Mycosis of the skin is the current state of the problem. Results of a multicenter study to study the incidence of superficial skin mycoses in the regions of the Russian Federation and evaluate the effectiveness of their treatment with sertaconazole. Mycoses of smooth skin

Inflammation of the lung tissue (pneumonia) is popularly called "pneumonia". Having heard such a diagnosis, even the patient who is farthest from medicine understands that the matter is serious, and ordinary raspberries and honey cannot be dispensed with.

Inflammation of the lungs develops against the background of a weakened immune system (in the elderly, with chronic diseases, etc.). The level of treatment of pulmonological patients today is quite high. The main success in the treatment of pneumonia is timely therapy, when the pathological focus has affected the smallest area.

The most common causes of pneumonia are:

• staphylococcus,
• streptococcus,
• moraxella,
• Pneumococcus,
• haemophilus influenzae.

Pneumonia can proceed classically or have erased symptoms. Typical (classic) symptoms include:

• increased body temperature (sometimes up to 40 ° C);
• lack of appetite or its decrease;
• general malaise;
• muscle pain;
• cough;
• chest or back pain;
• sweating;
• other.

Sometimes cough, fever and other severe symptoms are absent. Therefore, if fatigue, sweating and slight coughing do not go away for a long time, this is a reason to consult a doctor. The first steps towards treatment will be an x-ray of the lungs and a general blood test (always with a formula). These studies will help clarify the diagnosis, and determine the localization of the inflammatory process in the lung tissue.

Which doctor treats pneumonia?

Residents of small towns and villages do not always immediately have the opportunity to visit a specialized specialist - a pulmonologist. In this case, you should consult a therapist. Often, with mild forms of pneumonia (focal), it is enough to conduct an antibacterial course in tablets at home.

If pneumonia has already “gained momentum”, treatment should be carried out only in a hospital setting. To quickly eliminate pneumonia, injectable antibacterial agents are used (injections are performed intramuscularly or intravenously). The tactics of treatment is determined by the doctor, depending on the severity of the inflammation.

What medicines are used to treat pneumonia?

The drugs of choice number 1 are antibacterial agents. The following drugs are considered the most popular:

Antibacterial therapy for pneumonia is 10-14 days (depending on the severity of the inflammatory process). After the course of treatment, a control x-ray of the lungs is performed. And now, let's look at the most popular tools from this list.

Amoxiclav

This tool consists of two active ingredients - amoxicillin and clavulanic acid. Amoxiclav has moderate toxicity compared to antibiotics of other pharmacological series.

Clavulanic acid is a kind of assistant to amoxicillin. It inhibits the action of beta-lactamases (a group of bacterial enzymes), which have learned to resist antibiotics quite well.

• In addition to pneumonia, amoxiclav is used for sinusitis, cholecystitis, tonsillitis, otitis media, pyelonephritis and other infections.
• Amoxiclav is contraindicated in case of intolerance to the two main substances of which it consists, as well as pseudomembranous colitis, severe pathologies of the kidneys and liver. With prolonged use and the use of high doses, side reactions such as dyspepsia, allergic rash, fungal lesions of the mucous membrane, and others are sometimes observed.
• The dosage of the drug depends on the form of application, therefore it is prescribed strictly individually. The general condition of the patient and associated pathologies are also taken into account.

For ease of use, the manufacturer offers the following dosage forms: tablets, suspension (powder), solution (powder). Pharmacy prices fluctuate. For example, a powder for the preparation of a solution for injection and tablets in a dose of 500 mg cost about 400 rubles. Powder for the preparation of a suspension (400 mg) - 200 rubles.

Sumamed

Currently, sumamed (azithromycin) has gained particular popularity. Firstly, it has a wide spectrum of antibacterial activity, and secondly, it is convenient to use (tablets are taken once a day for 3-5 days in a row). Azithromycin dihydrate (the main substance of sumamed) is used not only in the form of tablets, but also in powder, capsules, suspensions. And that is not all. Sumamed has a liquid form (infusion bottles).

Sumamed is effective in many infectious processes caused by the reproduction of pathogenic microflora. I often prescribe it for bronchitis, pleurisy, pneumonia, as well as ENT infections: sinusitis, otitis, tonsillitis. Infectious diseases of the genitourinary system and skin no less need such a drug as sumamed.

• The drug is approved for use from the infancy period, starting from the age of six months (for suspension). If the weight of the baby is 5 kg, the dose of the suspension will be 2.5 ml. Solid forms of sumamed are allowed to be taken only from the age of three, when the child is able to take a pill and drink the medicine as it should. In pediatrics, lower dosages are used - 125 mg of sumamed.
• It is undesirable to take sumamed in case of impaired glucose tolerance (only for suspension), interruptions in heart rate, myasthenia gravis, low potassium in the blood.

The price of sumamed depends on the manufacturer - Israel or Croatia. For example, capsules and tablets from the Israeli company Teva cost about 450 rubles. The packages contain 6 capsules or tablets, which is enough for the entire course of treatment. Lyophilized powder for the preparation of an injection solution of 500 mg No. 5 costs 1500–1800 rubles. A suspension of 200 mg costs about 450–500 rubles.

Ceftriaxone

This drug belongs to powerful antibacterial agents, toxic. Shows high antibacterial activity, resistant to beta-lactamases. Ceftriaxone is used only for complicated infections, when its other "colleagues" could not overcome the bacterium that caused the disease.

The drug is used only for intramuscular and intravenous administration. The drug is produced in vials (0.5, 1.0 and 2.0 grams), where ceftriaxone is placed in the form of sodium salt.

• The spectrum of application of ceftriaxone completely covers infectious diseases of all organs and systems. These are pneumonia, sepsis, meningitis, severe tonsillitis, syphilis, peritonitis, otitis media and other pathologies.
• Do not use ceftriaxone with individual intolerance to the composition, renal and hepatic insufficiency, elevated bilirubin to high numbers, during the neonatal period, as well as in premature babies.
• Unfortunately, even when the right doses are observed, ceftriaxone often causes adverse reactions. Literally 3-4 days after the start of the injection, skin rashes with severe redness can be observed. In children, such rashes “love” the buttocks area.

The addition of candidiasis is also noted, and the liver indicators of ALT and AST in the biochemical blood test often increase. It is better to familiarize yourself with the list of possible adverse reactions in detail by reading the official instructions for the agent in question.

Important! Intramuscular injections of ceftriaxone are performed on lidocaine, because. the drug causes severe pain when administered. Before the first injection, it is necessary to conduct an allergy test for lidocaine, so that, God forbid, the patient does not experience severe complications in the form of Quincke's edema during the administration of the drug. If the patient is allergic, the drug can be administered intravenously, then pain will not be felt, and lidocaine will not be needed.

Ceftriaxone is produced both in the post-Soviet space and abroad, so price fluctuations will depend on the brand. Russian ceftriaxone (1 bottle) costs about 25 rubles. Russian pharmacies have Ukrainian, Indian, Portuguese and Chinese ceftriaxone.

The success of the treatment of pneumonia depends on the timely detection of the bacterium or virus that caused it. But, unfortunately, this is not always easy to do. The absence of sputum does not reveal the infection, i.e. there is no material for bakposev.

Viral and fungal pneumonia are more difficult to determine, and it all depends on the experience of the doctor. As antiviral therapy for pneumonia, drugs such as zanamivir, arbidol, oseltamivir can be used.

Medicines for pneumonia that do not contain antibacterial agents

As we already know, the lion's share of treatment for pneumonia falls on antibiotics (prescribe injections or pills). It is antibacterial agents that destroy the negative microflora that violates the imbalance in the body. Against the background of the development of pneumonia, the patient has a lot of concomitant symptoms - a cough, chest pain, sputum, increased heart rate, fever, and others.

To alleviate the patient's condition during illness, one has to resort to antibiotic therapy and add drugs that, in combination, will help get rid of pneumonia faster (that is, an individual treatment regimen is selected).

1. As expectorants, lazolvan, ACC, bromhexine, broncholithin, pertussin, licorice root (syrup) are suitable.
2. Bifido and lactobacilli, such as bifidumbacterin, hilak, Canadian yogurt and others, are used to maintain the intestinal microflora.
3. Antibacterial agents are always prescribed under the guise of antihistamines (loratadine, claritin, tavegil, fenistil, zodak).
4. To reduce body temperature, antipyretic drugs should be used: panadol, nurofen, acetylsalicylic acid, analgin.

To raise the body's defenses, immunomodulators and vitamins are recommended. For their appointment, you need to consult an immunologist. According to patients, homeopathic therapy gives good results in restoring strength during the rehabilitation period.

After a decrease in body temperature below 37.3 degrees, inhalations can be carried out with anti-inflammatory, bronchodilator and expectorant drugs:

• decasan,
• salbutamol,
• ambroxol.

During the rehabilitation period, physiotherapy is indicated. Oxygen therapy and special exercises for the lungs will help improve breathing function and relieve shortness of breath.

Diet therapy remains an important factor in recovery. Patients should limit all non-natural foods, as well as foods high in fat, acids, spices and sugar. The diet must include dairy products, vegetables, fruits, lean meats, fish, cereals, fortified drinks.

To cleanse the liver and kidneys from drug toxins, it is recommended to increase the drinking regimen (at least 1.5–2 liters per day).

