Fungal infections of dermatophytosis. What are dermatophytes? Treatment of concomitant pathologies

07.03.2019

Fungal diseases are the leading among many infectious skin lesions. One of the common pathologies is dermatophytosis. This pathology has begun to occur more often in medical practice.

Features of the disease

The disease in question is caused by dermatophytes. Interest in treatments for the disease has increased due to the strong spread of infection. The disease can equally often strike skin in men, women.

There are some age specific features.

They lie in the fact that dermatophytosis in children affects mainly the scalp.
As for young people, in this category the fungus is localized between the fingers, in the area of the inguinal folds.

ICD 10 code: B35 Dermatophytosis

Experts have found that the disease in question is observed much less frequently in the Negroid race. If a person has a weakened immune system, he is more likely to become infected with a fungus, in addition, the infection will be more severe, and may form.

Dermatophytosis interdigitalis (photo)

Classification of dermatophytosis

By localization

Typically, dermatophytes infect hair, the stratum corneum of the epidermis, and nails. There they actively reproduce and grow. Experts, taking into account the localization of the fungus, have identified the following subtypes of dermatophytosis:

Stop ().
Brushes.
Faces.
Inguinal.
Nails.
Torso.

A specialist will tell you about athlete's foot in this video:

By type of fungus

In addition, experts have found that onychomycosis is not always provoked by fungi such as dermatophytes. Sometimes this disease is provoked by yeast and mold fungi (trichomycosis, hair damage). In this case, you need to use the following classification of this pathology:

Dermatophytosis of the scalp.
Trichophytosis granuloma of Majocchi.
Dermatophytosis of the beard and mustache.
Folliculitis caused by dermatophyte fungi.

By type of lesion

There is also a classification developed taking into account the type of lesion:

Athlete's foot. The infection affects the epidermis.
Trichophytosis. The infection affects the stratum corneum of the hair and epidermis.
Onychomycosis. The fungus gets on the nail plates.

Causes

The disease manifests itself when fungi penetrate into the stratum corneum of the hair, dermis, and nail plates. This group of fungi (filamentous) includes:

Microsporam.
Trichophyton.
Epidermophyton.

In nature, researchers have discovered over 40 species of fungi, which experts classified as the above three genera of dermatophytes. Of the total number of mushrooms, 10 species are the most popular provocateurs infectious disease in people.

The source of infection is a sick person, pets, and soil. Taking into account the habitat, experts have identified the following types of dermatophytes:

Anthropophilic. Infestation by fungi of this group is epidemic in nature. Representatives of this group spread through household items. These include:
- Trichophyton menta-grophytes var. Interdigitale, Trichophyton violaceum, Trichophyton tonsurans, Trichophyton rubrum, Trichophyton schoenleinii.
- Epidermophyton floccosum.
- Microsporam audouini.
Bestiality. The fungus reaches people from pets (through contact, through pet care items). The group includes the following types:
- Microsporum canis.
- Trichophyton mentagrophytes var. Mentagrophytes, Trichophyton equinum, Trichophyton verrucosum.
Geophilic. Representatives of this group reach the epithelium from the soil in which they are located. The group includes:
- Microsporum gypseum,
- Microsporum nanum.

Symptoms

The disease we are considering has basic symptoms that are individual for each type of disease. The main ones include:

Red (they are characteristic of athlete's foot).
Many foci are not large sizes observed with trichophytosis. in the affected area, small scales form on it. As for the hair, it becomes dull, weakens, and a white sheath forms at its base.

Now consider the symptoms of the disease characteristic of each individual type of dermatophytosis:

Dermatophytosis on the feet and hands The appearance of redness, peeling, and keratinization of the skin is typical.
Dermatophytosis of the trunk The appearance of peeling with clear boundaries is typical. These formations can be large or small.
Dermatophytosis on the groin(groin area) is characterized by the appearance of large scale peelings and erythema. Papules and pustules appear at the edges of the lesions. The affected areas come in different colors (brown, yellow-brown, red).
Onychomycosis, which occurs on the nails of the hands and feet, manifests itself in the compaction of the nail plate, its destruction at the edges. The nail plates become a grayish-dirty color.
Dermatophytosis large folds , smooth skin manifests itself in the appearance of lesions, which are characterized by ring-shaped growth and scalloped formations. In the central part of the lesion, which is similar to a ring, peeling is noted.

Diagnostics

In order to choose the right course of therapy, specialists must conduct research aimed at identifying the causative agent of the disease. For this purpose, laboratory assistants take material (nails, scales, hair), which is then processed using alkaline solution. This procedure allows you to detect fungus, because after treatment with alkali, only masses of fungi will be visible under microscopy.

In addition to the main diagnostic method also additionally use:

Microscopy.
Sowing.
Wood's lamp.

Microscopy

Study of material removed from the affected area after treatment with potassium hydroxide. For diagnosis, they take the dermis, nails, and hairs. The dermis is collected using a scalpel and the edge of a glass slide. Initially removed upper layer epidermis, then these scales are placed on the central part of a glass slide and covered with another glass (cover glass).
To remove material for analysis from the nail plate, laboratory assistants use a scalpel. Specialists collect material from different parts of the nail plate when different forms diseases (material is taken from the inner part of the nail for distal-lateral subungual onychomycosis, from the outside if a superficial form of onychomycosis is determined. Material is also taken from the inner part for proximal subungual lesions).
For examination, broken hairs are taken using tweezers and a needle holder.

To process the seized material, potassium hydroxide (5 - 20%) is taken. The product is dripped onto the tip of the glass, and under the influence of capillary forces it flows between the glasses. When heated, bubbles form. After such clarification, the material taken is examined using a microscope. Mushroom mycelium is like a cluster of thin tubes. Partitions are observed inside these tubes.

Sowing

To carry it out you will need scales removed from the infected dermis, scrapings from nails and hairs. Cultivation of mushrooms is carried out on, which consists of glucose, peptone, agar-agar.

Wood's lamp

The procedure is performed in a dark room. If the hair is affected by Microsporum spp., specialists will observe a green glow.

They may also prescribe differential diagnosis with the following diseases:

Erythema.
Granuloma annulare.
Erythrasma.

Now let’s find out how to treat dermatophytosis.

This video will tell you how to get rid of nail and foot fungus:

Treatment

General principles

Therapy for dermatophytosis is carried out using various antifungal agents intended for internal use, as well as antiseptics and antimycotics intended for local therapy.

Of the systemic drugs, experts prescribe the following to combat dermatophytes:

"Terbinafine".
"Griseofulvin".

Drugs with a broad spectrum of action, included in the azole class, are prescribed for the treatment of dermatophytosis:

"Itraconazole".

Of the modern antimycotics, Terbinafine is considered very effective. We’ll talk about ointments for the treatment of dermatophytosis capitis below.

Scalp

Treatment of dermatophytosis of the scalp is more difficult. Systemic therapy is necessary to kill dermatophytes. Treatment of dermatophytosis that occurs on the scalp is carried out using the following drugs:

"Griseofulvin".
"Terbinafine".
"Fluconazole".
"Itraconazole".

