duration of therapy with systemic antifungal drugs is determined by the rate of nail growth. The mechanism of action of systemic antifungal drugs in accordance with this concept is reduced to suppressing fungal invasion during the growth of the nail plate. If the nail grows slowly, then a larger dose and duration of treatment are necessary.
Due to the fact that the “most convenient” localization described above is remote from the vascular network, access to it by systemic antifungal drugs is ensured only when they accumulate in the growing nail. At the same time, when using onycholytic agents and subsequent external use of antifungal drugs, the latter act as synergists, acting on the fungal mass in the opposite direction with systemic drugs.
Removing the affected nail plate , on the one hand, helps to destroy a significant part of the fungal cells, and on the other hand, it facilitates access of antifungal drugs used externally to the lesion. At the same time, the growth rate of the nail plate, i.e. “repressing” its affected part becomes less significant. In addition, the chances of providing an antifungal effect on subungual structures during breaks in taking systemic drugs according to an intermittent regimen increase.
The synergy between systemic and external treatment of onychomycosis is also due to the fact that the development of new systemic antifungal agents has moved towards obtaining highly active components with good bioavailability. The development of topical drugs focused on mechanisms for improving the delivery of the active substance through the nail plate.
Thus, from our point of view, it is legitimate to add to the proposed ways to increase the effectiveness of treatment of onychomycosis the removal of the affected part of the nail plate using an onycholytic method.
Combination therapy is especially indicated in elderly patients in whom the growth of the nail plate is slower, and therefore, to suppress the growth of the fungus with systemic drugs, higher doses and longer duration of treatment are required, which is associated with an increase in both the cost of treatment and the risk of possible side effects . It is necessary to take into account that in this category of patients, concomitant pathology is more common, which is a contraindication to the prescription of systemic antifungal drugs, as well as impaired peripheral circulation, which impairs the delivery of the latter to the lesion.
So, the following approaches to the treatment of onychomycosis can be distinguished:
1) local therapy:
a) with removal of the nail plate
- through the use of onycholytic agents;
b) without removing the nail plate (fungicidal varnishes);
2) systemic therapy:
— standard regimen (daily administration of an average therapeutic dose of the drug);
— a shortened regimen (usually with an increase in the daily dose);
- intermittent regimens (with an interval between courses comparable to the duration of treatment or longer);
3) combination therapy:
- combinations of certain systemic drugs;
- a combination of systemic drugs and local treatment, including with and without removal of the nail plates.
Some authors understand combination therapy as a combination of specific systemic treatment and pathogenetic methods of therapy, for example, agents that accelerate the growth of the nail plate. If necessary, any of the specific methods for treating onychomycosis should be used in combination with pathogenetic methods.
A combined treatment method, including terbinafine 250 mg/day + external use of antifungal drugs after removal of the affected part of the nail plate with an onycholytic agent, turned out to be the most effective. It exceeded the overall effectiveness of local therapy by 36.6%, systemic monotherapy by 8% and reduced the duration of treatment by an average of 8.6 weeks compared to local therapy and by 1.3 weeks compared to systemic therapy. Combination therapy made it possible to reduce the duration of taking a systemic antimycotic, which helped reduce the likelihood of developing possible side effects and, what is also very important, reduce the cost of treatment. This method of therapy turned out to be effective even in patients with the most severe manifestations of onychomycosis, which arose against the background of concomitant pathogenetically significant pathology.
Therefore, combination treatment is indicated for moderate lesions, although in this case systemic monotherapy can also be used. In severe cases, combination therapy has significant advantages over monotherapy. Moreover, achieving clinical remission is possible, as a rule, when using pathogenetic methods of treatment.