Folk remedies for pneumonia

Of course, home treatments are only an addition to the main therapy, or are used in cases where for some reason there is no access to pharmacy drugs. Despite its safety and availability, any combination of folk and chemical remedies should be agreed with the doctor.

Decoction for bronchitis and pneumonia

• coltsfoot;
• dried raspberries;
• oregano.

All components are taken in equal proportions. For 3 tablespoons of the mixture, you need to take 300 ml of boiling water, leave for 40 minutes. Strain, divide the infusion into six doses and drink during the day.

Figs with milk

Compound:

• figs (yellow or green fruits) - 4 pieces;
• milk - a large mug (250-300 ml).

Pour milk over figs and cook over low heat for 10 minutes. If fresh fruits are not available, use dried figs of any variety. After cooking, the mixture should cool down to about 35-40 degrees. The resulting broth does not need to be filtered. We divide it into two parts and drink between meals.

Oats + raisins + honey

• raisins and oats - 20 grams each;
• water - 1000 ml;
• honey - 10 ml.

Pour raisins and oats with a liter of boiling water. When the water in the saucepan becomes half as much, turn off the fire. Let the broth cool, then strain. In the resulting broth, add a tablespoon of honey (10 ml). We take 10-20 ml up to five times a day, so for 20 days.

Propolis tincture

Propolis is an effective bactericidal and anti-inflammatory agent. It enhances the action of antibacterial agents and anti-tuberculosis drugs. You can take propolis tincture in cases where the patient is not allergic to bee products.

• For pneumonia, 20% propolis tincture is used (purchased from beekeepers or at a pharmacy). Take 25 drops of tincture three times a day. Before use, dilute the drops in 10–20 ml of boiled water or milk. Drink only before meals for 30 minutes.
• The course of propolis treatment is long, about 45 days. Even if the pneumonia receded quickly, continue the course of treatment anyway. This will allow the immune system to recover and reduce the risk of recurrence of the disease.

The dose of propolis in pediatrics is calculated as follows: 1 year - 1 drop of propolis per 100 ml of liquid (water or milk).

Propolis tincture is recommended to be used as a rubbing agent before going to bed. The back and chest in the region of the bronchi are rubbed for one minute, a natural shirt is put on, and then immediately to bed and under the covers.

Hazelnuts with red wine

Peeled nuts (20-30 grams) pour 200 ml of dry red wine (it is better to take homemade). Mix the mixture over low heat for no more than 20 minutes. Take 20 minutes before meals.

Conclusion

The variety of medications sometimes leads even doctors into a dead end. It should be noted that pulmonology hospitals have vast experience in treating various types of pneumonia. Modern medicines for pneumonia and developed methods are used. The patient is around the clock under the attention of doctors. Treatment is carried out under the control of diagnostic methods.

You should not treat pneumonia on your own, there is a high risk of not curing the disease, and becoming a hostage to the chronic forms of this pathology. Remember, you can quickly get rid of pneumonia, literally within 5-7 days, with a competent and professional approach. If you are offered to go to the hospital and be treated, do not refuse, a week in a hospital bed, and you are healthy! Take care of yourself and your loved ones!

MINISTRY OF HEALTH OF THE REPUBLIC OF BELARUS

EDUCATIONAL INSTITUTION

GOMEL STATE MEDICAL UNIVERSITY

DEPARTMENT OF POLYCLINIC THERAPY AND GENERAL PRACTICE

WITH THE COURSE OF DERMATOVENEROLOGY

DERMATOVENEROLOGY COURSE

Approved at the meeting of the department

Minutes No. __ dated ______ 2014

Head of Department:

N.F. Bakalets

Topic: Mycoses. Characteristics of representatives of the kingdom of fungi (structure, reproduction). Pathogenesis. Classification. Clinic of dermatomycosis (inguinal epidermophytosis, epidermophytosis of the feet, rubrophytosis), candidiasis. Pseudomycosis(erythrasma, actinomycosis). Onychomycosis. Laboratory diagnostics. Treatment. Epid. measures in the foci of infection.

Educational and methodological development for students in dermatovenereology

Faculty of Medicine and Diagnostics

Dragoon G.V.

Gomel, 2014

This methodological development is intended for independent work of students. It presents: I. The relevance of the topic. II. The purpose of the lesson. III Tasks. IV Basic sections. V. Recommended literature. VI. Questions for self-preparation. VI. Answers to questions on the topic. VII. Examples of tasks and tests for programmed control.

I. Relevance of the topic

Fungal diseases are infectious diseases and are widespread on all continents. A person can become infected with mycoses both from a sick person (anthroponous mycoses), and from a sick animal (zooanthroponoses) and soil fungi (geophilic mycoses). Fungal diseases can affect all layers of the skin, mucous membranes, skin appendages, bones and internal organs. Knowledge of the clinical manifestations of candidiasis of the skin and mucous membranes is necessary not only for dermatologists, but also for doctors of various specializations, which is due to the frequent occurrence of this pathology as a complication of therapy with antibiotics, glucocorticoids and cytostatics. Prevention of fungal infections is very important, since their treatment is quite laborious and recurrence of a fungal disease is often possible.

II. Purpose of the lesson

To acquaint students with the epidemiology, pathogenesis and modern classification (according to ICD 10 revision) of mycoses, to teach students the diagnosis and differential diagnosis of keratomycosis, epidermophytosis, rubrophytosis, candidiasis, to study the principles of treatment and prevention of these diseases.

III. Tasks

To study the ways of infection with mycoses.

To study with students the clinical manifestations of various forms of keratomycosis, dermatophytosis, candidiasis.

To teach students to carry out differential diagnostics of fungal infections studied in a practical lesson with other dermatoses and among themselves.

To teach students to take material for testing for pityriasis versicolor, for candidiasis, for athlete's foot and athlete's groin, to teach students to use a Wood's lamp.

Discuss the principles of treatment and prevention of the considered nosology.

STUDENT SHOULD KNOW:

Morphology of higher and lower fungi.

Primary and secondary elements of skin rash.

Clinical manifestations of multi-colored lichen, piedra, athlete's groin, athlete's foot, rubrophytosis, candidiasis of the skin and mucous membranes.

Basic principles of treatment and prevention of these diseases (modern antimycotics for general and local use).

STUDENT SHOULD BE ABLE TO:

Recognize various clinical forms of multi-colored lichen, piedra, athlete's groin, athlete's foot, rubrophytosis, candidiasis of the skin and mucous membranes, make a differential diagnosis of them among themselves and with other dermatoses.

To take material for research on keratomycosis, dermatophytosis, candidiasis.

Know the methods and approaches to the treatment of fungal infections and be able to prescribe the main drugs used for their treatment (to know what indications and contraindications exist for dosage forms for general and local use used to treat these diseases, possible complications of therapy).

Prevent fungal infections, know how to disinfect clothes, shoes, household items.

PRACTICAL SKILLS:

curation of patients

Interpretation of laboratory research methods.

IV. Sections previously studied and required for this lesson (basic knowledge)

Histology of the skin and its appendages.

Morphology of mushrooms.

Pharmacology of antimycotics for general and local use.

Prescription principles.

term "mycosis of the skin" physicians designate an extensive group of infectious diseases, characterized by damage to the skin by fungi. Mycosis of the skin in most people begins with minor discomfort - the skin of the toes or hands is slightly itchy and itchy.

The fungus can affect almost any part of the body: if the areas where hair grows are not affected, the disease is called mycosis of smooth skin, if the scalp is affected, it is mycosis of the hairy skin.

Treatment of mycosis of smooth skin depends on the type of fungus, the area of ​​the affected area and the stage of the disease.

People who are far from medicine or who have never encountered such problems know what mycosis is, by its common name - lichen.

Lichen is a common type of mycosis, often transmitted from pets, often children suffer from this disease.

Mycosis of the skin is caused by fungi. Almost all of them are pathogenic for the human body (abnormal and provoke diseases), with the exception of fungi of the genus Candida. They are conditionally pathogenic - this means that in certain quantities, fungi form part of the normal microflora, but if they multiply excessively, they are dangerous.

The microorganisms that cause candidiasis begin to spread in the body if it is weakened by prolonged use of antibiotics, treatment of immune diseases, poor environmental conditions and an unfavorable radiation background.

In addition to fungi of the genus Candida, Trichophyton and Microsporum microorganisms are also common pathogens. They cause damage to the epidermis and the upper layer of the skin.

Mushrooms Malassezia furfur provoke multi-colored lichen. In total, biologists have identified approximately 500 species of fungi that cause skin diseases.

Types and types of mycosis

According to the location of the infection, doctors classify mycoses into the following types:

1. mycosis of the body;
2. foot mycosis;
3. mycosis of the skin of the hands;
4. mycosis of nails;
5. mycosis of the smooth scalp;
6. mycosis of the scalp (the latter is quite rare).

There are also different types of mycoses, depending on the type of microorganisms that provoked the disease:

• dermatomycosis(or dermatophytosis). They are caused by the fungi Trichophyton, Epidermophyton and Microsporum. Affect mainly nails, feet, hands, scalp;
• keratomycosis. The causative agent is the yeast-like fungus Malassezia furfur. The stratum corneum and epidermis, as well as hair follicles, are vulnerable to them. Keratomycosis are well-known seborrheic dermatitis and versicolor versicolor. Fungi reproduce well in a humid and warm environment, are common in the warm season and in countries with an appropriate climate;
• candidomycosis. Caused by Candida fungi. They are dangerous because they can affect not only the skin, but also the mucous membranes of the body (oral cavity, genitals, intestines), then spread to the internal organs;
• deep mycoses- a type of disease that affects not only the skin, but also internal organs. It is the most severe form, requires a long systematic treatment;
• pseudomycosis- diseases that, in terms of symptoms, are very similar to mycoses, but are caused not by fungi, but by bacteria, respectively, require a different treatment. A laboratory test, which is carried out when contacting a dermatologist, will help to determine the pathogen and make a diagnosis.

