Dermatophytes or nail fungus, symptoms and photos. Dermatophytosis of smooth skin. Diagnosis and treatment

Dermatophytosis - what is it? This is a disease expressed in the mycotic lesion of the substance keratin, which is located in the skin and nails of the human body (a disease that affects the nails is called onychomycosis).

Dermatophytosis has a fairly large number of symptoms and signs. They may vary depending on the site of the infection. The causative agents are dermatophytes. What it is? How to diagnose and treat the disease? The answers to these and other questions related to the topic under consideration can be found in the presented article.

Dermatophytes - what is it?

Dermatophytes are fungi belonging to the genera Trichophyton, Microsporum and Epidermophyton. These microorganisms differ in that they cannot feed on carbon dioxide from the air. They need prepared organic substances, and that is why the main substrate for them is keratin, which is found in large quantities in the skin and nails of humans or animals.

Some types of these bacteria can exist both in the body of animals and in humans, others - only in humans. In this regard, microorganisms are classified into two types: anthropophilic and zoophilic.

A distinctive feature of these microorganisms is that they have tremendous survivability. Dermatophytes can exist in the environment outside of living organisms for more than two years. They are able to withstand freezing with liquid nitrogen and high temperatures up to hundreds of degrees Celsius.

causative agents of dermatophytosis

What are dermatophytes? These are fungi that can cause a disease in humans called dermatophytosis. To date, more than forty species of the described fungi have been classified, of which ten are the most common causative agents of the described disease in humans.

There are several forms of fungi that cause dermatophytosis:

1. Anthropophilic - a disease of this group has an epidemic character. Mushrooms, which are its causative agent, are located on household items, and can also be transmitted from person to person.
2. Zoophilic - fungi are transmitted through pets, and a person does not have to be in direct contact with them. You can also become infected with dermatophytosis through contact with animal care items.
3. Geophilic - this group of microorganisms is located mainly in the soil, respectively, they can be infected on beaches, garden plots, etc. Fungi of this type, which are the causative agents of dermatophytosis, have a long lifespan. They can stay in the soil for more than two years.

Diagnosis of dermatophytosis and treatment of dermatophytes directly depends on the type of disease and the site of the lesion in the human body. In this regard, it is worth considering in detail the main classification of the disease and the accompanying symptoms.

Classification and symptoms

According to the generally accepted system, the described disease is classified depending on the site of the lesion. Distinguish dermatophytosis:

• hair;
• nails;
• hands and feet;
• skin and skin folds.

It is worth considering each type separately.

Dermatophytosis of the scalp

The fungal disease of dermatophytosis, which manifests itself in the scalp, is divided into four main forms:

1. microsporia;
2. trichophytosis;
3. favus;
4. kerion (is a purulent form of the disease).

The first two types of dermatophyte disease are combined under the same name "ringworm". The main signs of damage to the skin of the head are:

• hair loss;
• the formation of edema and redness;
• the appearance of black dots from broken hair.

The favus of the scalp can be recognized by the appearance of a crust, which consists of fungal hyphae. The most common symptom of this type is the appearance of a "mouse" smell.

The purulent form appears in situations where the disease is not subjected to intensive therapy for a sufficiently long period of time. To treat this form is much more difficult and longer.

Dermatophytosis of the nails or onychomycosis

More than ninety percent of fungal infections of the nails are due to the penetration of dermatophyte fungi. The most common forms of diseases such as onychomycosis and hyperkeratosis. Damage to the nail is determined by the following signs:

1. change in the shape of the nails;
2. color change;
3. destruction of the internal structure, etc.

According to statistics, the average period of treatment of the described disease is more than twenty years.

Dermatophytosis of the feet and hands

Dermatophytes cause more fungal infections of the feet than of the hands. The ideal environment for fungus to thrive is in warm, humid conditions that are created when shoes are worn for a long time. Infection of the feet with mycoses occurs due to the development of fungal species such as Rubrum, Mentagrophytes.

In patients with mycoses of the feet, the following areas are affected:

• space between fingers
• sole;
• lateral surface of the toes and hands.

The main signs of the appearance of dermatophytosis syndrome on the hands and feet are thickening and peeling of the skin, the appearance of cracks, rarely bubbles, etc.

Dermatophytosis of large folds of smooth skin

Dermatophytosis of smooth skin is much less common than the above types. The main places for the development of such a skin disease are:

1. shins;
2. shoulders;
3. back;
4. buttocks;
5. inguinal zone, etc.

Outwardly, the disease is manifested by the appearance of a ring, which is constantly increasing in size. Accompanying signs are peeling of the skin, the appearance of edema at the site of the lesion, etc.

Diagnostics

For the correct selection of the necessary course of therapy, it is worth considering all the features of the described fungal disease. This is done by laboratory testing of nails, hair, or skin flakes (depending on the site of the disease).

Doctors process the collected biomaterial with an alkali solution, which makes it possible to detect fungi. In addition, the following types of studies of the collected material can also be additionally carried out:

• Microscopy - treatment of the material with potassium hydroxide.
• Sowing.
• "Wood's lamp" - a study of hair in a dark room.

Treatment of dermatophytosis

The main treatment for dermatophytosis is the use of a variety of oral antifungal drugs. A variety of antiseptic and systemic antimyotic drugs can also be used for local therapy.

Treatment of dermatophytes that affect the hair is the most difficult. To completely rid a person of microorganisms, intensive therapeutic procedures are necessary.

This disease is treated by local and systemic therapy with the following drugs:

1. grisiofulvin;
2. terbinafine;
3. fluconazole;
4. itraconazole, etc.

This list is also relevant for the treatment of infections caused by the described fungi on the nails, hands and feet of a person. The duration of therapy depends on factors such as the prevalence of the disease, the age of the person, the type of disease, etc.