Combination therapy is especially effective in severe forms of onychomycosis, in elderly people due to the slow growth of nail plates; deterioration of peripheral circulation; the presence of concomitant pathology, making it necessary to reduce the course dose and duration of use of the systemic drug; in the presence of subungual hyperkeratosis or partial detachment of the nail plate, making it difficult for the systemic drug to penetrate into it; when the nail plates are affected only on the first fingers, since in this case it makes possible a significant reduction in the duration of use of the systemic drug.
Thus, today new methods and means of treating and preventing fungal diseases have appeared in the arsenal of dermatologists. They are available, safe, effective, i.e. meet all modern requirements. At the same time, timely consultation with a doctor, correct diagnosis and treatment adequate to the form and stage of the disease will save the patient from such a serious disease as fungal skin infection, or prevent its occurrence.
Prevention of mycosis of the feet comes down to personal (fighting foot sweating, etc.) and public (maintaining baths, showers in a hygienic condition) hygiene, sanitary and educational work.
Mycoses are a group of diseases that are caused by parasitic fungi (more than 400 species) and affect people, animals, insects and plants. There are ubiquitous (found everywhere), and there are endemic (you can only get infected with them in the countries of South America or Southeast Asia). Today, in the countries of the former CIS, superficial mycoses are most often found, since they belong to the category of contagious. We are talking about the following fungal diseases:
Superficial mycoses most often affect the skin and its appendages (hair, nails). Very rarely, the inflammatory process spreads to the underlying layers of the dermis. Usually the reason lies in an allergic reaction.
Most people may suffer from mycoses for years, but not even suspect it or mistakenly hope that the cause does not lie in them. Here is a list of the most common symptoms of skin fungi:
We should also talk about candidiasis, which affects both adults and children. According to statistics, every third person has encountered it at least once during their life. The causative agent is yeast-like fungi of the genus Candida, found in all countries, and most common in the tropics and subtropics. If we talk about the clinical picture, the following symptoms are characteristic of candidiasis:
Also very often affected are the interdigital spaces (in the form of cracks between the toes and hands), large folds (especially in obese people), and the skin under the mammary glands.
Much attention should also be paid to thrush, which is familiar not only to many girls, but also to men. Women usually encounter it after and before menstruation, during pregnancy. Men - after taking antibiotics and in the presence of infectious diseases (trichomoniasis, gonorrhea, etc.). The clinical picture looks like this:
In women, thrush, along with a rash on the labia, is also accompanied by swelling, a white coating and terrible itching. At the initial stage, it is easily treatable with antifungal drugs (Clotrimazole, Itraconazole, Fluconazole, etc.).
As for the selection of effective antifungal agents, you need to be careful, since without knowing the causative agent, you can aggravate your condition and “blur” the clinical picture, which will subsequently lead to long-term, expensive treatment. That is why we strongly recommend that when the first symptoms of mycosis appear, you contact a specialist (urologist, gynecologist, mycologist).
The disease mycosis of the skin is a fungal infection of the skin (see photo). The most common types are:
Mycosis of the skin, photo
Mycosis can be transmitted not only from humans, but also from animals - cats, dogs, rodents, cows, etc. Recently, the role of skin lesions by candida has increased significantly. There are several explanations for this:
In some cases, mycoses of the skin and nails occur with minimal clinical symptoms. Therefore, patients do not consult a doctor for help in a timely manner, which contributes to the disease becoming chronic. This creates significant difficulties for subsequent treatment.
With mycosis of the scalp, not only the skin, but also the hair is involved in the pathological process. The severity of involvement depends on the specific form of the disease.
Therefore, for early diagnosis of mycosis of the skin, a person needs to regularly examine his body, without waiting for intense subjective manifestations (itching and burning) to appear.
The causes of mycosis of the skin are fungi. With candidiasis they are opportunistic. Candida constantly lives on human skin, but under certain conditions they cause disease. In all other cases, mycosis is associated with pathogenic fungi.