Symptoms

The disease, as a rule, makes itself felt by reddening of the skin, itching, small vesicles localized in one area. This is how mycosis of the skin begins to appear. Most people do not pay attention to such “minor” symptoms, but in vain: at this stage, the fungus is easily excreted from the body, but very few people go to the doctor with the primary manifestations of skin problems.

Anxiety, as a rule, is caused by an already obvious manifestation of the disease: severe redness, exfoliation of the upper layer of the skin, soreness and itching of the affected area (these are signs of mycosis of smooth skin).

The appearance of diaper rash, rash, irritation in the groin, cavities between the fingers and toes, on the elbows, under the breasts in women should also be a reason to be wary and suspect mycosis of the folds.

Nails signal infection by uneven discoloration, brittleness, and peeling of the plate. If the scalp is affected, the lesions appear as one or more irritated areas from which hair falls out.

The affected area usually has the shape of a circle or oval, framed by a red roller. Bubbles appear on the reddened part of the skin.

The reason to immediately consult a doctor is the appearance on the body of several local lesions that can grow and merge into a single inflamed area. In this case, the skin is almost certainly suffering from a fungal infection and needs systematic treatment.

Transfer Methods

“Don’t even think about stroking a stray cat – you’ll catch lichen,” every child who is not indifferent to animals hears a formidable warning from their parents. And it’s good if you obey the elders: skin mycosis is easily transmitted to humans from infected animals, cats, dogs, small rodents, cows, and pigs can be carriers of the disease.

If you keep a pet in the apartment and your baby loves a pet, it is recommended to strictly monitor the child's compliance with simple hygiene rules: after playing with a cat or dog, you must wash your hands thoroughly.

The animal needs to be examined periodically - a pet can bring an infection from the street or from its fellows. It is good if the animal has been given all the necessary vaccinations and you regularly show it to the veterinarian: not only fungal infections, but a host of other diseases can be transmitted through dogs and cats.

Mycosis of the skin is easily transmitted by direct contact with a sick person using common household items. If such a nuisance happened to someone in your family, in no case do not use common household items with the patient - dishes, towels, clothes, bedding. Otherwise, the whole family will have to be treated.

Fungi that cause mycosis are quite tenacious in the external environment. Especially favorable conditions for them are created in public baths, saunas, pools, showers. In a warm and humid environment, mushrooms multiply well, so when visiting such establishments, it is advisable to bring your own hygiene items - soap, towels, sheets, slates.

Shoes after the bath and the pool should be very thoroughly washed and dried, if possible treated with salicylic alcohol. It is also advisable to have your own soap and towel in the office.

Infection with fungi is also possible during medical procedures and manipulations. The advice here is the same: if you contacted a healthcare institution, do not hesitate to check whether all the necessary hygiene rules are followed by doctors and nurses. And, of course, do not neglect them when you are treated at home.

The risk of contracting mycosis increases if a person has been treated with antibiotics for a long time, has a weak immune system or chronic diseases. Fungi easily enter the body if the skin is broken: infection occurs through cracks, abrasions and scratches on the skin.

The main function of our skin is barrier, protective. That is why injuries and wounds are recommended to be disinfected as soon as possible and to prevent dirt from entering. Microorganisms otherwise can enter the bloodstream directly, and not be localized on the outer integument.

To protect yourself from fungal infection, doctors recommend that you carefully monitor the condition of the skin, dry yourself after a bath or shower (mycosis of the skin develops in the cavities of the toes and hands), immediately contact a specialist at the first sign of a violation of the normal functioning of the skin.

Treatment

On the Internet you can find a description of many folk methods than to treat skin diseases. It is advisable to use them only after consulting a doctor. Mycosis of the skin is very different, the treatment has many features and is selected individually for each patient.

First of all, the doctor should refer the patient to the examination of a sample of the affected skin in the laboratory. This is necessary to identify a specific pathogen. Factors such as the depth and area of ​​the affected area, the location of the disease, the degree of its development, the general state of health and immunity, the presence of chronic diseases, the age of the patient, the possibility of an allergic reaction to drugs will also affect the doctor's choice of medicine.

If you went to the doctor at an early stage of the development of the disease, the external use of antifungal ointments will help defeat mycosis of smooth skin. Both local treatment and oral medication will be required when the disease has affected a large area of ​​\u200b\u200bthe skin.

Mycosis will be treated primarily with antifungal drugs applied topically: these are ketoconazole, clotrimazole, fluconazole, terbinafil. They are applied to the affected areas twice a day.

On the advice of a doctor, you can treat the skin with salicylic ointment at night, and in the morning with an iodine solution. Mycosis can affect vellus hair on the thighs, shins, forearms. In this case, in addition to local therapy, it is necessary to epilate diseased areas.

To be taken orally by a patient with mycosis, most likely, griseofulvin will be prescribed. The drug is safe, has proven itself well, it is prescribed even for children. However, griseofulvin can accumulate in the liver, so be sure to tell your doctor if you have problems with this organ.

The effectiveness of the selected preparations will be noticeable almost immediately, inflammation and peeling will pass, the skin will acquire its normal shade, healthy nail plates will grow back. If there is no improvement, we go to the doctor again and sort out the reasons - perhaps a stronger medicine is required.

After successful therapy and the disappearance of external signs of mycosis, the attending physician must necessarily refer you to a repeated laboratory test to make sure that there is no fungus in the body.

Prevention of mycosis

To prevent the infection from entering your body, you need to follow a few simple rules:

1. strictly observe hygiene, take your own towels, sheets, slippers to the public pool, bath, sauna, dry yourself thoroughly after a shower. It is advisable not to wear tight shoes and prevent sweating of the feet;
2. disinfect wounds and skin lesions;
3. strengthen immunity, monitor the condition of the skin and consult a doctor in time with its changes.

Among the most common fungal diseases today, the most common are mycoses of smooth skin, such as microsporia, trichophytosis, multi-colored lichen, mycosis of the feet (brushes), candidiasis. Sources of infection can be sick animals (cats, dogs, mouse-like rodents, cattle, etc.), as well as humans.

In recent years, there has been an increase in the number of diseases caused by opportunistic fungi, among them the most frequently recorded superficial forms of candidiasis. Such a wide prevalence of these mycoses can be explained by the massive use of modern therapies, the environmental situation and other factors that reduce the body's defenses. One of the reasons for the significant prevalence of mycoses is the weakening of sanitary and educational work in recent years.

Due to insufficient awareness of the sources and ways of spreading the infection, as well as adequate preventive measures, patients turn to the doctor late, and therefore mycoses turn into a chronic form, including in children suffering from mycoses of the scalp and smooth skin.

Epidemiology.

Infection in 80-85% of cases occurs as a result of direct contact with a sick animal or through objects contaminated with the hair of these animals. Infection of children can also occur after playing in the sandbox, since the microsporia pathogen is highly resistant to environmental factors and can remain viable in infected scales and hair for up to 7-10 years. Children are more likely to suffer from microsporia.

Clinic.

After 5-7 days from the moment of infection, foci appear on smooth skin, which can be observed both on open and closed parts of the body (children like to take animals in their arms, put them in bed with them). The foci are round or oval, pink or red, with clear boundaries, a raised ridge along the periphery, covered with vesicles and thin crusts, with peeling in the center. The lesions are usually small, 1 to 2 cm in diameter, single or multiple, sometimes confluent. In 85-90% of patients, vellus hair is affected.

Treatment.

In the presence of single foci of microsporia on smooth skin without damage to vellus hair, one can limit oneself only to external antifungal agents. Foci should be lubricated with alcohol tincture of iodine (2-5%) in the morning, and in the evening rub sulfuric salicylic ointment (10% and 3%, respectively). You can rub the following antimycotics 2 times a day: mycosolone, mycoseptin, travogen or 1 time a day in the evening - mifungar cream, mycospor - until the clinical manifestations resolve.

With multiple lesions of smooth skin and single foci (up to 3) with involvement of vellus hair in the process, it is recommended to prescribe the antifungal antibiotic griseofulvin at the rate of 22 mg per 1 kg of the child's body weight, in 3 doses after meals, in combination with keratolytic stratum corneum exfoliating in the foci means (salicylic acid 3.0, lactic or benzoic 3.0, collodion up to 30.0). With one of these agents, the foci are lubricated 2 times a day for 3-4 days, then a 2% salicylic ointment is applied under compress paper for 24 hours, the shedding scales of the stratum corneum of the epidermis are removed with tweezers and fluffy hair is epilated.

If during the control examination carried out using a fluorescent lamp or a microscope, affected hairs are found, the procedure is repeated. Detachment of the stratum corneum of the epidermis and manual epilation of vellus hair can be carried out after applying the "sealing" method. The foci are sealed in a tile-like manner with adhesive plaster strips for 2-3 days, this causes an exacerbation of the process, which, in turn, facilitates hair removal.