We will talk about the treatment of dermatophytosis of the feet and hands below.

Nails, feet and hands

The same drugs are also effective in the treatment of dermatophytosis of the nails, feet, and hands. The duration of therapy depends on the following factors:

prevalence of the lesion;
form of the disease;
age of the patient.

Disease prevention

To avoid unpleasant fungal infections, you should adhere to the following preventive measures:

Maintaining dry, clean skin.
Do not use items of questionable cleanliness (in the gym, swimming pool).
Monitor the cleanliness of underwear and clothing.
After water procedures, wipe your feet dry.
Use only your personal items.
Carry out skin treatment after visits gyms, swimming pools, baths.
Monitor the health of your pets (if you suspect lichen, contact your veterinarian).
Walk on the beach in public places in slippers.

Complications

The disease in question is not life-threatening. The main unpleasant point is the tendency of the disease to recur, as well as the fact that it has a chronic course.

Forecast

The disease can last from several months to a year or more. Complete recovery is possible with the right specialist approach to therapy (systematic, comprehensive, repeatable).

Even more useful information about dermatophytosis is contained in the video with Elena Malysheva:

Onychomycosis is an infectious fungal disease of the nails. The disease can be caused by various pathogens, but in almost all cases, it manifests itself in the same way. Men suffer from onychomycosis more often than women.

With onychomycosis, the fungus invades the tissue of the nail plate and destroys it, thereby creating a nutritious environment for yourself. Not all fungi can infect nails. Most often, the causative agents of the disease are:

Yeasts;
Dermatophytes;
Mold fungi.

Causes and symptoms of nail onychomycosis:

Causes of fungus and contributing factors

The disease has an infectious etiology, certain types pathogens, and, therefore, their sources of infection. Most often, infection occurs:

Upon contact with infected people. Most of the fungi that cause onychomycosis belong to the category of anthroponotic infections that affect only humans. In this case, the cause of infection may be the use of shared towels, nail scissors, washcloths, replacement shoes, and house slippers. Spores of such fungi can survive well in the soil, like in an incubator, for a long time, so there is no need to walk barefoot on the ground.
In contact with animals that may act as carriers of the pathogen.
From the environment. There are types of fungi (mainly mold groups) that do not require living organisms for life and development. They can reach humans from water, soil, or infected plants.

The chances of rapid development of the disease increase with certain factors, for example:

For diabetes mellitus;
In old age;
For vascular diseases;
Weak immunity;
Mechanical injuries of nails or skin diseases;
With regular visits to swimming pools, saunas or baths.

Classification of nail fungi

Let's consider the types of nail plate fungus depending on the pathogen. Most often these are dermatophytes.

Dermatophytes

This group of pathogens of onychomycosis includes fungi (80%-90% of diseases):

Dermatophytes are imperfect fungi that can infect skin, hair and nails..

The disease occurs against a background of reduced immunity. In this case, the infection is transmitted through contact with infected people, animals, or through soil in which fungal spores can be stored for a long period.

During the growth process, almost all fungi of this genus form mycelium (mycelium), which attaches to the nail, thereby causing its destruction.

Yeast mushrooms

The causative agent of the disease is most often:

Candida tropic;
Candida parapsilosis.

Yeast fungi of the genus Candida live on human skin and mucous membranes, and this is the norm.

If the patient’s immunity weakens, they begin to actively multiply, causing certain diseases, including onychomycosis.

To become infected, contact with another person is not required.

This genus of fungi does not form mycelium, so destruction of the nail plate rarely occurs.

Molds

The most common mold fungi that cause onychomycosis are:

Asperquillus;
Fusarium;
Scopulariopsis brevicaulis.

More than 40 types of molds can affect nails. They become the cause of onychomycosis quite rarely. The source of infection, in this case, is difficult to identify, as well as to diagnose the disease.

There are no typical symptoms that would distinguish nail infection by mold fungus, so the disease can only be determined after testing. Since the treatment of nail onychomycosis differs from that prescribed for a disease caused by dermatophytes, patients (often unsuccessfully) try to get rid of the disease.

Molds quickly destroy the nail, can spread throughout the body and damage internal organs.

Types of onychomycosis

Forms and features of nail damage

Distal-lateral form

The causative agent of this form of the disease, in more than 80% of cases, is the fungus Trichophyton rubrum, which most often affects the nails of the lower extremities. This form of the disease is the initial stage and indicates that the infection occurred recently.

The nail plate is affected from the free edge or from the lateral surfaces.

Narrow gray-yellow stripes form on it, forming a zone of dystrophy, which gradually spreads to the base of the nail. It becomes brittle and flakes off.

As the disease progresses, the nail thickens, peels off and can take on different shades (from brown to dirty brown).

Much less frequently, the causative agents of this form of onychomycosis are yeast mushrooms(Candida albicans) and molds(Scopulariopsis brevicaulis).

White surface form

This form of onychomycosis is less common than the previous one. Almost always, the causative agent is Trichophyton mentagrophytes, and only in isolated cases, the cause may be mold Asperquillus.

Small islands appear on the surface of the nail plate white, which gradually merge and cover the entire area of the nail. It begins to crumble () and acquires a gray tint.

The nail bed is not affected and the skin surrounding the nail is not inflamed. The disease mainly affects elderly patients.

Proximal form

This type of disease is rare. The causative agent can be both dermatophytes and mold or yeast fungi. It occurs when the infection spreads from the periungual fold or skin.

This article is often read with:

The color of the nails changes, spots appear in the area of the nail hole, and the nail quickly begins to peel off. In this case, a secondary infection occurs (re-infection).

An advanced form of the fungus takes a long time to heal; you can read more.

Dystrophic form

It is a consequence of the lack of treatment for previous forms of the disease. The nail is completely affected.

The nail fold thickens, the plate itself is almost completely destroyed and can no longer grow normally, only its remains are visible.

Treatment methods for onychomycosis

The following methods are used to treat onychomycosis:

Local treatment of nail fungus

This treatment is carried out mainly with the use of special ointments, creams and other preparations containing substances that effectively destroy fungi. Such means can be used either independently, full courses, and as part of complex combination therapy.

The advantage here is that the components of the ointments are delivered immediately to the site of the lesion, due to which the treatment process is not only more high efficiency, but also speed. However, there is also a minus. Products, as a rule, cannot penetrate into the deep layers of the nail, having only a superficial effect. Therefore, there is a high probability of relapse with this treatment.