Infection with mycosis occurs in different ways:
The presence of predisposing factors in a person significantly increases the likelihood of the disease. These factors include:
mycosis of the skin on the face photo
Skin infection with fungus during mycosis has its own specific symptoms, depending on the specific type of pathogen. However, there are also general signs, knowledge of which will help a person suspect a fungal infection:
photo of mycosis of the skin of the foot between the toes
The symptoms of mycosis of the skin of the feet and mycosis of the skin of the hands are significantly different from those discussed above, so we will dwell on them separately. Most often, interdigital folds are involved in the pathological process, but there may be inguinal, popliteal and others.
The main signs of the disease are:
Accurate diagnosis of this type of mycosis is made using microscopic examination. It makes it possible to identify fungal spores on the skin.
The main direction in the treatment of mycosis of the skin is antifungal therapy. Depending on the type of disease and the depth of the lesion, these drugs are prescribed locally or systemically. Often you have to combine these methods with each other.
At the same time, the prescription of keratolytic agents is required. They improve the process of skin renewal in areas where it is affected. A dermatologist selects effective medications; self-medication only wastes time.
It should be remembered that treatment of mycosis of the skin with folk remedies does not give results, so you should contact a specialist if you suspect this disease.
The most common skin mycosis in children is microsporia. Popularly this disease is called lichen. The causative agent is fluffy microsporum. It parasitizes the skin of domestic animals, causing infection.
However, in 2% of cases the disease can be transmitted from a sick child.
Infection with fungi occurs through close contact with animals or objects contaminated with spores. A common way to infect children is by playing in the sandbox. Microspores persist in sand for a long time, because they are very stable in the environment (can remain viable for up to 10 years).
Rashes on smooth skin with microsporia appear a week after infection. Their characteristic features are:
Treatment of mycosis in children depends on the involvement of vellus hair in the pathological process. If they are intact (healthy), then only local antifungal agents are prescribed:
If vellus hair is also affected, then Griseofulvin cannot be prescribed. This antimicrobial agent is metabolized in the liver, so throughout the treatment period biochemical blood tests are performed to monitor liver functions, and a gentle diet is prescribed.
The drug Griseofulvin for mycosis of the skin
Simultaneously with Griseofulvin, the child is lubricated with keratolytics (salicylic or benzoic acid). They exfoliate infected areas of the epidermis and promote its renewal.
To assess the effectiveness of treatment for microsporia, the doctor examines the child’s skin with a fluorescent lamp. In addition, microscopic analyzes of scrapings from lesions can be performed to identify fungi.
Analyzes are carried out several times:
Microsporia is considered cured if:
Not only treatment of mycosis of the skin with drugs contributes to recovery.
A number of important requirements must also be met:
Prevention of skin mycoses is carried out in several areas:
Mycoses are fungal diseases of the skin, its derivatives (hair, nails), mucous membranes and internal organs, which are infected through contact with a sick person or animal.
• deep mycoses (mycoses of the feet, etc.).
Keratomycosis is a fungal disease that affects the stratum corneum of the skin, occurs without any subjective sensations or inflammation, and does not affect skin appendages (hair, nails).
Factors causing keratomycosis:
• long-term use of glucocorticosteroids;
• increased blood sugar;
• wearing clothes made of synthetic materials;
• failure to comply with individual hygiene rules.
A fungal disease of the surface layer of the epidermis is caused by the fungus Pityrosporum obiculare. Foci of infection are detected mainly on the neck, chest, back, and shoulders. In most cases, young people get sick.
When examining the patient, the following is found:
• pink-brown spots on the skin;
• pityriasis-like peeling of the skin (intensive peeling occurs after exposure to UV rays).
Erythrasma is a fungal disease of the surface layer of the epidermis, also called pseudomycosis. Its causative agent is the fungus Corynebacterium minutissimum. Infection occurs mainly through contact with a sick person, as well as through the soil (when walking barefoot).