The results of treatment of smooth skin microsporia are monitored using a fluorescent lamp or microscopic examination for fungi. The first control study is done after the resolution of clinical manifestations, then after 3-4 days before the first negative analysis, and then after 3 days. The criteria for cure are resolution of the foci, absence of luminescence, and three negative microscopic examinations.

In the course of treatment, bed and underwear are disinfected: boiling in a soap-soda solution (1%) for 15 minutes (10 g of laundry soap and 10 g of caustic soda per 1 liter of water); five times ironing outerwear, covers from furniture, bedding with a hot iron through a damp cloth.

Prevention.

The main measure for the prevention of microsporia is the observance of sanitary and hygienic rules (you can not use someone else's underwear, clothes, etc.; after playing with animals, you must wash your hands).

Epidemiology.

With superficial trichophytosis caused by anthropophilic fungi, infection occurs through close contact with a sick person or indirectly through household items. Often children become infected from their mothers, grandchildren from grandmothers suffering from a chronic form of the disease. The incubation period lasts up to a week. With zooanthroponic trichophytosis, the sources of infection are sick animals: cattle, rodents. The highest incidence of this type of trichophytosis is recorded in autumn, which is associated with field work: it is at this time that the likelihood of infection through hay and straw increases. The incubation period ranges from 1–2 weeks to 2 months.

Clinic.

On smooth skin with superficial trichophytosis, foci can occur on any part of the skin - face, neck, chest, forearms. They have clear borders of a rounded or oval shape, with an elevated ridge along the periphery of a bright red color, they are larger in size than with microsporia. The lesions are reddish-bluish in color, with peeling, nodules on the surface; in the chronic form, they develop on the skin of the buttocks, knee joints, forearms, less often the back of the hands and other parts of the body, the foci do not have clear boundaries. Lamellar peeling is observed on the skin of the palms and soles. Vellus hair is often affected.

With trichophytosis caused by zoophilic fungi, the disease on the skin can occur in three forms: superficial, infiltrative and suppurative. The foci are usually located on open areas of the skin. With a superficial form, they are round or oval in shape, with clear boundaries, a raised ridge along the periphery, on which bubbles, crusts are visible, the center of the focus is pink, the ridge is bright red. The foci are larger in size than with microsporia. Sometimes they are located around natural openings - eyes, mouth, nose.

With an infiltrative form, the foci rise above the level of the skin, accompanied by inflammatory phenomena - infiltration. The suppurative form is characterized by the development of tumor-like formations, bright red in color, covered with purulent crusts due to the addition of a bacterial infection. When the focus is squeezed, pus is released from the hair follicles, soreness is noted. The disease is accompanied by a violation of the general condition, sometimes the temperature rises. In place of the former foci, after the resolution of clinical manifestations, cicatricial atrophy of the skin remains. Clinical forms of zooanthroponotic trichophytosis can pass one into another.

Diagnostics.

The diagnosis of trichophytosis is established on the basis of the clinic and upon detection of the fungus during microscopy of pathological material, and the type of pathogen is determined using a cultural study.

Treatment.

Treatment is carried out with antimycotics for external use. The foci are smeared with tincture of iodine (2-5%) during the day, sulfur-salicylic ointment (10% and 3%, respectively) or mycoseptin are rubbed in the evening. It is possible to carry out monotherapy with an ointment or cream (canison, mifungar, mycozoral, mycospor (bifosin), exoderil, mycozoral, etc. In the infiltrative form, a 10% sulfur-tar ointment is prescribed 2 times a day to resolve infiltration.

Treatment of the suppurative form of trichophytosis begins with the removal of crusts in the lesion using dressings with 2% salicylic ointment, which are applied for several hours. After removing the crusts, vellus hair is epilated. Then apply lotions with solutions that have a disinfectant and anti-inflammatory effect (furatsilin 1:5000, rivanol 1:1000, potassium permanganate 1:6000, ichthyol solution (10%), etc.). As a result of this treatment, the hair follicles are freed from pus, inflammation is reduced. Further, for resorption of the infiltrate, sulfur-tar ointment (5-10%) is prescribed in the form of rubbing or under wax paper. After the resolution of the infiltrate, antimycotics are used for external use (see the superficial form of trichophytosis).

In cases where vellus hair is affected in lesions on smooth skin, detachment of the stratum corneum of the epidermis is carried out, followed by hair removal. To do this, you can use salicylic collodion (10-15%), milk-salicylo-resorcinol collodion (15%). If there is no effect, griseofulvin is administered orally at a daily dose of 18 mg per 1 kg of body weight, in 3 doses after meals daily - until a negative analysis for fungi, then every other day. As an alternative method, you can prescribe terbinafine (Lamisil, Exifin) for adults at 250 mg (1 tab.) 1 time per day after meals daily, for children weighing up to 20 kg - 62.5 mg, from 20 to 40 kg - 125 mg , over 40 kg - 250 mg in combination with antimycotics for external use.

The criteria for cure for trichophytosis are resolution of clinical manifestations and three negative fungal tests at three-day intervals.

Prevention.

Prevention of trichophytosis depends on the type of pathogen. With superficial trichophytosis caused by anthropophilic fungi, the main preventive measure is to identify the source of infection, and it can be children with superficial trichophytosis, or adults suffering from a chronic form of the lesion. In recent years, there have been cases of chronic trichophytosis in children of middle and older age. With suppurative trichophytosis, preventive measures are carried out jointly by medical workers, epidemiologists and the veterinary service.

Mycosis of the smooth skin of the feet (hands). In a number of countries, up to 50% of the population suffer from athlete's foot. This disease is more common in adults, but in recent years it has often been observed in children, even infants.

Etiology.

The main causative agents of mycosis of the feet are the fungus Trichophyton rubrum (T. rubrum), which is isolated in almost 90% of cases, and T. mentagrophytes var. interdigitale (T. interdigitale). Damage to the interdigital folds, which may be due to yeast-like fungi, is recorded in 2-5% of cases. The anthropophilic fungus Epidermophyton floccosum is rarely isolated in our country.

Epidemiology.

Infection with mycosis of the feet can occur in the family through close contact with the patient or through household items, as well as in the bath, sauna, gym, when using someone else's shoes and clothes.

Pathogenesis.

The penetration of fungi into the skin is facilitated by cracks, abrasions in the interdigital folds, due to sweating or dry skin, abrasion, poor drying after water procedures, narrowness of the interdigital folds, flat feet, etc.

Clinic.

Clinical manifestations on the skin depend on the type of pathogen, the general condition of the patient. The T.rubrum fungus can cause damage to the skin of all interdigital folds, soles, palms, dorsal surfaces of the feet and hands, shins, thighs, inguinal-femoral, intergluteal folds, under the mammary glands and axillary region, torso, face, rarely - scalp. The process may involve fluffy and long hair, nail plates of the feet and hands. When the skin of the feet is affected, 3 clinical forms are distinguished: squamous, intertriginous, squamous-hyperkeratotic.

The squamous form is characterized by the presence of peeling on the skin of the interdigital folds, soles, palms. It can be floury, annular, lamellar. In the area of ​​​​the arches of the feet and palms, an increase in the skin pattern is observed.

The intertriginous form is the most common and is characterized by slight redness and peeling on the lateral contact surfaces of the fingers or maceration, the presence of erosions, superficial or deep cracks in all the folds of the feet. This form can transform into 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 vesicles open with the formation of erosions, which can merge, resulting in the formation of lesions with clear boundaries, weeping. When a bacterial infection is attached, pustules, lymphadenitis and lymphangitis occur. With the dyshidrotic form of mycosis, secondary allergic rashes are observed on the lateral and palmar surfaces of the fingers, palms, forearms, and shins. Sometimes the disease acquires a chronic course with an exacerbation in the spring and summer.

Squamous-hyperkeratotic form is characterized by the development of foci of hyperkeratosis against the background of peeling. The skin of the soles (palms) becomes reddish-cyanotic in color, in the skin grooves there is a bran-like peeling, which passes to the plantar and palmar surfaces of the fingers. On the palms and soles, pronounced annular and lamellar peeling can be detected. In some patients, it is insignificant due to frequent washing of hands.

In children, lesions of smooth skin on the feet are characterized by small-lamellar peeling on the inner surface of the terminal phalanges of the fingers, more often 3 and 4, or there are superficial, less often deep cracks in the interdigital folds or under the fingers, 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. Subjectively, patients are concerned about itching. In children, more often than in adults, there are exudative forms of lesions with the formation of vesicles, weeping eczema-like foci. They appear not only on the feet, but also on the hands.

Rubrophytosis of smooth skin of large folds and other areas of the skin is characterized by the development of foci with clear boundaries, irregular outlines, with an intermittent ridge along the periphery, consisting of merging pink nodules, scales and crusts, with a bluish tinge (in the center, the color is bluish-pink) . On the extensor surface of the forearms, shins, rashes can be located in the form of open rings. Often there are foci with nodular and nodular elements. The disease sometimes proceeds according to the type of infiltrative-suppurative trichophytosis (more often in men with localization in the chin and above the upper lip). Foci of rubrophytia on smooth skin may resemble psoriasis, lupus erythematosus, eczema and other dermatoses.