Most often used the following drugs for the treatment of nails with onychomycosis:

(Isoconazole) in the form of a cream, () in the form of creams or ointments, () in the form of creams, ointments or special solutions. These drugs belong to the Azole group. Their action is reduced to inhibiting the development of microorganisms and destroying their cells using enzymatic actions. They should be applied 1 – 2 times a day.
cream (Terbinafine), (Naftifin) in the form of a cream or special solution. The agents belong to the group of Allylamines and destroy the membranes of fungal cells, which leads to their destruction. Apply them twice a day.
, Cyclopiroxolamine and other derivatives of the well-known Hydrocortisone, which actively inhibit the development of fungi, gradually causing their death. Apply twice a day with mandatory drying after application.
Salicylic ointment 3%. The product effectively destroys dead keratinocytes, depriving the pathogen of nutrition.

Internal treatment of onychomycosis

Otherwise, this type of therapy is called systemic, and it is carried out using special capsules and tablets, the active substance of which is absorbed into the blood through the intestinal walls. The advantage of such products is that their components are able to accumulate in the affected nails, creating a prolonged effect and reducing the likelihood of further relapse. But the effect from them comes more slowly than from local drugs.

Such means include:

Surgical intervention

Today, operations to remove affected nails are performed very rarely, thanks to the extensive possibilities modern medicine and the availability of a wide range medicines and various therapy techniques.

The main indication for surgery at present is only the situation when fungal infection nails, a bacterial infection is added, which requires radical measures. Nail removal is also carried out when there is no drug treatment did not give the expected effect.

As a rule, a secondary infection that complicates the condition occurs if elementary rules hygiene, neglect of the disease or severe destruction of the platinum of the affected nail. Unlike fungi, additional infections capable of hitting different types tissues, which contributes to the appearance inflammatory process and suppuration.

In this case the nail must be removed so that doctors have the opportunity to provide more thorough treatment for a bacterial infection and prevent its spread.

It is important to remember that even removing the affected plate does not eliminate onychomycosis, so it is necessary to take special medications in any case, as well as follow other doctor’s recommendations.

Today, instead of surgery, doctors are increasingly resorting to the procedure of avulsion of the affected nail if it is necessary to remove it. To do this, the element is processed special drugs, for example, Nogtivit, which promotes rapid layer-by-layer death and does not cause pain.

Traditional treatment for nail fungus

Treatment of nail onychomycosis at home can be accompanied by the use of traditional medicine. Of course, such a disease can be completely cured only with the help of serious drug therapy, but some folk remedies are quite capable of inhibiting the development of fungi and the destruction of the nail caused by them.

Before using any product, you should consult a dermatologist or trichologist. The doctor will identify the type of pathogen and select the most suitable drugs for treatment.

Hygiene for nail fungus and lifestyle

To prevent the spread of the disease and infecting your family and friends, You should follow some simple rules:

There is no need to wear someone else's shoes, even for routine fitting. Since particles of the pathogen may remain in it.
It is better to avoid visiting public swimming pools, baths or saunas, but if you must go there, you need to wear rubber slippers and stay in them the entire time.
After a bath or shower, feet should be wiped dry and treated immediately by special means from fungus.
In a living room, it is important to wear slippers, preferably closed ones, but not creating greenhouse effect. They should be disinfected after each foot treatment.
The clothes of an infected person should be washed separately from others and placed on a personal shelf.
After washing a sick person, the bath or shower stall must not only be disinfected, but also treated with special anti-fungal solutions, working only with rubber gloves and shoes.
The room should be frequently ventilated and wet cleaned daily using disinfectants, removing all carpets from the floor.

It is important to remember that fungi do not react to temperature changes, they do not die even at +100°C and at -60°C, so clothes should be disinfected and not boiled.

Prevention of nail fungus

Now you know how to treat onychomycosis of the nails, but you can avoid infection. To avoid contracting such an infection, you must wear the right shoes. In summer it should not be cramped and completely closed. In winter, you should not stay in boots or boots for a long time. Shoes should be the right size, comfortable and light, not rub, not squeeze the foot or form corns.

Socks, stockings or tights should be made from natural materials without synthetics to ensure normal air circulation and avoid sweating. It is important to remember that the alkaline environment created by sweat is the ideal atmosphere for rapid development such microorganisms.

It is important to follow some rules, for example:

Nail fungus is an unpleasant disease of infectious nature. It causes not only aesthetic inconvenience, but can also lead to a variety of complications - from a secondary bacterial infection to the spread of the lesion to other parts of the body. Fortunately, ethnoscience knows many recipes to combat the disease, which sometimes turn out to be more effective than modern medications.

For quotation: Sergeev A.Yu., Sergeev Yu.V. Dermatophytosis // Breast cancer. 2003. No. 15. P. 845

MMA named after I.M. Sechenov, National Academy of Mycology, Moscow

Pathogens

Dermatophytes are called mold 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 causative agents of dermatophytosis.

The main causative agents of mycoses in Russia, according to our data, are, in order of occurrence, T. rubrum(Fig. 1), T. mentagrophytes(Fig. 2), M. canis(Fig. 3).

Rice. 1. Micromorphology of T. rubrum

Rice. 2. Micromorphology of T. mentagrophytes var. interdigitale

Rice. 3. Micromorphology of M. canis

Dermatophytes are called geophilic, zoophilic or anthropophilic depending on their usual habitat - soil, animal or human. Members of all three groups can cause human diseases, but their different natural reservoirs determine epidemiological features - the source of the pathogen, the prevalence and geography of areas (Table 1).

Epidemiology
Although many geophilic dermatophytes can cause infection in both animals and humans, the most common natural habitat for these fungi is soil. Members of the zoophilic and anthropophilic groups are believed to have descended from these and other soil-inhabiting saprophytes capable of destroying keratin. Zoophilic organisms can be sporadically transmitted to humans if they have an affinity for human keratin. Transmission occurs through direct contact with an infected animal, or through objects that come into contact with the fur and skin scales of these animals. Infections often occur in rural areas, but nowadays the role of domestic animals is especially great (especially in cases of infection M. canis). Many members of the zoophilic group are named after their animal hosts. The general epidemiological characteristic of zoonotic and anthroponotic dermatophytosis is high contagiousness. Dermatophytosis is perhaps the only contagious infection among all human mycoses.
Although many geophilic dermatophytes can cause infection in both animals and humans, the most common natural habitat for these fungi is soil. Members of the zoophilic and anthropophilic groups are believed to have descended from these and other soil-inhabiting saprophytes capable of destroying keratin. Zoophilic organisms can be sporadically transmitted to humans if they have an affinity for human keratin. Transmission occurs through direct contact with an infected animal, or through objects that come into contact with the fur and skin scales of these animals. Infections often occur in rural areas, but nowadays the role of domestic animals (especially in infection) is especially great. Many members of the zoophilic group are named after their animal hosts. 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 usually epidemic. The main increase in morbidity is due to anthropophilic species. Currently, anthropophilic dermatophytes can be found in 20% of the total 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.

Pathogenic properties and pathogenesis

All dermatophytes have keratinolytic activity, i.e. capable of decomposing animal and/or human keratin. The activity of keratinases and proteolytic enzymes in general is considered the basis for 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 varies among different dermatophytes. Most high activity is different T. mentagrophytes, very moderate - T. rubrum. The ability to decompose different types of keratin generally corresponds to the localization of the dermatophyte infection. So, E. floccosum- a species with low keratinolytic activity - does not affect hair.