The lesions are mainly localized in the inguinal-femoral folds, armpits, under the mammary glands, in the navel, abdominal folds, interdigital areas of the foot, on the head and foreskin of the penis. The disease is mainly observed in adults, more often in men.
• yellow-pink or red-brown spots of a round shape with clear boundaries on the skin;
• smooth or with fine flaking (soft to the touch);
• itching, pain (if complicated).
Dermatophytosis is a fungal skin disease that affects the epidermis and skin appendages, occurring with inflammatory reactions.
Factors causing dermatophytosis:
• contact with sick animals;
• metabolic disorders, hypo-, avitaminosis;
Trichophytosis is a fungal disease of the skin and its appendages. The causative agents are anthropophilic (parasitic on humans) and zoophilic (parasitic on animals) fungi of the genus Trichopyton. Anthropophilic fungi cause superficial, and zoophilic fungi cause infiltrative-suppurative trichophytosis. Mostly animals get sick, less often people (livestock breeders).
With superficial trichophytosis (ringworm), the lesions are localized on the scalp, torso, and nails. Mostly children get sick. Infection occurs through contact with a sick person or animal, as well as through personal items (hats, combs, etc.).
When examining a patient you may find:
• round spots of pink-red color with scales, and small bubbles and crusts all around (when the skin is infected);
• gray-white scales with flaking on the scalp and black dots in areas of extensive hair loss;
• thickening, lumpiness, unevenness, brittleness of the nail plates, gray-white spots along the edge of the nail (if the nails are affected).
With infiltrative-suppurative trichophytosis, the source of infection is an infected animal, less often a person. The lesion is localized on the surface of the skin, scalp, beard, and mustache. The disease does not recur.
When examining and questioning the patient, the following is revealed:
• rounded infiltrate on the skin of a bluish-red color with a diameter of 6-8 cm;
• hair loss due to enlargement of the mouths of hair follicles;
• pain and protrusion of pus in the form of drops, and sometimes in the form of a stream when pressing on the follicles;
• malaise (fever, swollen lymph nodes).
This mycosis, caused by fungi of the genus Microsporum, affects the surface of the skin and hair. Infection occurs mainly from humans and animals (cats and dogs), most often in childhood, rarely in adults (in most cases in women with sensitive skin). Mycosporia differs from trichophytosis in that its lesions have dissemination, that is, they can spread throughout the body and merge into a large lesion.
When examining the patient, the following is revealed:
• gray-white scales on the skin in the form of rings that overlap each other, sometimes merging;
• extensive hair breakage at a short distance from the skin. The hair becomes covered with a gray-white coating (fungal spores).
A fungal skin disease caused by the fungi Trichophyton rubrum, Trichophyton interdigitale, Trichophyton tonsurans, etc. The causative agents may be Microsporum canis and Epidermophyton floccosum.
For nail lesions, three subtypes of onychomycosis are also distinguished: normotrophic (yellow coloring of the nails and their thickening), hypertrophic (brown-gray nails with thickening, deformation, partial destruction), onycholytic (brown-gray color of the nail plate with atrophy and rejection of the nail from the bed) .
When examining the patient, the following is established:
• change in color (yellow or brown) of nails depending on the type of onychomycosis;
• change in the shape and condition of the nail depending on the type of disease (thickening, deformation, crumbling, atrophy, etc.).
Candidomycosis is a fungal disease that affects the skin, mucous membranes (oral cavity, vagina, intestines, urinary tract, etc.), caused by the yeast-like fungi Candida albicans.
Factors provoking candidiasis:
• decrease in the protective properties of the body;
• treatment with antibiotics (often leads to dysbacteriosis), glucocorticosteroids, cytostatics;
• unprotected sexual intercourse;
• overheating or hypothermia;
• excessive alcohol consumption.
Fungal infection (candidal stomatitis) affects the inner wall of the cheeks, tongue, and can spread to the tonsils, pharynx, corners of the mouth, and intestines (in severe cases).