The T. interdigitale fungus affects the skin of the 3rd and 4th interdigital folds, the upper third of the sole, the lateral surfaces of the foot and toes, and the arch of the foot. This mushroom has pronounced allergenic properties. With mycosis of the feet caused by T. interdigitale, the same clinical forms of the lesion are observed as with rubrophytosis, however, the disease is more often accompanied by more pronounced inflammatory phenomena. With a dyshidrotic, less often intertriginous form, large blisters may appear on the skin of the soles and fingers along with small bubbles, in the case of bacterial flora, with purulent contents. The foot becomes edematous, swollen, pain appears when walking. The disease is accompanied by fever, deterioration of health, the development of allergic rashes on the skin of the upper and lower extremities, trunk, face, an increase in inguinal lymph nodes; the clinical picture is similar to that observed in eczema.

Diagnosis.

The diagnosis is established on the basis of clinical manifestations, the detection of the fungus during microscopic examination of skin flakes and the identification of the type of pathogen - during a cultural study.

Treatment.

Treatment of mycosis of the smooth skin of the feet and other localizations is carried out with antimycotic agents for external use. With squamous and intertriginous forms of lesions on the feet and other areas of the skin, drugs are used in the form of a cream, ointment, solution, spray, you can combine a cream or ointment with a solution, alternating their use. Currently, the following drugs are used to treat this disease: Exifin cream, Mycozoral cream, Nizoral cream, Canison cream and solution, Mycosone cream, Mycospor cream (Bifosin), Mifungar cream, Lamisil cream and spray, Mycoterbin cream. These drugs are applied to cleansed and dried skin 1 time per day, the duration of treatment is on average no more than 2 weeks. Antibiotics such as travogen, ecalin, batrafen, mycoseptin, mycosolone are used 2 times a day until the clinical manifestations resolve, then treatment is continued for another 1-2 weeks, but already 1 time per day - to prevent relapse.

In nodular and nodular forms of rubrophytia, after the removal of acute inflammatory phenomena with the help of one of these ointments, a sulfur-tar ointment (5-10%) is prescribed to further resolve clinical manifestations. With intertriginous and dyshidrotic forms (the presence of only small vesicles) of mycosis of the feet, drugs with combined action are used, which, along with an antifungal agent, include a corticosteroid, such as mycosolone, travocort, or a corticosteroid and an antibacterial drug - triderm, pimafucort.

In acute inflammation (weeping, blistering) and severe itching, treatment is carried out as in eczema: desensitizing agents (intravenous or intramuscular injection of calcium chloride solution (10%), sodium thiosulfate solution (30%), calcium gluconate solution (10%) or calcium pantothenate orally; solutions of methylene blue or brilliant green, fucorcin.Then they switch to pastes - boron-naftalan, ichthyol-naftalan, ACD-F3 paste with naftalan, if complicated by bacterial flora - lincomycin (2%) At the 2nd stage of treatment after resolution of acute inflammatory phenomena use the above antimycotic agents.

Quickly and effectively eliminate the symptoms of inflammation and itching in the presence of both fungal and bacterial infections allows such a drug as triderm, which contains, in addition to an antimycotic (clotrimazole 1%), a broad-spectrum antibiotic (gentamicin sulfate 0.1%) and a corticosteroid (betamethasone dipropionate 0 .05%). The presence of 2 dosage forms in triderm - ointment and cream - makes it possible to use it with a different nature and at various stages of the pathological process.

If external therapy is ineffective, systemic antimycotics are prescribed: itraconazole in a continuous regimen of 200 mg per day for 7 days, then 100 mg for 1-2 weeks; terbinafine (lamizil, exifin) 250 mg once a day daily for 3-4 weeks; fluconazole (150 mg once a week for at least 4 weeks).

Prevention.

To prevent foot mycosis, it is necessary to observe, first of all, the rules of personal hygiene in the family, as well as when visiting a bath, sauna, swimming pool, gym, etc .; disinfect shoes (gloves) and underwear during the treatment period. After visiting the bath, swimming pool, sauna, to prevent mycosis of the feet, dactarin spray-powder should be applied to the skin of the interdigital folds and soles.

versicolor is a fungal disease caused by Malassezia furfur (Pityrosporum orbiculare), a yeast fungus.

Pityriasis versicolor is quite widespread in all countries; young and middle-aged people suffer from it.

Etiology.

Malassezia furfur as a saprophyte is found on human skin and, under favorable conditions, causes clinical manifestations.

Pathogenesis.

Factors contributing to the development of the disease have not yet been precisely established, however, multi-colored lichen is more common in people suffering from excessive sweating, with a change in the chemical composition of sweat, diseases of the gastrointestinal tract, endocrine pathology, vegetative-vascular disorders, and also with immune deficiency. .

Clinic.

The disease is characterized by the presence of small spots on the skin of the chest, neck, back, abdomen, less often the upper and lower extremities, axillary and inguinal-femoral areas, on the head; spots are initially pink in color, and then become light and dark brown; there is also a slight peeling, sometimes it can be hidden and come to light only when scraping. Rashes often merge, forming extensive areas of damage. After sunburn, as a rule, white spots remain as a result of increased peeling. The disease is characterized by a long course with frequent exacerbations.

Diagnosis.

The diagnosis is made on the basis of clinical manifestations, when the pathogen is found in skin flakes during microscopic examination and in the presence of a characteristic yellow or brown glow under a Wood's fluorescent lamp, as well as a positive test with iodine.

Treatment.

Currently, there is a sufficient choice of antimycotic drugs for topical use, which have a pronounced antifungal effect against the causative agent of pityriasis multicolor. These include imidazole and triazole derivatives, allylamine compounds. During the treatment of the disease, the following are used: exifin cream (applied to cleansed and dried skin in the lesions 2 times a day for 7-14 days, if necessary, after a 2-week break, the course of treatment can be repeated), nizoral cream, mycozoral ointment, cream and canison solution, mycosone cream, mifungar cream (prescribed 1 time per day, treatment duration 2-3 weeks); lamisil cream and spray; nizoral shampoo (applied to the affected areas of the skin for 3-5 minutes for three days and washed off in the shower). With common, often recurrent forms of multi-colored lichen, systemic antimycotics are more effective: itraconazole (prescribed 100 mg once a day for two weeks, then take a two-week break, if necessary, repeat the course of treatment), fluconazole (150 mg once a week within 4-8 weeks). During treatment, it is necessary to disinfect clothes, hats, underwear and bed linen of the patient by boiling in a 2% soap-soda solution and ironing with a hot iron while wet. The patient's family members should also be examined.

Prevention.

To prevent the recurrence of mycosis, it is necessary to use nizoral shampoo. Treatment should be carried out from March to May 1 time per month for 3 days in a row.

Smooth skin candidiasis- a fungal disease caused by yeast-like fungi of the genus Candida.

Etiology.

Pathogens are opportunistic fungi that are widely distributed in the environment. They can also be found on the skin and mucous membranes of the mouth, digestive tract, and genitals of a healthy person.

Epidemiology.

Infection from the external environment can occur with constant fractional or massive infection with fungi.

Pathogenesis.

Both endogenous and exogenous factors can contribute to the occurrence of candidiasis. Endogenous factors include endocrine disorders (usually diabetes mellitus), immune deficiency, severe somatic diseases, and a number of others. The development of the disease is possible after the use of a number of modern drugs: broad-spectrum antibiotics, immunosuppressive and hormonal drugs. The occurrence of candidiasis in the interdigital folds of the hands is facilitated by frequent contact with water, as this develops skin maceration, which is a favorable environment for the introduction of the pathogen from the external environment.

Clinic.

On smooth skin, small folds on the hands and feet are more often affected, less often - large ones (inguinal-femoral, axillary, under the mammary glands, intergluteal). Foci outside the folds are located mainly in patients with diabetes mellitus, severe general diseases, and in infants.

In some patients, the disease begins in small skin folds with the formation of small, barely noticeable bubbles on the lateral contact surfaces of hyperemic skin, the process gradually spreads to the fold area, then peeling, maceration appears, or shiny eroded surfaces of a rich red color with clear boundaries immediately appear, with exfoliation of the stratum corneum of the epidermis along the periphery. The 3rd and 4th interdigital folds on one or both hands are more often affected. The disease is accompanied by itching, burning, and sometimes soreness. The course is chronic, with frequent relapses.

In large folds, lesions are dark red, shiny, with a moist surface, with a strip of exfoliating stratum corneum of the epidermis, occupying a significant surface, having clear boundaries and irregular outlines. New small erosions appear around large foci. In children, the process of large folds can spread to the skin of the thighs, buttocks, abdomen, torso. Painful cracks sometimes form in the depth of the folds.

Candidiasis of smooth skin outside the folds has a similar clinical picture.

Diagnosis.

The diagnosis is made on the basis of a typical clinic when a fungus is found in a scraping from skin flakes during a microscopic examination.

Treatment.

Limited and sometimes widespread acute forms of smooth skin lesions, especially those that develop during antibiotic therapy, are usually easily treated with local antimycotic agents in the form of a solution, cream, ointment, and can resolve even without treatment after antibiotics are discontinued.

In case of candidiasis of smooth skin of large folds with acute inflammatory phenomena, treatment should be started with the use of an aqueous solution of methylene blue or brilliant green (1-2%) in combination with an indifferent powder and carried out for 2-3 days, then antimycotic drugs are used - until the resolution of clinical manifestations.