The introduction of the pathogen colony into the epidermis is ensured by both keratinolytic activity and hyphal growth. Like molds, dermatophytes have a specialized apparatus for directed hyphal growth. 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 directed growth pressure.

The depth of advancement 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 protective factors. Thus, dermatophyte infection involves only non-living, keratinized tissue.

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-keratinizing tissues washed by blood. Deep forms of dermatophytosis have been described in patients with pronounced deficiency one or more resistance factors.

Classification

The foreign classification of mycoses, adopted in ICD-10, is based on the principle of localization (Table 2). This classification convenient from a practical point of view, but does not take into account the etiological features of dermatophytosis in some locations. At the same time, variants of etiology determine epidemiological characteristics and the need for appropriate measures, as well as features of laboratory diagnosis and treatment. In particular, representatives of the genera Microsporum and Trichophyton have unequal sensitivity to certain antimycotics.

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

The term “dermatomycosis”, which is sometimes used to replace the commonly used name of dermatophytosis, in our opinion, is inappropriate and cannot serve as an equivalent to dermatophytosis. Dermatomycoses are fungal infections of the skin in general, i.e. and candidiasis, and pityriasis versicolor, and many mold mycoses.

Dermatophytosis of the scalp

Abroad, the following clinical and etiological forms are distinguished: tinea capitis: 1) ectotrix infection. Called Microsporum spp.(anthropozoonotic microsporia of the scalp); 2) endothrix 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 in Russia is microsporia . The main causative agent of dermatophytosis of the scalp in Russia and Eastern Europe is Microsporum canis. Number of registered cases of microsporia per year last years amounted to 100 thousand per year. The occurrence of pathogens of anthroponotic microsporia ( M. ferrugineum) and trichophytosis ( T. violaceum), common on Far East and in Central Asia, it should be considered 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 lesions is dull, brittle, light gray in color, and is covered in a white sheath at the base. Hair loss above the surface of the skin explains why the lesions appear trimmed, corresponding to the name “ringworm.” The skin in the lesion is slightly hyperemic and swollen, covered with grayish small scales. This clinical picture corresponds to the name “gray patch lichen”.

For trichophytosis of the scalp characterized by multiple isolated small (up to 2 cm) lesions. Typically, hair breaks off at the skin level, leaving a stump in the form of a black dot peeking out from the mouth of the follicle (“blackhead lichen”).

Classic painting favus characterized by the presence of scutulae ( scutula, lat. scutellum) - a crust of dirty gray or yellow color. The formed scutula is a dry saucer-shaped crust, from the center of which hair emerges. Each scutula consists of a mass of hyphae glued together with exudate, i.e. is essentially a colony of fungus. IN advanced cases the scutulae merge, covering most of the head. The continuous crust of favus resembles a honeycomb, which is what gives the disease its Latin name. With widespread favus, the crusts give off an unpleasant, “mouse” (barn, cat) smell. Currently, favus is practically not found in Russia.

The infiltrative-suppurative form of microsporia and trichophytosis is characterized by severe 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 bluish, with clear boundaries and a bumpy surface, covered with numerous pustules and erosions, often hidden under purulent-hemorrhagic crusts. Characterized by dilated mouths of the follicles, from which yellow pus is released when pressed. A similar picture is compared to a honeycomb ( kerion). Kerion is often accompanied general phenomena- fever, malaise, headache. Painful regional lymphadenitis develops (usually posterior cervical or postauricular nodes).

Nail dermatophytosis

Onychomycosis affects at least 5-10% of the Russian population, and over the past 10 years the incidence has increased 2.5 times. Onychomycosis on the feet is three to seven times more common 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 there are two types: T. rubrum And T. mentagrophytes var. interdigitale. T. rubrum- the main causative agent of onychomycosis in general.

Highlight three main clinical forms of onychomycosis: distal-lateral, proximal and superficial, depending on the location of the pathogen. The most common is the distal form. In this case, 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 the skin. The infection spreads to the root of the nail, and in order for it to progress, the growth rate of the fungus must exceed the speed natural growth nail in the opposite direction. Nail growth slows down with age (up to 50% after 65-70 years), and therefore onychomycosis predominates in older people. Clinical manifestations of the distal form are loss of transparency of the nail plate (onycholysis), manifested as whitish or yellow spots in the thickness of the nail, and subungual hyperkeratosis, in which the nail appears thickened. In the rare proximal form, the fungi penetrate through the proximal nail fold. 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.

We will not dwell on the features of clinical assessment of the severity and course of onychomycosis, which is the subject of several of our books and dozens of articles. Let us note here that onychomycosis is the most difficult form of dermatophytosis to treat, and largely due to errors in the treatment of onychomycosis, the population continues to have a long-term source of dermatophyte infection. Our epidemiological study showed that the average estimated duration of the disease at present (in the presence of dozens of effective antimycotics) is 20 years, and according to the results of a survey of middle-aged patients, it is about 10 years. Quite a lot for a contagious disease.

Dermatophytosis of the hands and feet

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

Infection with mycosis of the feet caused by T. rubrum(rubrophytosis of the feet), more often occurs in the family, through direct contact with the patient, as well as through shoes, clothes or general subjects everyday life. The infection is characterized by a chronic course, damage to both feet, and frequent spread to smooth skin and nail plates. With a long course, the involvement of the skin of the palms, usually the right (working) hand, is characteristic - the “two feet and one hand” syndrome ( 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. The affected area exhibits mild erythema, moderate to severe peeling, and in some cases a thick layer of hyperkeratosis. Hyperkeratosis is most pronounced in points that bear the greatest load. In cases where the lesion 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(athlete's foot), most often occurs in public places - gyms, baths, saunas, swimming pools. With athlete's foot, an interdigital form is usually observed. In the 3rd, 4th, and sometimes in the 1st interdigital fold, a crack appears, bordered at the edges 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 associated) and are usually 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 mycosis of the feet. In this case, small bubbles form on the toes, in the interdigital folds, on the arch and lateral surfaces of the foot. IN in rare cases they merge to form blisters (bullous form).

Dermatophytosis of smooth skin and large folds

Dermatophytosis of smooth skin is less common than mycosis of the feet or onychomycosis. Lesions on smooth skin can be caused by any dermatophytes. As a rule, in Russia they are called T. rubrum(rubrophytosis of smooth skin) or M. canis(microsporia of smooth skin). There are also zoonotic mycoses of smooth skin caused by more rare species dermatophytes.

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

In some cases, doctors, without recognizing mycosis of smooth skin, prescribe corticosteroid ointments to the area of erythema and infiltration. In this case, the inflammatory phenomena subside, and mycosis takes on an erased form (the so-called tinea incognito).