Prevention

In order to avoid infection with fungal infections caused by the fungal microorganisms described in the article, it is necessary to perform the following preventive processes:

• Keep the skin dry and clean.
• Do not use publicly accessible personal hygiene items (e.g. in gyms, swimming pools, etc.).
• Regularly change underwear and observe intimate hygiene.
• Dry your feet thoroughly after bathing or showering.
• Treat the skin with antiseptics after visiting sports complexes, baths, saunas, etc.
• Carry out regular inspections of pets, as well as monitor their cleanliness.
• On beaches, in swimming pools, saunas and other public places, move only in slippers.

Despite the seriousness of the described disease, it does not pose a threat to human life. All over the world, there has never been a fatal outcome, the cause of which would be dermatophytosis.

The main problem in the treatment of this disease is its tendency to relapse. You can completely get rid of it with the help of a systemic complex treatment, repeated several times. However, it is worth recalling that the period of getting rid of dermatophytes can exceed decades.

• What is Dermatophytosis
• What causes Dermatophytosis
• Symptoms of Dermatophytosis
• Diagnosis of Dermatophytosis
• Treatment of Dermatophytosis
• Which doctors should you contact if you have Dermatophytosis

What is Dermatophytosis

What causes Dermatophytosis

Dermatophytes are called fungi- ascomycetes of the family Arthodermataceae (order Onygenales), belonging to three genera - Epidermophyton, Microsporum and Trichophyton. In total, 43 species of dermatophytes are known, of which 30 are pathogens of dermatophytosis.

The main causative agents of mycoses are, in order of occurrence, T. rubrum, T. mentagrophytes, M. canis.

Dermatophytes are called geophilic, zoophilic, or anthropophilic, depending on their usual habitat - soil, animal or human body. Members of all three groups can cause human diseases, but their various natural reservoirs determine the epidemiological features - the source of the pathogen, the prevalence and geography of the ranges.

Although many geophilic dermatophytes can cause infection in both animals and humans, the soil is the most common, natural habitat for these fungi. Members of the zoophilic and anthropophilic groups are believed to have descended from these and other soil-dwelling saprophytes capable of degrading keratin. Zoophilic organisms can sporadically be transmitted to humans if they have an affinity for human keratin. Transmission occurs through direct contact with an infected animal, or through objects that fall on the hair and skin scales of these animals. Infections often occur in rural areas, but pets are now especially important (especially in M. canis infections). Many members of the zoophilic group are named after their animal owners. The general epidemiological characteristic of zoonotic and anthroponotic dermatophytosis is high contagiousness. Dermatophytosis is perhaps the only contagious infection among all human mycoses.

The nature of infections caused by anthropophilic dermatophytes is, as a rule, epidemic. The main increase in the incidence is provided by anthropophilic species. Currently, anthropophilic dermatophytes can be found in 20% of the general population, and the infections they cause are the most common mycoses. According to our epidemiological study, there is an increase in the incidence of dermatophytosis.

Pathogenesis (what happens?) during Dermatophytosis

All dermatophytes have keratinolytic activity, i.e. capable of degrading animal and/or human keratin. The activity of keratinases and proteolytic enzymes in general is considered the basis of the pathogenic properties of dermatophytes. Keratinases themselves are capable of decomposing not only keratin, but also other animal proteins, including collagen and elastin. The activity of keratinases is not the same in different dermatophytes. T. mentagrophytes is characterized by the highest activity, and T. rubrum is quite moderate. The ability to decompose different types of keratin generally corresponds to the localization of a dermatophyte infection. Thus, E. floccosum, a species with low keratinolytic activity, does not affect hair.

The introduction of the colony of the pathogen into the epidermis is provided by both keratinolytic activity and the growth of hyphae. Like molds, dermatophytes have a specialized apparatus for directed growth of the hyphae. It is directed to the points of least resistance, usually at the joints between adjacent cells. Penetrating hyphae of dermatophytes are traditionally considered special perforator organs. It is still unclear whose role in the invasive process is more important - keratinases or directional growth pressure.

The depth of promotion of the fungal colony in the epidermis is limited. In skin infections, dermatophytes rarely penetrate deeper than the granular layer, where they are met by natural and specific defense factors. Thus, a dermatophyte infection covers only non-living, keratinized tissues.

The available data on the factors of protection of the macroorganism in dermatophytosis cast doubt on the point of view of some authors that with this infection there is a lymphohematogenous spread of the pathogen or its occurrence in non-keratinized tissues washed by blood. Deep forms of dermatophytosis have been described in patients with severe deficiency of one or more resistance factors.

Symptoms of Dermatophytosis

The basis of foreign classification of mycoses adopted in ICD-10, the principle of localization is laid down. This classification is convenient from a practical point of view, but does not take into account the etiological features of dermatophytosis in some localizations. At the same time, etiology options determine the epidemiological characteristics and the need for appropriate measures, as well as the features of laboratory diagnosis and treatment. In particular, representatives of the genera Microsporum and Trichophyton have unequal sensitivity to some antimycotics.

The generally accepted classification for a long time was the one proposed by N.D. Sheklakov in 1976. In our opinion, a reasonable and acceptable compromise is the use of the ICD classification with clarification, if necessary, of the etiology of the pathogen or its equivalent. For example: dermatophytosis of smooth skin (tinea corporis B35.4) caused by T. rubrum (syn. rubrophytosis of smooth skin). Or: dermatophytosis of the scalp (B35.0 favus/microsporia/trichophytosis).

The term "dermatomycosis", with which they sometimes try to replace the common name of dermatophytosis, is inappropriate and cannot serve as an equivalent of dermatophytosis.

Dermatomycoses are fungal infections of the skin in general, i.e. and candidiasis, and multi-colored lichen, and many mold mycoses.