Of the antimycotic agents for candidiasis of smooth skin, they use: canison solution and cream, mycosone cream, mifungar cream, candide cream and solution, triderm ointment and cream, pimafucort, pimafucin, travocort, travogen, nizoral cream, mycozoral ointment, ecalin.

With widespread processes on the skin and in case of ineffectiveness of local therapy, antimycotics of systemic action are prescribed: fluconazole (Diflucan, Forkan, Mycosyst) - for adults at a dose of 100-200 mg, for children at the rate of 3-5 mg per kg of body weight, itraconazole (100-200 mg), nizoral (adults 200 mg, children weighing up to 30 kg - 100 mg, over 30 kg - 200 mg) 1 time per day daily, as well as the polyene antibiotic natamycin (adults 100 mg 4 times a day, children 50 mg 2-4 times a day). The duration of treatment is 2-4 weeks.

Prevention.

Prevention of smooth skin candidiasis in adults and children is to prevent its development in people suffering from background diseases, as well as in people receiving antibacterial, corticosteroid, immunosuppressive therapy for a long time. To prevent the development of candida infection in children hospitalized in somatic departments and receiving broad-spectrum antibiotics, it is necessary to prescribe fluconazole at the rate of 3 mg per kg of body weight 1 time per day, treatment is carried out during the entire main course of therapy. Patients with intestinal candidiasis are prescribed nystatin 2-4 million units per day or natamycin 50 mg for children and 100 mg for adults 2 times a day for 15 days.

For citation: Sokolova T.V., Malyarchuk T.A., Gazaryan O.L. Mycoses of the feet - an epidemiological problem of dermatology // BC. 2014. No. 8. S. 571

The incidence of superficial mycoses of the skin

Superficial mycoses of the skin (SMC) are an actual interdisciplinary problem in all countries of the world. MVP are registered in 20% of the world's population. The results of a multicenter study conducted in 2003 in 16 European countries with a survey of more than 70 thousand people showed that mycoses were registered in 35% of cases. More than 2.5 million people suffer from opportunistic mycoses in the world. The proportion of PMC in the structure of dermatoses reaches 37-40%. The number of patients with MVP for 10 years has increased by 2.5 times, and the increase in incidence every year was 5%. The intensive indicator (PI) of the incidence of MVP in patients who applied to the clinic of the Medical Center of the Administration of the President of the Russian Federation in 1990-1999 was 63.9‰.

In Russia in 2010-2013 two multicenter studies were conducted, which made it possible to study the incidence of MVP in general and foot mycoses (MS) in particular, in outpatients in different regions of the country using IP. It was calculated in ppm per 1000 outpatients who visited a dermatologist with various dermatoses. In 2010-2011 The study involved 62 dermatologists working in 42 medical and preventive treatment facilities (HCIs) in 19 regions of the Russian Federation. Within 2 months. doctors took into account the number of outpatients (50,398) who applied to them, including those with MVP (7005) and MS (1650). The proportion of patients with MVP in the structure of dermatological pathology was 14%, of which 34.6% were MS. PI incidence of MVP was 94.5, ringworm - 62.5, MS - 32.7. PI incidence of MS in Russian cities ranged from 4.1‰ (Samara) to 162‰ (Kirov). In 11 regions it exceeded the all-Russian indicator, and in 8 regions it was lower. In 2012-2013 174 doctors from 50 cities of the Russian Federation took part in the multicenter study. The analysis of 5025 questionnaires filled out by dermatologists was carried out. It was found that more than half of the patients (55.4%) had dermatophytosis (ICD-10 code B.35), about a quarter had superficial skin candidiasis (B.37) and keratomycosis (B.36) (22.4% and 22 .2%, respectively). MS was the leader in the structure of dermatophytosis, accounting for more than 1/3 (35.7%) of all cases. Dermatophytosis of large folds was registered in more than 26.4% of patients. Almost every fifth patient (20.9%) had mycosis of the trunk. Dermatophytosis of other localizations were less common: extremities (excluding lesions of the feet and hands) - 7.8%, hands - 6.3%, faces - 2.9% of cases.

The incidence of mycosis of the feet
Dermatophytosis predominates in the structure of PMK, which are recorded in 10% of the world's population. Dermatophytosis is second only to pyoderma. Therefore, they are often called "diseases of civilization". Among dermatophytosis, MS is confidently leading, accounting for more than 1/3 of cases. The predominance of MS and onychomycosis in the structure of MVP is evidenced by numerous studies of domestic and foreign specialists. An analysis of the results of the Achilles project (1988-1997), in which several European countries and the Russian Federation took part, showed that 35% of patients who turned to a dermatologist had one or another mycosis. The proportion of MS was 22%, onychomycosis - 23%.

An increase in the incidence of MS is recorded everywhere. In the Russian Federation, from 2002 to 2006, the incidence of MS and hands increased by 3.9%. In Moscow, over 10 years (from 1991 to 2001), a 1.6-fold increase was registered (IP per 100 thousand population was 335 versus 212), and in the Republic of Bashkortostan from 2000 to 2006 - by 27.8%. In the Republic of Tatarstan, the incidence of MS in the structure of dermatological pathology is 27.8%, fungal pathology - 75.3%. In the Komi Republic, for the period from 1999 to 2008, the incidence of MS and hands increased by 77.4%, and onychomycosis - by 143.2%. In Ukraine, dermatomycosis was detected in 52% of dermatological patients, MS and onychomycosis accounted for 47%. In Uzbekistan, these figures were 15% and 41%, respectively. In Kazakhstan, the number of patients with dermatomycosis increased by 3.9 times over 5 years, and in the Republic of Kyrgyzstan, the incidence of dermatomycosis increased by 1.7 times from 1990 to 2012.

The data of foreign authors also indicate an unfavorable situation with MS. In Europe, it is registered in every third patient who turned to a dermatologist. In Spain, for more than 20 years (1962-1984), the incidence of rubrophytosis has doubled - from 30 to 64%, and in Romania for 40 years - from 0.2% to 59.5%. In a mass survey of the population of Hong Kong, MS was registered in 20.4% of cases, and damage to the nail plates - in 16.6%.

At the same time, there is evidence indicating a rare occurrence of onychomycosis in outpatients in Sweden (9%) and in the general population in the UK (3%). In a targeted survey of the population by Spanish dermatologists, MS was detected only in 2.9%, and onychomycosis - in 2.8% of cases.

Gender characteristics of patients with MS. Literature data in most cases indicate that men are more likely to get sick with MS. According to Russian dermatologists, MS is registered in 10-20% of the adult population. At the same time, men get sick 2 times more often than women, older people more often than young people. . In the Kyrgyz Republic, MS in men is registered 1.5-3 times more often. In Europe, America, Australia, the proportion of men in the structure of MS incidence reaches 68.4%. The predominance of MS in men has been reported in Singapore. When examining more than 8.5 thousand patients who applied to general practitioners in Denmark, clinical changes in the nail plates were detected in 16.5% of patients, and onychomycosis in almost all cases was in men.

In Russia, MS is registered in every second patient over the age of 70 years. In the United States (Ohio) and Canada, the incidence in the over 70 age group was 3.2 times higher than in middle-aged people (28.1% versus 8.7%). In India, onychomycosis was more frequently reported in men, with an average age of 34.5 years.

The data of the Hot Line project conducted by the National Academy of Mycology of the Russian Federation, on the contrary, indicate that among those who applied for onychomycosis, 2/3 were women. Similar data were obtained by G.Yu. Kournikov et al. (2006) (68% vs 32%) and M.L. Escobar (2003) (62% vs 38%). In Armenia, onychomycosis in women was registered 2.6 times more often than in men (72% versus 28%). At the same time, in Colombia, no statistically significant difference was found between gender and the incidence of onychomycosis.

Currently, MS and onychomycosis are often detected in children. In the Russian Federation, in children under 6 years of age, the incidence of MS in 2000 compared to 1973 increased from 0.18% to 4%. Children, as a rule, were infected from adults - parents, relatives, governesses. In Europe and America, the frequency of onychomycosis during mass examinations of children ranges from 0.3% to 30.7%. When examining schoolchildren, onychomycosis was rarely recorded (0.18%) with a predominance in boys and children living in rural areas.

MS and onychomycosis dramatically reduce the quality of life of patients. The influence of MS on labor adaptation was proved: a moderate decrease in working capacity was registered in 35.0 ± 2.1% of patients, a sharp decrease in working capacity - in 19.3 ± 1.8%, accompanied by neuroses and depression - in 55.7 ± 2 .2%, a sense of shame due to a cosmetic skin defect - in 21.4±1.8%.
Etiology of MS at the present stage. Literature data indicate that MS pathogens are dermatophytes, yeast-like fungi of the genus Candida, and mold fungi. However, their role in the pathogenesis of MS and onychomycosis has changed over time.