Mycoses of large folds caused by dermatophytes also retain character traits: peripheral ridge, central resolution and polycyclic outlines. Most typical location- inguinal folds and inner side hips. The main causative agent of inguinal dermatophytosis is currently T. rubrum(inguinal rubrophytosis). The traditional designation of tinea cruris in the domestic literature was inguinal athlete's foot in accordance with the name of the pathogen - E. floccosum(old name - E. inguinale).

What forms of dermatophytosis predominate in Russia?

We studied the prevalence of dermatophytosis according to the Medical Center of the Administration of the President of the Russian Federation, where in the 1980-90s. a system of continuous annual medical examination of the contingent was implemented (on average 28,000 patients per year). The prevalence and incidence of dermatophytosis depending on location was studied by analyzing case reports over a two-year period. The overall prevalence (number of reported cases), incidence (number of cases newly identified per year) and incidence detected during clinical examination were studied. Indicators were calculated in absolute values and per 1000 PMC contingent.

The average number of patients with dermatophytosis over 10 years (1990-99) was 63.92 per 1000 PMC population. Over a 10-year period, there was a wave-like change in the number of reported cases of dermatophytosis. From 1997 to 1999, there was an increase in the number of reported cases of dermatophytosis.

Proportion of dermatophytosis of nails in total number of reported cases of dermatophytosis was about 77%. Thus, onychomycosis (dermatophytosis of the nails) was predominant among all diagnoses of dermatophytosis . Mycosis of the feet was in second place in terms of occurrence, and mycosis of smooth skin was in third place. Dermatophytosis of the nails was recorded more than 3 times more often than dermatophytosis of all other localizations taken together (Fig. 4). In this case, if dermatophytosis of the skin of the feet and nails was simultaneously detected, dermatophytosis of the nails was recorded.

Rice. 4. Number of registered cases of dermatophytosis depending on localization for 1 year of the study (33529 IB processed)

Dermatophytosis, including onychomycosis, made up a significant proportion of dermatological pathology (31%), and the share of onychomycosis itself was 24%. Dermatophytosis (including dermatophytosis of the nails) and onychomycosis itself took second place in terms of occurrence, second only to all non-fungal and non-oncological skin diseases taken together (Fig. 5).

Rice. 5. Dermatophytosis in the structure of dermatological pathology

Thus, at least in relation to the adult population, onychomycosis and mycosis of the feet, usually combined with it, should be recognized as the main form of dermatophytosis in Russia and the modern “leaders” of dermatological morbidity.

Laboratory diagnosis of dermatophytosis

The basic principle laboratory diagnosis of dermatophytosis - detection of pathogen mycelium in pathological material . This is enough to confirm the diagnosis and begin treatment. Pathological material: skin flakes, hair, fragments of the nail plate are subjected to “clarification” before microscopy, i.e. treatment with alkali solution. This allows the horny structures to dissolve and only the masses of the fungus remain in view. The diagnosis is confirmed if filaments of mycelium or chains of conidia are visible in the preparation. IN laboratory diagnostics Dermatophytosis of the scalp also takes into account the location of the fungal elements relative to the hair shaft. If the spores are located outside (typical of Microsporum species), this type of lesion is called ectothrix, and if inside, then endothrix (typical of Trichophyton species). Determination of etiology and identification of dermatophytes is carried out according to morphological features after culture isolation. If necessary, additional tests are carried out (urease activity, pigment formation on special media, the need for nutritional supplements, etc.). For quick diagnostics 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

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 for dermatophytosis griseofulvin And terbinafine . Drugs with a wider spectrum of action belong to the azole class (imidazoles - ketoconazole, triazoles - fluconazole, itraconazole). The list of local antimycotics includes dozens different connections And dosage forms and is constantly replenished.

Among modern antimycotics Terbinafine has 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.

Considerable experience has been accumulated in the use of terbinafine in Russia, new regimens of systemic and combination therapy have been developed, in particular, for dermatophytosis of the nails.

Local 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 the rest of the children's team, and in treatment they used various methods hair removal The main treatment method for dermatophytosis of the scalp is systemic therapy. Griseofulvin, terbinafine, itraconazole and fluconazole can be used in treatment. Griseofulvin still remains the standard treatment for dermatophytosis of the scalp in Russia.

Terbinafine is more effective than griseofulvin overall, but is also less active against M. canis. This is manifested in the discrepancy between domestic and foreign recommendations, since in Western Europe and the USA under tinea capitis more often they mean trichophytosis, and in Russia - microsporia. In particular, domestic authors noted the need to increase the dose for microsporia by 50% of the recommended dose. 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 is 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. Local therapy is applicable mainly only for the superficial form, the initial phenomena of the distal form, or lesions of single nails. In other cases, systemic therapy is more effective. Modern local remedies for the treatment of onychomycosis include antifungal nail varnishes. Systemic therapy includes terbinafine, itraconazole and fluconazole (Table 3).

The duration of treatment with any drug depends on the clinical form of onychomycosis, the extent of the lesion, the degree of subungual hyperkeratosis, the affected nail and the age of the patient. To calculate the duration, we currently use the special KYOTOS index we proposed. Combination therapy may be prescribed in cases where systemic therapy alone is insufficient or has a long duration. Our experience with combination therapy with terbinafine includes its use in short courses and intermittent regimens, in combination with antifungal nail varnishes.

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 antimycotics for topical use include creams, aerosols, and ointments. If these agents are not available, local antiseptics are used. The duration of treatment ranges from two weeks when using modern drugs to four when using traditional drugs. In case of chronic squamous-hyperkeratotic form of mycosis of the feet, involvement of the hands or smooth skin, or damage to 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. If nails are affected, the treatment period is extended. Systemic therapy is also indicated for acute inflammatory phenomena and vesiculobullous forms of infection. Externally in these cases, lotions, antiseptic solutions, aerosols, and also combined agents, combining corticosteroid hormones and antimycotics. Desensitizing therapy is indicated.

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

External antifungal drugs are used in the form of creams or ointments; it is possible to use an aerosol. 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 clinical manifestations disappear and another 1 week. After that. The drugs should be applied to the lesion and another 2-3 cm outward from its edges.

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

Prospects for the fight against dermatophytosis in Russia

Currently, there is an almost continuous increase in the incidence of dermatophytosis. The majority of cases of the disease today are mycosis of the feet and onychomycosis. At the same time, the official statistical picture of morbidity may differ from the real one, since a significant part of patients avoid going to medical centers.

Our studies of etiology, epidemiology and clinical features dermatophytosis have shown that predominates in Russia chronic infection caused by T. rubrum (so-called rubrophytia) . Thus, most cases of dermatophytosis, at least in adults, represent an anthroponotic infection, and its only source is the patients with dermatophytosis themselves. At the same time, rubrophytosis, as modern studies, including ours, have shown, is a disease with a long-term course, low severity of symptoms, and frequent intra-family transmission.