Dermatophytosis of the scalp
Abroad, the following clinical and etiological forms of tinea capitis are distinguished:
1) ectothrix infection. Called Microsporum spp. (anthropozoonotic microsporia of the scalp);
2) endotrix infection. Called Trichophyton spp. (anthroponotic trichophytosis of the scalp);
3) favus (scab). Called T. shoenleinii;
4) kerion (infiltrative suppurative dermatophytosis).

The most common of these infections is microsporia. The main causative agent of dermatophytosis of the scalp in Eastern Europe is Microsporum canis. The number of registered cases of microsporia in recent years has been up to 100 thousand per year. The occurrence of pathogens of anthroponotic microsporia (M. ferrugineum) and trichophytosis (T. violaceum), common in the Far East and Central Asia, should be recognized as sporadic.

The classic picture of microsporia is usually represented by one or more rounded lesions with fairly clear boundaries, from 2 to 5 cm in diameter. The hair from the foci is dull, brittle, light gray in color, dressed in a white sheath at the base. Hair loss above the surface of the skin explains why the lesions appear clipped, befitting the name "ringworm". The skin in the focus is slightly hyperemic and edematous, covered with grayish small scales. The specified clinical picture corresponds to the name "lichen gray spots".

For trichophytosis of the scalp multiple isolated small (up to 2 cm) foci are characteristic. Breaking off of hair at the level of the skin is typical, leaving a stump in the form of a black dot peeping out of the mouth of the follicle (“deprive blackheads”).

Classic favus painting characterized by the presence of scutula (scutula, lat. shield) - dirty gray or yellow crusts. The formed skutula is a dry saucer-shaped crust, from the center of which a hair emerges. Each scutula consists of a mass of hyphae glued together by exudate, i.e. essentially a colony of the fungus. In advanced cases, the scutula merge, covering most of the head. A solid crust with a favus resembles a honeycomb, which is due to the Latin name of the disease. With a common favus, an unpleasant, “mouse” (barn, cat) smell comes from the crusts. Currently, favus is practically not found in Russia.

For infiltrative suppurative form of microsporia and trichophytosis characteristically pronounced inflammation with a predominance of pustules and the formation of large formations - kerions. Kerion - a painful dense focus of erythema and infiltration - has a convex shape, looks bright red or cyanotic, with clear boundaries and a bumpy surface, covered with numerous pustules and erosions, often hidden under purulent hemorrhagic crusts. Characterized by enlarged mouths of the follicles, from which, when pressed, yellow pus is released. A similar picture is compared with honeycombs (kerion). Kerion is often accompanied by general symptoms - fever, malaise, headache. Painful regional lymphadenitis develops (usually posterior or behind the ear nodes).

Dermatophytosis of the nails
Onychomycosis affects at least 5-10% of the population, and over the past 10 years, the incidence has increased by 2.5 times. Onychomycosis on the feet occurs 3-7 times more often than on the hands. Dermatophytes are considered the main causative agents of onychomycosis in general. They account for up to 70-90% of all fungal nail infections. The causative agent of onychomycosis can be any of the dermatophytes, but most often two species: T. rubrum and T. mentagrophytes var. interdigitale. T. rubrum is the main causative agent of onychomycosis in general.

Allocate three main clinical forms of onychomycosis: distal-lateral, proximal and superficial, depending on the place of introduction of the pathogen. The most common is the distal form. In this case, the elements of the fungus penetrate into the nail from the affected skin in the area of ​​the broken connection of the distal (free) end of the nail and skin. The infection spreads to the root of the nail, and for its advancement, the superiority of the growth rate of the fungus over the rate of natural growth of the nail in the opposite direction is necessary. Nail growth slows down with age (up to 50% after 65-70 years), and therefore onychomycosis prevails in the elderly. Clinical manifestations of the distal form are the loss of transparency of the nail plate (onycholysis), which manifests itself as whitish or yellow spots in the thickness of the nail, and subungual hyperkeratosis, in which the nail looks thickened. With a rare proximal form, fungi penetrate through the proximal nail ridge. White or yellow spots appear in the thickness of the nail at its root. In the superficial form, onychomycosis is represented by spots on the surface of the nail plate.

The average estimated duration of the disease at the present time (in the presence of dozens of effective antimycotics) is 20 years, and according to the results of a survey of middle-aged patients - about 10 years. Quite a lot for a contagious disease.

Dermatophytosis of the hands and feet
Mycoses of the feet are ubiquitous and occur more frequently than any other skin mycoses. The main causative agent of mycosis of the feet is T. rubrum, much less often mycosis of the feet is caused by T. mentagrophytes var. interdigitale, even less often - other dermatophytes. Foot mycoses caused by T. rubrum and T. mentagrophytes have specific epidemiology and clinical features. At the same time, variants of mycosis of the feet are possible, typical for one pathogen, but caused by another.

Infection with foot fungus caused by T. rubrum (rubrophytosis of the feet) most often occurs in the family, through direct contact with the patient, as well as through shoes, clothing, or common household items. The infection is characterized by a chronic course, damage to both feet, frequent spread to smooth skin and nail plates. With a long course, involvement of the skin of the palms, as a rule, of the right (working) hand is characteristic - the syndrome of "two feet and one hand" (tinea pedum et manuum). Usually T. rubrum causes a chronic squamous-hyperkeratotic form of mycosis of the feet, the so-called "moccasin type". With this form, the plantar surface of the foot is affected. In the affected area, there is mild erythema, moderate or severe peeling, and in some cases a thick layer of hyperkeratosis. Hyperkeratosis is most pronounced at the points bearing the greatest load. In cases where the focus is continuous and covers the entire surface of the sole, the foot becomes as if dressed in a layer of erythema and hyperkeratosis like a moccasin. The disease, as a rule, is not accompanied by subjective sensations. Sometimes the manifestations of rubrophytosis of the feet are minimal, represented by slight peeling and cracks on the sole - the so-called erased form.