In the 30s of the XX century. in the USA and Canada in the etiology of MS, Trichophyton mentagrophytes var. interdigitale (Tr. m. var. interdigitale). Trichophyton rubrum (T. rubrum) was isolated only in 8-10% of cases. In the 40-50s. Tr ratio. m. var. interdigital/T. rubrum was already 5:1, and by 1966 had reached 1:11. Let's consider this on the example of other countries of the world. In Bulgaria, dermatophytes with MS were isolated in 90.9% of patients, including T. rubrum - only in 14.8% of patients, Tr. m. var. interdigitale - in 34.3%, E. inguinale - in 1.8%, fungi of the genus Candida - in 3%, combined yeast and mold flora - in 1.8%. in India in the 1970s and 1980s. with MS, T. rubrum was sown in 47.6% of cases, Tr. m. var. interdigitale - in 21.4%. In Spain (Barcelona) in 1986, T. rubrum accounted for 50% of MS pathogens, Tr. m. var. interdigitale - 29%, E. inguinale - 9%. In Denmark, T. rubrum was the cause of MS in 48%, Tr. m. var. interdigitale - in 14%, E. inguinale - in 10.3% of cases. In 92% of patients, the skin and nails of the feet were involved in the process, in 6% - the skin and nails of the hands. In Romania, these figures were 52%, 41% and 6.5% respectively. It is important to note that the nails, especially the first toes, were affected by both dermatophytes and fungi of the genus Scorulariorsis. In Italy, the leadership of T. rubrum has been recorded since the 1980s. 20th century It was verified in 41.6% of patients with MVP, including in 100% of cases from lesions on the skin and nails of the feet.

In the 90s. 20th century T. rubrum has been the leading cause of MS in Southeast Asia, West Africa, and Northern Australia. At the beginning of the twentieth century. it began to spread rapidly in Russia, Europe, North and South America. Greece at the end of the 20th century. (1994-1998), when examining 791 patients with onychomycosis, dermatophytes with a predominance of T. rubrum were isolated in 72.3% of cases, molds - 9.6%, yeast-like fungi of the genus Candida - in 2%, mixed flora - in 16, 1% of cases. The cause of damage to the nail plates on the hands, on the contrary, was more often yeast-like fungi of the genus Candida (72%), less often - dermatophytes (10%), mold fungi (5.6%) and mixed flora (12.4%). In the Russian Federation, the proportion of T. rubrum in the structure of isolated dermatophyte cultures was 80%. In a study of 271 patients with diabetes mellitus (DM) of the 1st and 2nd types in Denmark, onychomycosis was detected in 22% of patients, dermatophytes caused the disease in 93% of cases, fungi of the genus Candida - only in 7%.

For the end of the twentieth century. and the first decade of the 21st century. characteristic is the predominance of dermatophytes in the structure of pathogens of mycoses and onychomycosis of the feet. At the same time, some researchers point to their leading value, while others note a decrease in their share against the background of an increase in that of pathogens of yeast and mold flora. So, in Moscow, in the structure of isolated dermatophyte cultures, T. rubrum in onychomycosis accounts for 80%, Tr. m. var. interdigitale - only 8%. In St. Petersburg, the main causative agent of MS in 91.5-92% of patients is T. rubrum. In Surgut, T. rubrum prevailed (75%), the share of Tr. m. var. interdigitale was 23%, Candida albicans - 2%. In the Republic of Tatarstan, in the pathogenesis of MS, the leading place is occupied by dermatomycetes (65.7%), mainly fungi of the genus Trichophyton: T. rubrum (48.1%) and Tr. m. var. interdigitale (13.8%), detected both separately and in association with yeast-like and / or mold fungi. The use of the PCR method to determine the etiology of onychomycosis in military personnel made it possible to identify T. rubrum and Tr. m. var. interdigitale in 72.9% of patients, which is 27.9% higher than when using the cultural method.

Interesting data were obtained during a survey of veterans of special risk units exposed to ionizing radiation. Dermatophytes were the cause of MS in 78% of cases. T. rubrum was sown in almost all patients (96%), in isolated cases - Tr. m. var. interdigitale (3.2%) and E. floccosum (0.6%). Candida spp. were an independent etiological agent in 16.5% of cases. Associations of dermatophytes, yeast-like fungi, bacteria and molds were found in 5.5% of cases.

In the Russian Federation, the proportion of T. rubrum in the structure of MC pathogens decreased to 65.2%. The importance of yeast-like fungi of the genus Candida (34.8%) and mold fungi (6.3%) increased. A similar situation was noted in Taiwan (60.5%, 31.5% and 8% respectively) . In Turkey, with onychomycosis, dermatophytes were sown in 59-78% of cases, and yeast-like fungi of the genus Candida - in 22-41%.
It should be noted a number of regions of the world where yeast-like fungi of the genus Candida began to prevail over dermatophytes. Thus, in the Republic of Bashkortostan from 2000 to 2006, there was a decrease in the role of T. rubrum in the etiology of MS by 14.3% and a significant increase in the proportion of fungi of the genus Candida (6.9 times) and mold fungi (6.2 times) . In Kazakhstan, the proportion of T. rubrum in the etiology of MS was only 47.9%, and it prevailed in older people, and E. interdigitale - in young people. In Indonesia, with MS, T. rubrum was sown in 50.1% of cases, yeast-like fungi of the genus Candida - in 26.2%. Finds of mold fungi (3.1%) and mixed flora (1.8%) were rare. In 18.7% of cases, the type of pathogen could not be established. In Colombia, yeast-like fungi with MS were isolated in 40.7%, dermatophytes - in 38%, molds - in 14%, mixed flora - in 7.3% of cases. It is significant that the yeast flora prevailed in women, dermatophytes - in men. In Brazil and the Philippines, dermatophytes in onychomycosis of the feet accounted for only 13%, with yeast flora dominating.
Exogenous factors contributing to the spread of MS are numerous and well studied. The predominance of the incidence of MS in large metropolitan areas makes it possible to call them "diseases of civilization". It is essential that urban residents, aggregating in rural areas, retain the old foundations of life. The increase in the incidence of MS is associated with the deterioration of the environmental situation, material and social living conditions of the majority of the Russian population, non-compliance with sanitary and hygienic conditions in everyday life and public places. This is especially typical where people walk barefoot or use impersonal shoes (bowling alleys, rent skates, skis, slippers when visiting friends' apartments), sleeping bags. Wars, national conflicts contribute to the movement of large flows of people. This contributes to the deterioration of the sanitary and hygienic living conditions of the population and, as a result, the growth of infectious diseases, including MS. Migration of the population is observed when working on a rotational basis, during commercial and tourist trips within the country and abroad. In these situations, the likelihood of close contacts between people, the use of impersonal personal hygiene items, more frequent visits to public baths, pools, beaches, etc., increases.

Climatic conditions play an important role in the epidemiology of MS. The disease is most often recorded in countries with a subtropical and tropical climate. This is facilitated by high ambient temperature and humidity. Occupational factors influence the incidence of MS. They often occur in miners, workers in the metallurgical and textile industries, affecting up to 28.2-54.3% of workers. And among workers in the petrochemical industry, the incidence of MS reaches 65%. Predispose to the occurrence of MS industrial hazards in the electronics industry and in industries associated with vibration.

In recent years, there has been an increase in the number of reports of a high incidence of MS in individuals exposed to ionizing radiation. Nuclear tests in the USSR have not been widely reported in the press for many years. Veterans of special risk divisions worked at different test sites: Semipalatinsk, Totsk, Northern test site (Novaya Zemlya). These are assemblers of nuclear charges, participants in tests on Ladoga, testers at uranium mines, small test sites, liquidators of accidents at nuclear power plants and submarines.

Risk groups include military personnel and athletes. The factors influencing the spread of the infection are the use of closed and impersonal shoes, shared showers, changing rooms, frequent injuries to the toes, etc. Thus, in the military personnel of the West Siberian region, the incidence of MS (25.7%) is almost 2 times higher, than the civilian personnel of the Russian Army (13.7%). In Denmark, the incidence of military personnel reached 91% by the end of their service. In Vietnam, under conditions of high temperature and humidity, the incidence of MS soldiers increased from 1.5% to 74%. The main reason was the use of impersonal shoes.
Often people become infected as a result of frequent visits to public places - swimming pools, baths, saunas, gyms. Epidemiological studies within the framework of the national project "Hot Line" showed that 28% of patients became infected with MS in this way. Constant trauma to the skin and nails of the feet in middle-aged and older patients with flat feet, calluses, corns, hallux valgus, osteoarthrosis contributes to the introduction of pathogenic fungi when visiting swimming pools, baths, saunas, sports clubs, fitness centers. A certain role in the epidemiology of MS is played by visits to hairdressers and beauty salons, where nail trimming procedures are used in foot care. The cause of MS can be foot microtrauma of any etiology, wearing closed, synthetic, rubber and tight shoes.
Intrafamilial infection is observed quite often. T. rubrum infection reaches 87.7-88%. When examining more than 8.5 thousand patients with onychomycosis in Denmark, the family nature of the disease was established in 22% of cases. Foreign researchers even believe that the intrafamilial route of infection prevails over infection in public baths, swimming pools and gyms.
Endogenous factors play a significant role in the pathogenesis of MS. Therefore, this pathology becomes an important interdisciplinary problem. Endogenous factors contributing to the onset of MS are numerous. These include insufficiency of the function of the vessels of the lower extremities, endocrine diseases, immunodeficiencies, vegetovascular dystonia, anatomical features of the feet, hypovitaminosis, chronic dermatoses, etc. .