• white cheesy plaque in the mouth. When scraping the area of the mucosa, an inflamed area or ulcers are observed;
• dryness and cracks in the corners of the mouth;
• malaise, increased body temperature (with candidiasis of the tonsils and pharynx).
This is a severe form of dysbiosis, when the body does not receive vitamins and other useful substances. In children, the disease manifests itself in stunted growth and weight loss.
When examining the patient, the following is noted:
• dyspeptic disorders (diarrhea, gas formation, etc.);
• an admixture of white flakes in the stool.
This type of candidiasis is associated with a violation of the microflora of the mucous membranes of the genital organs. In women, as a rule, it manifests itself as vulvovaginitis, in men - balanitis or balanoposthitis. The disease is transmitted sexually and both partners are subject to treatment.
Upon examination and questioning of the patient, the following is discovered:
• itching and burning of the vagina and vulva;
• curdled vaginal discharge;
• pain during sexual intercourse, urination.
When examining and questioning the patient, the following is established:
• burning and itching on the head, foreskin of the penis;
• redness on the head of the penis (a white coating may be observed);
• pain during sexual intercourse, urination;
• white discharge when urinating.
Mycosis of the foot is a fungal disease of the skin and its appendages on the feet.
Factors causing mycoses of the feet:
• endocrine system disorder;
• failure to comply with personal hygiene rules;
• circulatory disorders in the lower extremities, overheating or hypothermia;
• microtraumas in interdigital folds, foot cracks;
• direct contact with a sick person.
This is a fungal skin disease caused by the fungus Trichopyton mentagrophytes var.interdigitale. The pathology has several forms - erased, squamous, intertriginous, dyshidrotic.
The main signs of the erased form of athlete's foot
The erased form is the initial stage, in which the folds between the toes are affected.
• slight peeling of the skin;
In the squamous form, lesions appear on the lateral arches of the feet and the lateral surfaces of the fingers.
• rash in the form of gray-white flaky scales;
In the dyshidrotic form, the arches of the feet are affected; foci of fungal infection are localized in large areas of the sole, on the skin of the fingers and in the interdigital folds.
• bubbles with a thick tire, when opened, weeping pink erosions are formed.
In the intertriginous form, the lesions are located on the interdigital folds.
When examining and questioning the patient, note:
• wet round red diaper rash;
Fungi affect the skin and nails of the feet, and sometimes occur on the hands. The causative agent is the fungus Trichophyton rubrum.
• dryness, thickening and redness of the skin of the feet, damage to the entire foot including nails and vellus hair;
• small scales and small blisters (with rubrophytosis of smooth skin);
• severe itching (if the lesion is located in the folds).
Basically, diagnostics includes examination by a specialist (dermatovenereologist, gynecologist, etc.), studying the patient’s medical history and laboratory tests (general blood and urine tests, culture of samples from the patient on nutrient media and microscopic diagnostics to identify a certain type of fungus).
To confirm the diagnosis of pityriasis versicolor, the Balzer test is used: the affected area, as well as adjacent healthy areas of skin, are treated with a 5% alcohol solution of iodine, and the affected areas are stained more intensely than the surrounding healthy skin.
They also use examination of lesions under a Wood's lamp (yellow light) and microscopic examination of scales for the presence of fungus.
To achieve a positive result during treatment and prevent relapse of the disease, antifungal drugs are prescribed both locally and orally.
Treatment of patients with chronic forms is much more difficult. With improper therapy associated with inaccurate dosage and duration of treatment, as well as individual immunity to a certain group of antifungal agents, complications and (or) relapses may occur.
Therefore, bacteriological cultures should be carried out to establish sensitivity to certain antifungal drugs.
Fungi can quickly become resistant to antifungal agents that are used repeatedly. As a rule, antifungal drugs are also widely used: griseofulvin, levorin, fluconazole, amphotericin B, clotrimazole, terbinafine, triiodresorcinol.