Infection with mycosis of the feet caused by T. mentagrophytes (epidermophytosis of the feet) occurs more often in public places - gyms, baths, saunas, swimming pools. With epidermophytosis of the feet, an interdigital form is usually observed. In the 3rd, 4th, sometimes in the 1st interdigital fold, a crack appears, bordered by white stripes of macerated epidermis, against the background of surrounding erythema. These phenomena may be accompanied by an unpleasant odor (especially when a secondary bacterial infection is attached) and, as a rule, are painful. In some cases, the surrounding skin and nails of the nearest toes (I and V) are affected. T. mentagrophytes is a strong sensitizer and sometimes causes a vesicular form of athlete's foot. In this case, small bubbles form on the fingers, in the interdigital folds, on the arch and lateral surfaces of the foot. In rare cases, they merge, forming blisters (bullous form).

Dermatophytosis of smooth skin and large folds
Smooth skin dermatophytosis is less common than athlete's foot or onychomycosis. Smooth skin lesions can cause any dermatophytes. As a rule, in Russia they are caused by T. rubrum (smooth skin rubrophyton) or M. canis (smooth skin microsporia). There are also zoonotic mycoses of smooth skin caused by rarer types of dermatophytes.

Foci of mycosis of smooth skin have characteristic features - ring-shaped eccentric growth and scalloped outlines. Due to the fact that in the infected skin the phases of the introduction of the fungus into new areas, the inflammatory reaction and its resolution gradually change, the growth of foci from the center to the periphery looks like an expanding ring. The ring is formed by a roller of erythema and infiltration, peeling is noted in its center. When several annular foci merge, one large foci with polycyclic scalloped outlines is formed. For rubrophytosis, as a rule, affecting adults, widespread foci with moderate erythema are characteristic, while the patient can also have mycosis of the feet or hands, onychomycosis. Microsporia, which mainly affects children infected from domestic animals, is characterized by small coin-shaped foci on closed areas of the skin, often - foci of microsporia of the scalp.

In some cases, doctors, not recognizing mycosis of smooth skin, prescribe corticosteroid ointments to the focus of erythema and infiltration. In this case, the inflammatory phenomena subside, and mycosis takes an erased form (the so-called tinea incognito).

Mycoses of large folds, caused by dermatophytes, also retain their characteristic features: peripheral ridge, resolution in the center and polycyclic outlines. The most typical localization is the inguinal folds and the inner side of the thigh. The main causative agent of inguinal dermatophytosis is currently T. rubrum (inguinal rubrophytosis). The traditional designation of tinea cruris in the domestic literature was epidermophytosis inguinal in accordance with the name of the pathogen - E. floccosum (the old name is E. inguinale).

Diagnosis of Dermatophytosis

The basic principle of laboratory diagnosis of dermatophytosis is the detection of the mycelium of the pathogen in the pathological material. This is enough to confirm the diagnosis and start treatment. Pathological material: skin flakes, hair, fragments of the nail plate, are subjected to “enlightenment” before microscopy, i.e. treatment with alkali solution. This makes it possible to dissolve the horn structures and leave only the masses of the fungus in the field of view. The diagnosis is confirmed if filaments of mycelium or chains of conidia are visible in the preparation. In the laboratory diagnosis of dermatophytosis of the scalp, the location of the elements of the fungus relative to the hair shaft is also taken into account. If the spores are located outside (typical for Microsporum species), this type of lesion is called ectothrix, and if inside, then endothrix (typical for Trichophyton species). Determination of the etiology and identification of dermatophytes are carried out according to morphological features after the isolation of the culture. If necessary, additional tests are carried out (urease activity, pigment formation on special media, the need for nutritional supplements, etc.). For quick diagnosis of microsporia, a Wood's fluorescent lamp is also used, in the rays of which the elements of the fungus in the foci of microsporia give a light green glow.

Treatment of Dermatophytosis

In the treatment of dermatophytosis, all systemic antifungal agents for oral administration and almost all local antimycotics and antiseptics can be used.

Of the systemic drugs, they act only on dermatophytes or are approved for use only in dermatophytosis griseofulvin and terbinafine. Drugs with a broader spectrum of action belong to the class of azoles (imidazoles - ketoconazole, triazoles - fluconazole, itraconazole). The list of local antimycotics includes dozens of different compounds and dosage forms and is constantly updated.

Among modern antimycotics, terbinafine is distinguished by the highest activity against pathogens of dermatophytosis. The minimum inhibitory concentrations of terbinafine average about 0.005 mg / l, which is orders of magnitude lower than the concentrations of other antimycotics, in particular, azoles. Therefore, for many years, terbinafine has been considered the standard and drug of choice in the treatment of dermatophytosis.

Topical treatment of most forms of dermatophytosis of the scalp is ineffective. Therefore, before the advent of oral systemic antimycotics, sick children were isolated so as not to infect other members of the children's team, and various methods of epilation were used in the treatment. The main treatment for dermatophytosis of the scalp is systemic therapy. Griseofulvin, terbinafine, itraconazole, and fluconazole may be used in treatment. Griseofulvin is still the standard treatment for scalp dermatophytosis.

Terbinafine is more effective than griseofulvin overall, but also less active against M. canis. This is manifested in the discrepancy between domestic and foreign recommendations, since in Western Europe and the USA tinea capitis is more often understood as trichophytosis, and in Russia as microsporia. In particular, domestic authors noted the need to increase the dose for microsporia by 50% of the recommended one. According to their observations, effective daily doses of terbinafine for microsporia are: in children weighing up to 20 kg - 94 mg / day (3/4 125 mg tablets); up to 40 kg - 187 mg / day (1.5 125 mg tablets); more than 40 kg - 250 mg / day. Adults are prescribed doses of 7 mg / kg, not more than 500 mg / day. Duration of treatment - 6-12 weeks.