Numerous works of domestic and foreign scientists are devoted to the study of the occurrence of MS in patients with various diseases. According to epidemiological studies within the framework of the Achilles project, in 16 countries of the world the leading diseases predisposing to the onset of MS in adults are diabetes (one third of patients), vascular pathology of the lower extremities (21%), obesity (16%), pathology of the foot ( fifteen%) .
In patients with DM, onychomycosis occurs 1.5 times more often than in the main population, and MS - in 58.6-62.4% of cases. The foot in DM is a target organ due to the development of peripheral polyneuropathy and angiopathy, severe trophic disorders occurring against the background of long-term and persistent decompensation, metabolic imbalance, impaired immunogenesis and foot deformity. The frequency of registration of MS in patients with DM with impaired main circulation, detected by ultrasound Doppler, was 73.6%, and in patients with normal vascular patency - 53.5%. MS in patients with DM develops against the background of severe microhemodynamic disorders, and the frequency of its registration increases with the severity of sensory disorders in the lower extremities.

Elevated blood sugar in DM creates favorable conditions for hypercolonization of the patient's body with mycotic flora. The etiological factor in most cases (89.3%) is T. rubrum. Other authors point to the predominance of mixed infection over monoinfection, which should be taken into account when choosing treatment tactics. Thus, T. rubrum as a monoinfection was verified only in 38.0±5.8% of cases, and mixed infection with C. albicans - in 51.0±6.0% and with Aspergillus - in 11.3±3.7 %. There are indications that in half of the cases T. rubrum forms associations with Candida spp. and Penicillium spp. .

The risk group in the occurrence of MS are patients with vascular disorders in the lower extremities - chronic venous insufficiency (CVI), obliterating endarteritis, Raynaud's syndrome, etc. . Clinical manifestations of MS in patients with vascular pathology were found in 75.6±3.9% of cases. The use of oscillography and rheovasography in MS made it possible to identify vascular disorders in 90-95% of patients. At the same time, 2/3 of the patients had functional disorders, the rest had persistent spastic conditions, obliterating endarteritis, Raynaud's syndrome, CVI up to the development of a varicose symptom complex. On the other hand, in CVI of the lower extremities MS was diagnosed in 38% of patients, and in chronic obliterating diseases of the arteries - in 16%. Fungi in CVI were detected in 2/3 (60.9%) patients.
Interesting data were obtained when comparing the microcirculation of the nail bed of the toes using a computerized capillaroscope in patients with MS and healthy volunteers. Endothelial dysfunction was revealed against the background of the inflammatory process. With MS, the degree of capillary tortuosity (2.0±0.9 vs. 1.1±0.8) and the size of the perivascular zone (111.2±18.4 µm vs. 99.4±14.4 µm) increased, a decrease in the rate of blood flow.

Information about the impact of dysfunctions of the autonomic nervous system in patients with MS is presented by a number of authors, and often these disorders are key links in pathogenesis. Changes in the functional state of the peripheral autonomic nervous system are characterized by a decrease in the amplitude of the skin sympathetic potential by 1.4 times and a lengthening of its latent period by 2.9 times. This contributes to the formation of trophic and metabolic disorders in the lesions in patients with this pathology. It is significant that the most pronounced changes (p<0,05) отмечаются у больных со сквамозно-гиперкератотической формой МС. С другой стороны, выраженный гипергидроз в области стоп предрасполагает к возникновению экссудативных форм заболевания .

MS is confidently leading in the structure of dermatological foot pathology. At the same time, MS is often registered in patients with various dermatoses. In patients with psoriasis, MS is detected in 46.5% of cases. At the same time, MS with onychomycosis was diagnosed in 18.9% of patients, and mycocarriage - in 13.4%. Similar data are given by foreign authors - 13%. With psoriatic lesions of the nails, onychomycosis was observed in 63.3% of cases. In patients with keratoses (45% of hereditary and 55% of acquired etiology), onychomycosis was verified in 54.4% of cases. The incidence of onychomycosis in patients with autoimmune skin diseases is 1.5 times higher than in patients without such conditions. The combination of punctate keratolysis with MS was observed in 63.3% of cases, while the dyshidrotic form of the disease prevailed, eczematization often occurred, and the clinical picture of MS was veiled by manifestations of punctate keratolysis.

In the last two decades, numerous studies have been carried out confirming the relationship between skin mycoses and diseases of allergic origin. The role of fungi in the pathogenesis of atopic dermatitis, bronchial asthma, urticaria, allergic rhinitis and conjunctivitis, microbial eczema and other diseases has been proven. The ability of Trichophyton components to bind to IgE antibodies was revealed by several methods - radioallergosorbent, enzyme-linked immunosorbent assay, Western blotting, and radioimmunoprecipitation. A high frequency of registration of an increased level of IgE antibodies (31%) and an increase in sensitivity to Trichophyton (16.5%) was noted in pedicurists who come into contact with the skin and inhale the fungal allergen. Specific therapy in the event of the development of a delayed-type hyperergic reaction to Trichophyton should be prolonged using antimycotics that do not affect the activity of steroids (terbinafine and fluconazole). Dry skin in atopic dermatitis is the cause of frequent microtrauma and infection. Mycogenic sensitization to C. albicans was detected in patients with psoriasis in 77.9% of cases, it correlated with the severity of the process and prevailed in the exudative form of the disease.

Veterans of special-risk departments with MS and exposed to ionizing radiation have a wide spectrum of somatic pathology, taking into account immunosuppression. Chronic diseases of the musculoskeletal system prevailed - 69% (osteochondrosis of various parts of the spine - 63%, arthrosis of various joints - 21%), vascular diseases of the lower extremities - 71% (atherosclerosis obliterans - 12%, varicose disease - 67%). Pathology of the gastrointestinal tract occurred in 55% of patients (chronic gastroduodenitis - 39%, peptic ulcer of the stomach and duodenum - 9%, pancreatitis - 26%).
Currently, much attention is paid to the study of MVP in patients receiving systemic glucocorticosteroids (SGCS). Currently, the contingent of such patients has increased significantly. SGCS is used in shock conditions, treatment of rheumatic diseases, bronchial asthma, allergic dermatosis, sarcoidosis, blood diseases, organ transplantation and many other pathologies. Many authors attribute the use of SGCS to risk factors for the development of MVP.

MS on the background of taking SGCS are distinguished by an unusual spectrum of pathogens and atypical clinical manifestations. The leader is T. rubrum (92.1%), rare - Candida spp. (7.4%), and Tr. m. var. interdigitale (2.1%). In 1/3 of patients, MS is combined with candidiasis of the mucous membranes of the gastrointestinal tract and genitals. In 96.4% of cases, the causative agent is C. albicans, in 3.6% - C. tropicalis.
The clinical effectiveness of the treatment of onychomycosis of the feet does not exceed 67%, while the etiological cure was observed in 46%, complete - in 33% of patients; with onychomycosis of the hands - in 83%, 71% and 67%, respectively. Recurrence of foot onychomycosis within 12 months. occurs in 47%, onychomycosis of the hands - in 25% of patients.

MS is often complicated by secondary pyoderma. A relationship between dermatophytes and pyogenic bacteria has been revealed. The synergism of pyococci and fungi, on the one hand, promotes deep penetration of dermatophytes into the skin. And the persistence of MS, on the other hand, increases the possibility of infection of the skin with bacteria due to the violation of trophism and integrity of the skin in the presence of cracks and erosions. Clinical manifestations of the intertriginous form of MS are the result of the interaction of dermatophytes and bacterial flora, and the ratio of dermatophytes/bacteria changes in favor of the latter, which enhances the inflammatory response in the focus. Attachment of secondary pyoderma in dyshidrotic-exudative forms of MS is observed in 25-30% of patients. In these cases, mycoses proceed torpidly and are more difficult to treat. In the Republic of Tatarstan, MS complicated by secondary pyoderma is recorded in 14.8% of cases and is a serious dermatological problem.

MS is an actual problem in erysipelas of the lower extremities. The incidence of MS with onychomycosis in this group of patients reaches 72-91%. There are two points of view on the role of MS in the pathogenesis of erysipelas. Some authors do not consider MS to be a risk factor for erysipelas, others define it as a very significant one. The main causative agent of MS in patients with recurrent erysipelas of the lower extremities is T. rubrum (96%). In 44% of cases it is associated with C. albicans. An important role in the pathogenesis of the disease is played by zinc deficiency, the content of which in patients with MS with relapses of erysipelas is 2 times lower than without them. With an increase in the frequency of recurrence of erysipelas, the content of zinc in the blood serum in patients with MS is steadily decreasing.
MS of candidal etiology, compared with healthy people, is more often recorded in patients with hypothyroidism and hyperthyroidism. The prescription of antibiotics, hormones, cytostatics, chemotherapeutic and other drugs for a number of diseases also contributes to the persistence of the mycotic flora, causing chronic MS and failure in treatment. In patients receiving immunosuppressants, onychomycosis was detected in 24% of cases. In Iceland, it was found that patients with oncological pathology are more likely to suffer from onychomycosis than healthy people.

Immune deficiency plays an important role in MS infection and disease recurrence. No wonder MS and onychomycosis are dermatological markers of HIV/AIDS.
According to L.E. Ibragimova, half of the HIV-infected young men of military age in the Ulyanovsk region had MS in combination with onychomycosis. In this case, both the somatic disease and MS are aggravated.

Conclusion
A review of numerous publications in domestic and foreign literature on the epidemiology of MS indicates the relevance of this problem on an interdisciplinary scale. The organization of care for this contingent of patients should be built taking into account all the listed factors, which, in fact, are much more. It is essential to hold scientific and practical conferences, symposiums, congresses, seminars, round tables with the participation of related specialists under the auspices of dermatologists, mycologists, microbiologists.

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