This raises the question of the feasibility of a complete victory over rubrofitia. The main goal therapeutic and preventive measures should be the identification and treatment of patients with rubrophytosis. According to this goal, we formulate the following tasks:

Active search for patients with rubrophytia . This task can be carried out both within the framework of medical examination programs and with the help of mass treatment and preventive campaigns such as a “hotline”. However, such methods are associated with significant costs and cannot be implemented at the federal level. More perfect approach This problem can be solved by effective sanitary educational work, focused on the constant influx of patients in specialized treatment centers. It is promising to introduce self-diagnosis programs for onychomycosis and mycosis of the feet, which increase motivation for treatment.
Improving therapeutics . It is necessary to reach an acceptable low level relapses after treatment of onychomycosis, improve and simplify treatment regimens, making them available not only to dermatologists, but also to doctors general practice. From our point of view, the KIOTOS index, already introduced into clinical practice, is suitable for solving the last problem, making it possible to choose an adequate treatment regimen for onychomycosis and at the same time not requiring significant clinical experience of the attending physician. To successfully combat rubrophytosis by general practitioners, it is also necessary to simplify and unify approaches to their laboratory diagnostics, sufficient to confirm the diagnosis. For this purpose, direct PCR probes can be used to detect T. rubrum in clinical material, and work in this direction is already being carried out.
It is also necessary to find a compromise between the cost and effectiveness of treatment, for which combination therapy with keratolytics can be used to avoid long courses of systemic therapy.
Development of fundamentally new means of prevention . The immediate task is sanitary and educational work aimed at early prevention and prevention of rubrophytosis before the development of onychomycosis, the treatment of which is associated with great difficulties and costs. Further research is needed to clarify certain aspects of the proposed strategy for combating dermatophytosis, working in existing areas. And even more so, it is necessary to unite the efforts of specialists and scientists, practicing doctors and healthcare organizers of different profiles.

Literature:

1. New in the taxonomy and nomenclature of fungi. Under. ed. Yu. T. Dyakova and Yu. V. Sergeeva. M.: 2003. 164-192.

2. Sergeev A. Yu., Sergeev Yu. V. Fungal infections. Guide for doctors. M.: BINOM-Press, 2003. 440 p.

3. Sergeev A. Yu., Ivanov O. L., Sergeev Yu. V., Vakhlakov A. N., Sedova T. N., Dudnik V. S. Research modern epidemiology onychomycosis. Bulletin of dermatology and venereology. - 2002; 3:31-35

4. Sergeev A. Yu. Modern ideas about the pathogenesis of onychomycosis. Immunopathology, allergology, infectology. 2000; 1: 101-110.

5. Potekaev N. N. Microsporia. Russian medical journal. 2000; 8 (4): 189-196.

6. Sergeev Yu. V., Sergeev A. Yu. Onychomycosis. Fungal nail infections. M.: Geotar medicine. 1998, 126 p.

7. Sergeev A. Yu. Fungal diseases of nails. M.: National Academy of Mycology - Medicine for everyone. 2001.- 164 S.

8. Sergeev Yu. V., Sergeev A. Yu., Mokina E. V. Buchinsky O. I. Hotline: The first mass campaign to identify and treat patients with onychomycosis. In the book: advances in clinical immunology and allergology. (edited by A.V. Karaulov). M.: 2002.- pp. 355-363.

9. Guide to laboratory diagnosis of onychomycosis. Ed. A. Yu. Sergeeva. M.: Geotar medicine. 2000, 154 p.

10. Sergeev Yu.V., Potekaev N.S., Leshchenko V.M., Larionova V.N.. Lamisil: improving the treatment of onychomycosis caused by dermatophytes // Bulletin of Dermatology and Venereology. 1995; 5:54-56.

11. Potekaev N. S. Kurdina M. I., Potekaev N. N. Lamisil for microsporia. Vestn. dermatol. 1997; 5:69.

12. Sergeev Yu. V., Sergeev A. Yu., Leshchenko V. M. Modern program for the fight against dermatomycosis in Russia. In the book: Successes medical mycology. (edited by Yu. V. Sergeev) M.: 2002. T. 2. P. 160-162.

Description:

Dermatophytosis is an infectious disease caused by dermatophytes. The attention this problem is currently receiving is due to the extreme prevalence of the infection and the continuing challenges of its diagnosis and treatment.

Causes of dermatophytosis:

Dermatophytes are called mold 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 causative agents of dermatophytosis.

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

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

Pathogenesis:

All dermatophytes have keratinolytic activity, i.e. capable of decomposing animal and/or human keratin. The activity of keratinases and proteolytic enzymes in general is considered the basis for 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 varies among different dermatophytes. T. mentagrophytes has the highest activity, T. rubrum has very moderate activity. The ability to decompose different types of keratin generally corresponds to the localization of the dermatophyte infection. Thus, E. floccosum, a species with low keratinolytic activity, does not affect hair.

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-keratinizing tissues washed by blood. Deep forms of dermatophytosis have been described in patients with a severe deficiency of one or more resistance factors.

Symptoms of dermatophytosis:

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

For a long time, the generally accepted classification was proposed by N.D. Sheklakov in 1976. In our opinion, a reasonable and acceptable compromise is the use of the ICD classification, clarifying, if necessary, 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 / microsporia / trichophytosis).

The term “dermatomycosis,” which is sometimes used to replace the commonly used name for dermatophytosis, is inappropriate and cannot serve as an equivalent to dermatophytosis.

Dermatomycoses are fungal infections of the skin in general, i.e. and candidiasis, and multicolored, and many mold mycoses.

Dermatophytosis of the scalp
Abroad, the following clinical and etiological forms of tinea capitis are distinguished:
1) ectotrix infection. Caused by Microsporum spp. (anthropozoonotic scalp);
2) endothrix infection. Caused by Trichophyton spp. (anthroponotic scalp);
3) favus (scab). Caused by 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 considered sporadic.

Trichophytosis of the scalp is characterized by multiple isolated small (up to 2 cm) lesions. Typically, hair breaks off at the skin level, leaving a stump in the form of a black dot peeking out from the mouth of the follicle (“blackhead lichen”).

The classic picture of the favus is characterized by the presence of scutula (lat. shield) - crusts of dirty gray or yellow color. The formed scutula is a dry saucer-shaped crust, from the center of which hair emerges. Each scutula consists of a mass of hyphae glued together with exudate, i.e. is essentially a colony of fungus. In advanced cases, the scutulae merge, covering most of the head. The continuous crust of favus resembles a honeycomb, which is what gives the disease its Latin name. With widespread favus, the crusts give off an unpleasant, “mouse” (barn, cat) smell. Currently, favus is practically not found in Russia.

The infiltrative-suppurative form of microsporia and trichophytosis is characterized by severe 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 bluish, with clear boundaries and a bumpy surface, covered with numerous pustules and erosions, often hidden under purulent-hemorrhagic crusts. Characterized by dilated mouths of the follicles, from which yellow pus is released when pressed. A similar picture is compared to a honeycomb (kerion). Kerion is often accompanied by general symptoms - fever, malaise, headache. Painful regional nodes develop (usually posterior cervical or postauricular nodes).