In the treatment of dermatophytosis of the nails, local and systemic therapy, or a combination of both, is also used - combination therapy. Topical therapy is mainly applicable only for the superficial form, the initial manifestations of the distal form, or lesions of single nails. In other cases, systemic therapy is more effective. Modern topical treatments for onychomycosis include antifungal nail polishes. Systemic therapies include terbinafine, itraconazole, and fluconazole.

The duration of treatment with any drug depends on the clinical form of onychomycosis, the prevalence of the lesion, the degree of subungual hyperkeratosis, the affected nail, and the age of the patient. The special KIOTOS index we have proposed is currently used to calculate the duration. Combination therapy can be prescribed in cases where systemic therapy alone is not enough or it has a long duration. Our experience with combination therapy with terbinafine includes its use in short courses and in an intermittent regimen, in combination with antifungal nail polishes.

In the treatment of dermatophytosis of the feet and hands, both local and systemic antifungal agents are used. External therapy is most effective for erased and interdigital forms of mycosis of the feet. Modern topical antimycotics include creams, aerosols, and ointments. If these funds are not available, local antiseptics are used. The duration of treatment ranges from two weeks with the use of modern drugs to four - with the use of traditional drugs. In chronic squamous-hyperkeratotic form of mycosis of the feet, involvement of the hands or smooth skin, lesions of the nails, local therapy is often doomed to failure. In these cases, systemic drugs are prescribed - terbinafine - 250 mg per day for at least two weeks, itraconazole - 200 mg twice a day for one week. With damage to the nails, the duration of therapy is extended. Systemic therapy is also indicated for acute inflammation, vesiculo-bullous forms of infection. Outwardly in these cases, lotions, antiseptic solutions, aerosols, as well as combined agents that combine corticosteroid hormones and antimycotics are used. Desensitizing therapy is indicated.

External therapy for lesions of smooth skin is indicated for isolated lesions of smooth skin. With the defeat of vellus hair, deep and infiltrative-suppurative dermatophytosis, tinea incognito, systemic therapy is indicated. We also recommend it for the localization of lesions on the face, and for widespread rubrophytosis (although nails are usually affected as well).

External antifungals are used in the form of creams or ointments; aerosol may be used. The same drugs are used as for the treatment of mycosis of the feet. The duration of external therapy is 2-4 weeks. or until the disappearance of clinical manifestations and another 1 week. after that. The preparations should be applied to the lesion and another 2-3 cm outward from its edges.

With simultaneous damage to the scalp or nails, systemic therapy is carried out according to the appropriate schemes. In other cases, with systemic therapy, terbinafine is prescribed at a dose of 250 mg / day for 2-4 weeks. (depending on the pathogen), or itraconazole 1 cycle of pulse therapy (200 mg twice a day for 1 week). Similar schemes are used for inguinal dermatophytosis.

Almost 5% of all malignant tumors are sarcomas. They are characterized by high aggressiveness, rapid hematogenous spread and a tendency to relapse after treatment. Some sarcomas develop for years without showing anything ...

Viruses not only hover in the air, but can also get on handrails, seats and other surfaces, while maintaining their activity. Therefore, when traveling or in public places, it is advisable not only to exclude communication with other people, but also to avoid ...

Returning good vision and saying goodbye to glasses and contact lenses forever is the dream of many people. Now it can be made a reality quickly and safely. New opportunities for laser vision correction are opened by a completely non-contact Femto-LASIK technique.

Cosmetic preparations designed to care for our skin and hair may not actually be as safe as we think.

Excess heat and moisture creates a favorable environment for the growth of fungi.
Dermatophytes are spread by contact with infected animals or people, as well as with contaminated household items.
Dermatophytosis smooth skin is a common superficial fungal infection of smooth skin characterized by well-demarcated annular lesions with central resolution, erythema, and peripheral scaling.
Dermatophytes: Trichophyton, Microspornm and Epidermophyton species.

Diagnosis of dermatophytosis of smooth skin

Diagnosis established on the basis of history, examination and microscopy.
Morphology: a well-demarcated annular lesion with resolution in the center, erythema and desquamation along the periphery. Concentric lesions are highly specific (80%) for dermatophyte infections.
Other characteristic features: itching in the affected areas.
Lesions can be located anywhere on the body, including the face and underarms.

Unrecognized or tinea incognito - a dermatophyte infection that was not previously recognized by the doctor / patient, while topical steroids were used to treat the lesion. With the use of steroids, the dermatophyte continues to grow, creating cosmetic problems. In some cases, the infection causes hyperpigmentation.
Dermatophytosis of smooth skin can capture large areas of the body.

KOH microscopy is useful for confirming clinical findings or when the diagnosis is unclear. For this purpose, a scraping is taken from the peripheral and erythematous area of ​​the focus, using the edge of a glass slide or a scalpel. To obtain a sufficient amount of the stratum corneum without causing bleeding, the procedure must be performed with pressure. If the material is taken incorrectly, as well as in cases where the patient uses topical antifungal drugs or microscopy is performed by an inexperienced specialist, a false negative result can be obtained.
For faster dissolution of epithelial cells without heating, KOH with dimethyl sulfoxide (DMSO) is used. You can use fungal dye.

Skin scrapings with culture are the gold standard, but more expensive, and may take about two weeks to grow.
If the KOH test and culture are negative, but the clinical picture still indicates a fungal infection, a biopsy should be performed, sending the obtained material in formalin to the laboratory for Schiff staining.