Nail dermatophytosis
Onychomycosis affects at least 5-10% of the population, and over the past 10 years the incidence has increased 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.

There are three main clinical forms of onychomycosis: distal-lateral, proximal and superficial, depending on the location of the pathogen. The most common is the distal form. In this case, 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 the skin. The infection spreads to the root of the nail, and for its advancement the rate of growth of the fungus must exceed the rate of natural growth of the nail in the opposite direction. Nail growth slows down with age (up to 50% after 65-70 years), and therefore onychomycosis predominates in older people. Clinical manifestations of the distal form are loss of transparency of the nail plate (onycholysis), manifested as whitish or yellow spots in the thickness of the nail, and subungual hyperkeratosis, in which the nail appears thickened. In the rare proximal form, the fungi penetrate through the proximal nail fold. White or yellow spots appear in the thickness of the nail at its root. In the superficial form, it is represented by spots on the surface of the nail plate.

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

Dermatophytosis of the hands and feet
Mycosis of the feet is widespread and occurs more often than any other. 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, and even more rarely - other dermatophytes. Foot mycoses caused by T. rubrum and T. mentagrophytes have epidemiological 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 mycosis of the feet 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, affecting both feet, and often spreading to smooth skin and nail plates. With a long course, the skin of the palms is typically involved, usually the right (working) hand - the “two feet and one hand” syndrome (tinea pedum et manuum). Typically, 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. The affected area exhibits mild erythema, moderate to severe peeling, and in some cases a thick layer of hyperkeratosis. most pronounced at points bearing the greatest load. In cases where the lesion 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 (athlete's foot) most often occurs in public places - gyms, baths, saunas, swimming pools. An interdigital form is usually observed. In the 3rd, 4th, and sometimes in the 1st interdigital fold, a crack appears, bordered at the edges 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 associated) and are usually 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 toes, 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
Dermatophytosis of smooth skin is less common than mycosis of the feet or onychomycosis. Lesions on smooth skin can be caused by any dermatophytes. As a rule, in Russia they are caused by T. rubrum (rubrophytosis of smooth skin) or M. canis (microsporia of smooth skin). There are also zoonotic mycoses of smooth skin caused by rarer species of dermatophytes.

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

In some cases, doctors, without recognizing mycosis of smooth skin, prescribe corticosteroid ointments to the area of erythema and infiltration. In this case, the inflammatory phenomena subside, and the mycosis takes on an erased form (the so-called tinea incognito).

Mycoses of large folds caused by dermatophytes also retain characteristic features: peripheral ridge, central resolution 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 in accordance with the name of the pathogen - E. floccosum (the old name was E. inguinale).

Diagnostics:

The basic principle of laboratory diagnosis of dermatophytosis is the detection of mycelium of the pathogen in pathological material. This is enough to confirm the diagnosis and begin treatment. Pathological material: skin flakes, hair, fragments of the nail plate are subjected to “clarification” before microscopy, i.e. treatment with alkali solution. This allows the horny structures to dissolve and only the masses of the fungus remain in 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 fungal elements relative to the hair shaft is also taken into account. If the spores are located outside (typical of Microsporum species), this type of lesion is called ectothrix, and if inside, then endothrix (typical of Trichophyton species). Determination of etiology and identification of dermatophytes are carried out based on morphological characteristics after isolation of the culture. If necessary, additional tests are carried out (urease activity, pigment formation on special media, the need for nutritional supplements, etc.). To quickly diagnose 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 for dermatophytosis: griseofulvin and terbinafine. Drugs with a wider spectrum of action belong to the azole class (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 has 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.

Local 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 the rest of the children's team, and various methods of hair removal were used in treatment. The main treatment method for dermatophytosis of the scalp is systemic therapy. Griseofulvin, terbinafine, itraconazole and fluconazole can be used in treatment. Griseofulvin remains the standard treatment for dermatophytosis of the scalp.

Terbinafine is more effective than griseofulvin overall, but is 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 more often means trichophytosis, and in Russia - 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 is 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. Local therapy is applicable mainly only for the superficial form, the initial phenomena of the distal form, or lesions of single nails. In other cases, systemic therapy is more effective. Current topical treatments for onychomycosis include antifungal nail varnishes. Systemic therapy includes terbinafine, itraconazole and fluconazole.

The duration of treatment with any drug depends on the clinical form of onychomycosis, the extent of the lesion, the degree of subungual hyperkeratosis, the affected nail and the age of the patient. To calculate the duration, our proposed special KIOTOS index is currently used. Combination therapy may be prescribed in cases where systemic therapy alone is insufficient or has a long duration. Our experience with combination therapy with terbinafine includes its use in short courses and intermittent regimens, in combination with antifungal nail varnishes.

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 antimycotics for topical use include creams, aerosols, and ointments. If these agents are not available, local antiseptics are used. The duration of treatment ranges from two weeks when using modern drugs to four when using traditional drugs. In case of chronic squamous-hyperkeratotic form of mycosis of the feet, involvement of the hands or smooth skin, or damage to 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. If nails are affected, the treatment period is extended. Systemic therapy is also indicated for acute inflammatory phenomena and vesiculobullous forms of infection. Externally in these cases, lotions, antiseptic solutions, aerosols, as well as combination products that combine corticosteroid hormones and antimycotics are used. Desensitizing therapy is indicated.

Among the causative agents of fungal diseases of the toenails, dermatophytes are the most common. They can affect not only the plates, but also the skin of the feet, as well as the interdigital folds. Let's take a closer look at what this type of fungus is, its causes and main manifestations.

Dermatophytes affect not only nails, but also skin

Dermatophytes - what are they?

Dermatophytes (dermatophytes, dermatophiton)– molds that belong to several genera (Epidermophyton, Microsporum, Trihophiton). Pathogenic microorganisms affect keratin-containing areas of the body - nails, stratum corneum of the epidermis, scalp - and are the causative agent infectious disease dermatophytosis. The pathology belongs to the group of dermatomycosis, which can injure the skin of the hands, feet, and folds.

Dermatophyte fungus under a microscope

Fungi of this genus penetrate into the upper layer of the toenails and cause the development of onychomycosis. Not typical for dermatophytes deep penetration into the nail, making the disease more treatable.

Causes of dermatophytes of toenails

The development of dermatophyton on toenails has several main causes:

decline protective forces body;
bruises of the nail plates;
interruptions in normal supply lower limbs blood;
systemic pathologies in severe forms ( diabetes, blood diseases, heart disorders).

Dermatophytosis is a contagious disease. You can catch a fungal infection when visiting swimming pools, gyms, saunas, and also if you use other people's household items (slippers, towels, bed linen). Pathogenic organisms are found not only in humans, but also in animals, in particular, dermatophytes occurs in cats and dogs. Therefore, pets can easily bring the virus into the house after walking outside.

Onychomycosis on the legs, caused by dermatophytes, can develop during long-term treatment with antibiotics, corticosteroids, and immunosuppressive drugs.