Differential diagnosis of skin dermatophytosis

Granuloma annulare is an inflammatory benign dermatosis of unknown origin characterized by both dermal and annular papules.
Psoriasis is characterized by plaques with scales on the extensor surfaces of the body. Sometimes the plaques are ring-shaped. Inverse psoriasis in intertriginous zonases can also mimic smooth skin dermatophytosis.
In erythema annular centrifugus, scaly red rings appear with a patch of normal skin in the center, with scaling following the erythema as the ring expands, while in dermatophytosis, scaling precedes the erythema.

When infected with a skin migrating larva, serpiginous passages are observed, laid by the larva of the crooked head, which may have an annular pattern and be mistaken for smooth skin dermatophytosis.
Nummular eczema is characterized by round, coin-shaped, red, scaly plaques without central resolution.
Erythrasma is localized in the axillary and inguinal regions, does not have an annular configuration and resolution in the center. Glows coral red under a Wood's lamp.

Treatment of dermatophytosis of the skin

In the event of dermatophytosis in limited areas of smooth skin, topical antifungal drugs are used.
Although almost all topical antifungal drugs are effective in the treatment of dermatophytosis of the feet and smooth skin, clinical data indicate that allylamines (terbinafine) are more effective than expensive azoles.

Studies show that terbinafine 1% cream or solution (once a day for seven days) is highly effective for smooth skin dermatophytosis and groin dermatophytosis. With the 1% cream (known commercially as Lamisil), the mycological efficacy was 84.2% compared to 23.3% with placebo.

The average number of courses required for treatment was 1.6.

If dermatophytosis of smooth skin occupies large areas of the body, systemic antifungal drugs are considered first-line therapy. However, if the size of the affected area is limited, it will not be a mistake to try local therapy. A patient with unrecognized dermatophytosis required systemic therapy to resolve the infection. Unfortunately, the post-inflammatory hyperpigmentation did not completely resolve.
A randomized controlled trial showed that in the treatment of dermatophytosis smooth skin and tinea groin, itraconazole 200 mg orally for one week daily was as effective, safe and well tolerated as itraconazole 100 mg for two weeks.

In one study, patients with a laboratory diagnosis of dermatophytosis smooth skin and groin were randomly divided into two groups, who received either 250 mg terbinafia once daily or 500 mg griseofulvin once daily for two weeks. Efficacy for terbinafia was higher at week 6.

So, if a systemic drug is needed, clinical evidence supports the use of
- Terbinafia at a dose of 250 mg daily for two weeks,
- Itracoiazole at a dose of 200 mg daily for one week,
- Itracoiazole at a dose of 100 mg daily for two weeks.

The patient is advised to keep the skin dry and clean. Infected pets must be treated.
For difficult-to-treat and widespread disease, a second visit to the doctor is scheduled after 4-6 weeks. If bacterial superinfection is likely, follow-up examination should be carried out earlier.

Clinical example of smooth skin dermatophytosis. A six-year-old girl was brought to the doctor because of a round, itchy lesion on her body. The rash was first discovered two weeks ago. Several patches of baldness have been observed in a domestic cat. Note concentric circles with scaling, erythema, and resolution in the center. Under the Wood's lamp, the lesion glowed green; analysis with KOH revealed branching and septate hyphae. The child was given a topical antifungal cream twice a day, and after 3-4 weeks the dermatophytosis resolved.

Dermatophytosis is a collective name that characterizes a group of fungal skin lesions. The second name of the pathology is dermatomycosis. Dermatophytosis can affect any part of the body, is accompanied by a number of specific symptoms and is quickly treated with fungicidal agents.

It looks like the causative agent of dermatophytosis on the skin through a microscope

Pathology is caused by dermatophyte fungi. This class includes three pathogens - Microsporum, Trichophyton and Epidermophyton. Microsporia, also known as ringworm, ranks first in prevalence among fungal infections with a high degree of contagiousness. The pathogen enters the skin upon contact with an infected person or stray animal.

Trichophytosis is another contagious disease, also known as scab. Trichophytosis is easily transmitted from person to person, and from animal to person, in the second case, the disease proceeds in a more severe form.

Epidermophytosis is a lesion of the hairy areas of the skin. Most often, inguinal dermatophytosis provoked by this pathogen is diagnosed.

Dermatophytosis can also be understood as any mycosis of smooth skin caused by pathogenic microflora. All fungi that provoke the development of this disease feed on keratin, which is found in the skin, hair and nail plates.

Dermatophytosis is the collective name for fungal infections of the epidermis. In addition to dermatophyte fungi, mold and yeast fungi, which are initially aggressive towards the body and are not part of the normal human microflora, can provoke this pathology.

Thus, the main reason for the development of the disease is the penetration of pathogenic microflora into the human body. This happens in three ways:

• upon contact with an infected person;
• in close contact with stray animals;
• through soil and dust.

Despite the high degree of contagiousness of some types of dermatophytosis, for example, ringworm, the action of provoking factors is additionally necessary for the development of fungal diseases. A healthy person will not get mycosis by accidental contact with a carrier of the fungus. Factors that increase the risk of developing dermatophytosis:

• decreased immunity;
• some chronic diseases;
• non-compliance with personal hygiene;
• hormonal imbalance;
• work specifics.

A decrease in immunity, for example, due to infectious diseases or severe stress, weakens the protective function of the skin, therefore, upon contact with a carrier of the disease, a rapid development of the fungus is noted.

Patients with diabetes mellitus, chronic dermatological diseases, as well as HIV-infected people are prone to dermatophytosis. This is due to changes occurring in the body against the background of the listed pathologies, as a result of which it becomes susceptible to the action of pathogenic microflora.

Another factor that provokes the development of the disease is the neglect of the rules of personal hygiene. The fungus multiplies rapidly on dirty skin, and sweat acts as an excellent breeding ground for it.

An important role in the development of dermatophytosis is played by the specifics of human work. People who are in confined spaces for a long time, or who are constantly in contact with the ground, are more susceptible to this disease.

Disease classification

More than thirty different pathogenic fungi can cause skin infections

Dermatomycosis is classified according to three criteria:

• type of pathogen;
• localization of the lesion;
• type of epidermal lesion.

According to the type of pathogen, microsporia, trichophytosis and epidermophytosis are distinguished. Despite the prevalence of these pathogens, more than thirty different pathogenic fungi can provoke dermatophytosis, so this classification is generalized.

Any disease caused by a fungus that destroys the keratin of the stratum corneum of the epidermis is rightly called dermatophytosis. During the life of pathogenic fungi, skin keratinization is disturbed, which is a common symptom for all types of dermatomycosis.

Localization of the lesion

Dermatophytosis is easily recognizable from the photo, but people are often confused by the variety of forms and symptoms of this disease. Ringworm can affect almost any part of the body. The most common forms of pathology:

• inguinal dermatophytosis;
• dermatophytosis of the feet;
• dermatophytosis of the hands;
• onychomycosis or dermatophytosis of the nails;
• dermatomycosis of smooth skin;
• dermatophytosis of the scalp.

Moreover, each of the listed forms of the disease can be caused by various pathogens, which leads to the variability of specific manifestations of skin lesions.

Type of skin lesion

Pseudomembranous candidiasis affects the mucous membranes of the mouth or larynx

According to the type of lesion, all fungal infections of the epidermis are divided into several large groups:

• dermatophytosis;
• keratomycosis;
• candidiasis;
• deep mycosis.

Dermatophytosis is most often called ringworm and any epidermal lesions that affect the hairy areas of the skin. Such diseases are characterized by severe peeling, thinning and hair loss, a change in the structure of the epidermis in the affected area.

Keratomycosis refers to any fungal skin lesions that lead to the destruction of keratin in the epidermis. A typical representative of this group of diseases is versicolor, in which dekeratinization of the skin occurs and the formation of brown and milky spots.

Candidiasis is a group of mycoses caused by a yeast fungus of the genus Candida. This fungus affects smooth skin, inguinal folds, mucous membranes. Vaginal candidiasis, also known as thrush, is the most common fungal infection in women. Yeast fungi can affect the mucous membrane of the mouth, internal organs, and the gastrointestinal tract.

Each type of dermatophytosis has its own characteristics, which depend on the causative agent of the disease and the localization of the skin lesion. For example, with ringworm, a regular-shaped patch with a pronounced inflamed edging forms on the skin. The epidermis in the area of ​​the spot is very flaky, in the center and along the periphery the hair breaks off and thins, a rash may appear. A characteristic feature of the disease is severe painful itching.

Pityriasis versicolor is accompanied by the formation of spots of different shades of brown. In this disease, there is no inflammatory reaction and itching, the pathology is considered non-contagious.

Almost all fungi cause severe flaking and changes in the structure of the epidermis. This is due to the breakdown of keratin in the skin.

Candidiasis of the skin is manifested by inflamed stripes and spots, similar to diaper rash. The epidermis in the affected area turns red and swells, severe pain and itching appear, and a light film may form on the inflamed skin.

Dermatophytosis of the scalp

With dermatophytosis of the head, symptoms of seborrhea appear, in various forms.

Symptoms of dermatophytosis of the scalp depend on the causative agent of the disease. If the pathology is caused by microsporia or trichophytosis, the characteristic signs of the pathology are:

• flaky spots of the correct form;
• swelling of the skin in the affected area;
• severe itching;
• rapid hair contamination;
• focal alopecia.

Ringworm on the head can appear as one large spot or several small foci. This disease leads to hair thinning. If treatment is not started in a timely manner, alopecia areata develops - small areas with impaired hair growth or complete baldness. Despite the frightening symptoms, the hair is restored quite quickly, subject to adequate and timely therapy.

With dermatophytosis of the scalp caused by yeast fungi, symptoms of seborrhea appear, only in a more severe form. The skin is very itchy, large scaly scales form, tightness and discomfort are constantly felt.

Dermatophytosis of the scalp is especially noticeable at the hairline, on the temples or on the neck. Usually, red, inflamed spots or thick, greasy crusts appear in these areas. Damage or separation of the crust exposes bright red, inflamed skin, which, when damaged, causes itching.

Onychomycosis

Dermatophytosis of the nails or onychomycosis is one of the most common dermatological diseases. Pathology is characterized by the destruction of keratin in the nail plates on the hands and feet. Infection occurs due to:

• non-compliance with personal hygiene;
• visits to public showers and pools without slippers;
• wearing someone else's shoes.

Using other people's towels or walking barefoot in crowded places greatly increases the risk of infection with nail fungus. Dermatophytosis of the nails can be caused by various fungi - yeast, mold or dermatophytes. Pathology is characterized by a slow increase in symptoms and a very long treatment. Typical symptoms:

• thickening of the nail plates;
• the appearance of spots and longitudinal furrows;
• fragility and delamination of nails;
• the formation of thick exudate under the nails;
• unpleasant pungent odor.

Most often, onychomycosis affects the toenails. Infection of the fingers usually occurs when using someone else's manicure tools, or by self-infection, in case of non-compliance with hygiene standards when treating infected toenails.

Foot and hand injury

Dermatophytosis of the feet is accompanied by a pungent odor, redness and thickening of the skin

Dermatophytosis of the feet is another common disease. The reason most often is a decrease in local immunity against the background of hyperhidrosis (excessive sweating of the legs), wearing too narrow shoes and non-compliance with foot hygiene. Dermatophytosis of the feet is characterized by the following symptoms:

• flaky spots on the feet;
• redness and thickening of the skin;
• itching of the interdigital spaces;
• strong unpleasant odor from the feet;
• the formation of cracks in the rough skin of the heels.