Symptoms

Dermatophytes, affecting the nail plate, have vivid manifestations:

loss of transparency of the nail, its cloudiness, change in color;
the appearance of white or yellowish spots and stripes on the nails;
thickening of the stratum corneum, growth of the lesion (nails become denser, resemble a beak or claws);
development of the inflammatory process on the periungual fold, the plate crumbles, collapses and can separate from the bed (late stages of dermatophytosis of the nails).

What a nail lesion with dermatophytes looks like is shown in the photo.

When fungus appears, the nail changes color and peels

The negative manifestations of the disease cannot be ignored. The sooner the cause of changes in the nail plate is diagnosed, the better the pathology can be treated.

Diagnosis of dermatophytosis

Detection of fungal infection is based on 3 methods.

Clinical data. The doctor examines the damaged areas and interviews the patient to identify additional symptoms of the disease.
Microscopy. IN laboratory conditions Biological material is collected (scraping of injured tissue), with which the presence of fungal spores is determined under a microscope.
Cultural analysis is the inoculation of pathogenic material on a nutrient medium, which makes it possible to identify the intensity of growth and the infection culture itself. The method allows not only to determine the type of fungus, but also to find out its sensitivity to certain antibacterial agents.

Professional diagnosis is needed to rule out similar diseases(psoriasis, lichen) and selection antifungal drugs, which has a detrimental effect on a particular pathogen.

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Analysis is necessary to accurately identify the disease

Treatment of dermatophytes

Nail fungus caused by dermatophytes requires complex and long-term treatment. Traditional therapy can be supported by folk remedies.

Pharmacy drugs

The drug has a wide spectrum of action. It is used in the treatment of mycoses of various etymologies, including dermatophytes. The dosage is determined by the doctor based on the severity and characteristics of the disease. Usually 150 ml once a week is enough. Fluconazole therapy lasts until the fungus completely disappears and a healthy nail grows back (from 3 months to 1 year).

Fluconazole is a broad-spectrum drug

The antifungal agent helps to destroy the membrane structure of the virus cells, which leads to the rapid death of dermatophytes.

Mode of application:

steam the nails, remove the stratum corneum, clean with a nail file;
Apply a thin layer of cream to the nail plate and rub in well;
Repeat the procedure 1-2 times a day.

The course of treatment with Terbinafine ointment lasts from 4 to 6 months. With continuous use during this time, the fungus disappears and a healthy nail grows back.

In severe stages of dermatomycosis, doctors prescribe Terbinafine tablets. The dosage is prescribed individually, taking into account all the nuances of the course of the disease.

Terbinafine effectively copes with nail fungus

The active ingredient - ciclopiroxolamine - effectively fights dermatophytes on early stages nail lesions, usually in the distal stage (from the upper edge of the plate).

How to treat:

steam injured toenails well, treat with a nail file and dry;
Apply a thin layer of the medicine to the affected areas (plate and periungual fold), rub in thoroughly;
The procedure should be carried out 2 times a day, preferably in the morning and before bedtime.

Batrafen contains the active substance - cyclopiroxolamine

Folk remedies

Dermatomycosis, in particular dermatophytosis of the toenails, requires an integrated approach. In order to enhance the therapeutic effect pharmaceutical drugs can be supported by alternative medicine.

Iodine and peroxide

Dilute a small amount of iodine in a bowl with warm water. You need to steam your feet in the prepared solution for at least 15–20 minutes. Treat softened nails as much as possible with a pumice stone or nail file and dry thoroughly. Lubricate the treated areas with 3% peroxide.

Iodine inhibits the division of fungal spores, and hydrogen peroxide produces a disinfecting effect, which together creates unfavourable conditions for the development of a pathogenic environment.

You will need 50 g of dry herb and 1 liter of boiling water. Pour the crushed celandine with water and simmer over low heat for 5–10 minutes, then let the broth brew for at least 2 hours. Pour the prepared liquid into a bowl with hot water. You need to steam your feet in a healing decoction for 20–30 minutes, then dry them well and wipe the areas injured by dermatophytes with celandine oil (2–3 drops for each nail).

Dermatophytosis should be treated in this way until a healthy nail grows (up to 2–3 months). It is advisable to carry out the procedure before bedtime.

Celandine helps get rid of fungus quickly

For 3 l warm water(37–40 degrees) dilute 100 g of salt. Keep your feet in this bath for at least 20 minutes, after which remove as much of the stratum corneum as possible and apply antifungal ointment.

Salt procedures help antimycotic substances penetrate deeper into the affected areas, thereby increasing the therapeutic effect of drugs.

The use of certain folk remedies in the fight against dermatophytosis of the nails should be agreed with a doctor. This will avoid negative reactions of the body and complications.

Salt is simple and accessible remedy for treating fungus

Fungus prevention

The success of basic treatment of fungus depends not only on medications and folk remedies, but also on compliance with preventive measures.

When visiting swimming pools and saunas, it is important to use personal replacement shoes, a towel and other household items. After completing the procedures, it is recommended to treat the feet and hands with antifungal agents.
Wash your feet at least once a day cold water and soap.
Pick up comfortable shoes. This will avoid skin damage (abrasions, calluses, microcracks).
Avoid diaper rash, combat increased sweating of the lower extremities.
Change socks, tights, stockings daily.

Don't forget to wash your feet thoroughly

By following simple rules, you can protect yourself from fungal infections and keep your feet and nails in good condition.

Dermatophyte molds live in the soil and are found in both humans and animals. The disease is contagious and spreads quickly. It is recommended not to self-medicate, but to consult a specialist at the first symptoms. To successfully get rid of the fungus, it is important to follow the doctor’s recommendations, not interrupt therapy (there is a risk of relapse) and follow preventive measures.

Features of the disease

Classification of dermatophytosis

By localization

By type of fungus

By type of lesion

Causes

Symptoms

Diagnostics

Microscopy

Sowing

Wood's lamp

Treatment

General principles

Scalp

Nails, feet and hands

Disease prevention

Complications

Forecast

Causes of fungus and contributing factors

Classification of nail fungi

Dermatophytes

Yeast mushrooms

Molds

Types of onychomycosis

Forms and features of nail damage

Distal-lateral form

White surface form

Proximal form

Dystrophic form

Treatment methods for onychomycosis

Local treatment of nail fungus

Internal treatment of onychomycosis

Surgical intervention

Traditional treatment for nail fungus

Hygiene for nail fungus and lifestyle

Prevention of nail fungus

Description:

Causes of dermatophytosis:

Pathogenesis:

Symptoms of dermatophytosis:

Diagnostics:

Treatment of dermatophytosis:

Dermatophytes - what are they?

Causes of dermatophytes of toenails

Symptoms

Diagnosis of dermatophytosis

Treatment of dermatophytes

Pharmacy drugs

Folk remedies

Iodine and peroxide

Fungus prevention

Interesting articles

Interesting articles