Dermatophytosis of the feet is accompanied by a pungent odor, aggravated by sweating. Washing the feet eliminates the smell for a very short time, it quickly reappears.

Dermatophytosis of the hands develops when infected from another person or a decrease in local immunity. A factor predisposing to the development of the disease may be damage to the skin by chemicals, including household chemicals. Dermatophytosis of the hands is characterized by severe peeling of the palms, redness of the interdigital spaces, itching and cracking.

Dermatophytosis of smooth skin

Dermatophytosis smooth skin is a mycosis that can affect any part of the body. Most often, such mycosis appears on the chest, back, in the armpits, on the face. This pathology is characterized by the following symptoms:

• the formation of an inflamed spot of a round or oval shape;
• redness of the skin in the affected area;
• pronounced border of the spot;
• peeling and itching;
• erythema.

Dermatophytosis of the face is manifested by spots on the cheeks or on the forehead. Dermatophytosis of smooth skin is characterized by the formation of one large focus. In the absence of timely treatment, the fungus quickly spreads to healthy areas of the skin, and several smaller foci form around the first spot.

Inguinal dermatophytosis

Inguinal dermatophytosis is more common in men than in women. This type of mycosis affects the hairy areas of the body, so the symptoms of the disease are similar to dermatophytosis of the scalp. Inguinal dermatophytosis develops as a result of the use of other people's hygiene items or self-infection, when other parts of the body are affected by the fungus.

Inguinal dermatophytosis is characterized by the following symptoms:

• skin inflammation;
• pronounced peeling;
• redness of the epidermis;
• the formation of ulcers and dense crusts.

Inguinal dermatophytosis is accompanied by severe discomfort and requires timely treatment, otherwise infection of the sexual partner is possible.

Diagnostics

Laboratory analysis will help to accurately identify the presence of the causative agent of a fungal infection.

With dermatophytosis, treatment is prescribed only after an accurate determination of the causative agent of the disease. To do this, it is necessary to analyze the skin scraping of the affected area. A dermatologist deals with the diagnosis and treatment of dermatophytosis.

Be sure to conduct a differential diagnosis to exclude other dermatological diseases, such as psoriasis, erythrasma, contact dermatitis.

For the analysis, a small fragment of the skin is taken, most often the scales are scraped at the site of peeling, which are then sent to the laboratory for microscopic analysis. When the nails are damaged, a small area of ​​the affected nail plate is taken for analysis.

In the case of deep mycoses or the impossibility of determining the causative agent of the disease using microscopy, it is necessary to conduct a PCR analysis.

Principle of treatment

Therapy of dermatophytosis should be comprehensive, treatment is based on the use of broad-spectrum antifungal agents. The exact names of drugs and the form of their release depend on the localization of the disease.

When smooth skin is affected, antifungal ointments and solutions are used. Dermatophytosis is treated with potent agents with broad antifungal activity. These drugs include:

• Exoderil;
• Lamisil;
• Terbinafine;
• Naftifin;
• Miconazole.

At the time of treatment, it is necessary to thoroughly cleanse the skin. Additionally, any antiseptics are used, and then an antifungal ointment is applied. Processing is carried out up to two times a day. With severe symptoms, the doctor prescribes antifungal drugs in tablets - Fluconazole, Nystatin, Itraconazole. Such drugs are taken either once in a large dose, or for 1-2 weeks at a minimum dosage. The exact dosage regimen depends on the severity of the symptoms of the disease.

In case of damage to the scalp or inguinal region, it is necessary to use funds in liquid form. The active ingredients are the same, but most often drugs based on naftifine or griseofulvin are prescribed. With a fungus on the head, medicated shampoos are used:

• Ketoconazole;
• Nizoral;
• Griseofulvin;
• Sebosol;
• Keto Plus.

These shampoos are used up to three times a week. They are applied to the skin, foamed and left for 5 minutes, and then washed off with water.

In the treatment of inguinal dermatophytosis, it is recommended to remove excess hair in the affected area in order to be able to apply the healing cream without hindrance. If for some reason hair removal is not possible, a fungal shampoo is used for treatment. The first line drug of choice in this case is Griseofulvin.

For the treatment of onychomycosis, preparations are used in the form of a cream, solution or nail polish. The first-line drugs of choice among antifungal ointments are Exoderil and Lamisil. These products are distinguished by high antifungal activity and quite effectively get rid of nail fungus at the initial stage.

In advanced cases, it is necessary to use varnishes and solutions. These include:

• Exoderil;
• Loceryl;
• Batrafen;
• Mycosan.

These drugs are applied to the nail plate 2-4 times a week, depending on the composition and recommendations of the doctor. Hot nail baths should be done daily, which soften the nail plates and make it easy to remove destroyed particles. For the care of nails affected by the fungus, only disposable manicure accessories should be used, otherwise the risk of re-infection is high.

Forecast

Dermatophytosis is quickly treated with the help of fungicidal agents with timely detection

With the timely detection of symptoms, dermatophytosis is quite successfully treated and disappears without a trace. On average, therapy takes about 4 weeks if smooth skin is affected, and about 8 weeks in case of damage to the scalp and scalp.

Foot fungus resolves in an average of 2 months. Treatment of the fungus on the hands takes 3-6 weeks, depending on the severity of the symptoms.

Onychomycosis is treated for a long time, a complete cure occurs only after the growth of healthy nails. With the defeat of the fingers, it takes about 6 months, with the defeat of the toenails, the duration of treatment reaches 9-12 months.

Prevention

Dermatophytosis is a contagious disease, so prevention is reduced to minimizing contact with potential carriers of a fungal infection. You should follow the rules of personal hygiene when visiting public places with high humidity and be careful in contact with stray animals.