home Audience 5 Mycosis of the skin is a current state of the problem. Dermatophytosis is a pressing problem of modern dermatology. Symptoms and forms

Mycosis of the skin is a current state of the problem. Dermatophytosis is a pressing problem of modern dermatology. Symptoms and forms

Mycosis of smooth skin is a dermatrophy in which reddish spots with flaky edges form on the skin. In the absence of drug treatment, scales appear in the affected areas, which are covered with papules and pustules without a central depression.

Modern experts divide such mycosis into dermatomycosis and keratomycosis. It should be noted that nail plates and hair can also suffer from them.

Causes

A huge number of factors can provoke the development of mycosis of smooth skin.. It should be noted that, according to statistics, every second person on Earth has encountered such a disease.

These mycoses can be caused by:

It should be noted that mycosis of smooth skin can develop only with weakened immunity. If a person’s protective functions are in order, then pathogenic microorganisms will not be able to develop. They will manifest themselves as distinctive features only when immunity decreases. For this reason, you should regularly take vitamin complexes and follow the rules of a healthy lifestyle.

Symptoms and forms

Recognizing such a skin lesion, the symptoms of which appear only after prolonged development, is quite simple. A person gradually begins to face a number of problems that complicate his life. Skin mycosis can be recognized by:

If any signs of such a disease appear, you should immediately visit your doctor. Only he will be able to identify the lesion and prescribe the most appropriate treatment. You should not ignore the lesion, as otherwise you risk the development of serious complications. The specialist will also be able to determine what type of smooth skin mycosis you have:

Drug treatment

It is very important that treatment of mycosis of smooth skin takes place under the full supervision of a physician. For therapy it is necessary to use antifungal drugs, without which it will not be possible to get rid of the pathogen. They are necessary for both local and general therapy. It should be noted that the selection of medication should be done by a doctor - only he will be able to assess the degree of damage, as well as the individual characteristics of the body. Usually, Terbinafine, Miconazole and others creams are used to treat this disease. They are applied to the skin 2 times a day.

Terbinafine Ketoconazole Clotrimazole Miconazole

It is also necessary to regularly treat the affected areas with sulfur tincture, salicylic acid or. This will help create an acidic environment that fungi cannot tolerate. It is also impossible to do without taking pills that kill pathogens inside the body. Under no circumstances prescribe them to yourself - this can lead to dire consequences. To treat mycosis of smooth skin on the thighs or legs, it is necessary to seal the damaged areas with a plaster and remove hair using hair removal.

Sulfur tincture Salicylic acid iodine

Milk-salicylic collodion, which must be used 4-5 times a day, can cope well with such a disease. You can also make compresses from salicylic or zinc ointment, which perfectly relieve inflammation. Over time, you will be able to notice how all the signs of the disease go away, and the skin, hair and nails begin to recover. You will have to do this to make sure that the treatment is correct.

Treatment with folk remedies

At the initial stage of mycosis of smooth skin, you can try treatment with folk remedies. However, you must adhere to all precautions and keep in mind that if there is no effect from the chosen therapy for a long time, you should immediately consult a doctor.

Even regular coffee will help cope with such damage - you just need to brew this drink and dilute it in the bathroom. It must be taken every day for 2 weeks. Over time, you will notice how the skin becomes smooth and silky, and inflammation and swelling begin to go away. The following recipes are also used for such therapy.

Definition. Fungal skin diseases (dermatomycosis) are infectious skin diseases caused by fungi.

Currently, about 50 species of fungi that are pathogenic to humans have been described. From a medical point of view (dermatological

In clinical practice), three species are of interest - dermatophytes, yeast-like fungi and molds.

Dermatophytes divided into three main groups depending on the structure of conidia - Trichophyton(22 species), Micro-sporum(16 species) and Epidermophyton(1 type).

According to the ecological classification, among dermatophytes, geophilic, zoophilic and anthropophilic fungi are distinguished.

Geophilic mushrooms (E. flocossum, M. audouinii, T. mentagrophytes var. interdigitale, T. rubrum etc.) can be pathogenic for humans and animals, zoophilic (M. canis, M. nanum, T. mentagrophytes, T. verrucosum etc.) - mainly for animals, sometimes for humans, anthropophilic (M. gypseum, M. fulvum etc.) - for humans. Anthropophilic fungi apparently evolved from zoophilic fungi, some of which adapted to human keratin and lost the ability to digest animal keratin.

The role of different types of fungi in the development of one or another clinical form changes periodically. So, for example, in the 1940-1960s. the first place in the frequency of development of mycoses of the feet and folds was occupied, respectively T. mentagrophytes And E. flocossum, and in 1970-1990s - T. rubrum. It should also be noted that the role of certain fungi in the development of certain clinical forms of the disease varies in different regions. In particular, lesions of the scalp in Europe are mainly caused by M. canis, in North America - T. tonsurans, in South America, Africa, India and Pakistan - T. violaceum.

Among yeast-like fungi - typical representatives of opportunistic microflora - plays a leading role in the development of mycoses Candida albicans.

Molds widely distributed in soil, air, and fruits of plants rich in sugars. Plays a leading role in the development of mycoses Scopulariopsis brevicaulis.

Etiology and pathogenesis. Fungi can affect the stratum corneum, skin appendages, mucous membranes of the oral cavity and genital organs, dermis, hypodermis, as well as other deep tissues (with deep mycoses).

The development of fungal skin lesions is determined by the following factors: pathogenicity and virulence of the pathogen, the state of the microorganism, and environmental conditions.

Diagnostics. The diagnosis of fungal skin lesions in the vast majority of cases must be confirmed

laboratory research methods: microscopic, allowing to establish the presence of a fungus, cultural, identifying the fungus, in rare cases, histological examination is carried out. For a number of mycoses, fluorescent diagnostics are used.

The microscopic method is used to examine scales, vesicle covers, nail plates, and hair. The causative agent of the fungal disease can be detected after the horny substance clears in a hot solution of caustic alkali. To do this, crushed pieces of the test material are placed on a glass slide and a drop of 20% potassium hydroxide solution is applied to them. Following this, the glass is heated over the burner flame until a drop of white rim of alkali crystals appears around the periphery. Then a cover glass is placed on the preparation and it is examined under a microscope. Positive results of the study are the findings of the fungus - threads of mycelium and spores, which, however, do not allow the identification of the fungus.

Cultural examination determines the genus and species of the fungus, in addition, it is more informative than microscopy. The most widely used are Sabouraud's medium or wort agar containing antibiotics.

Luminescent diagnostics consists of ultraviolet illumination of lesions through a Wood filter and is used mainly for hair lesions with microsporia and favus.

Classification. In recent years, N.D. Sheklakov’s classification has been used in domestic dermatology, according to which four groups of mycoses and a group of pseudomycoses are distinguished. Mycoses include:

1) keratomycosis (lichen versicolor, etc.);

2) dermatomycosis (athlete's foot, mycosis caused by red trichophyton, trichophytosis, microsporia, favus);

3) candidiasis;

4) deep mycoses.

The group of pseudomycosis includes erythrasma, actinomycosis, etc.

Currently, in most countries the most widely used classification of fungal skin diseases is based on etiology. There are mycoses caused by dermatophytes (further detail is based on the indication of the localization of mycosis), yeast-like fungi and molds. Mycoses caused by dermatophytes:

1) scalp;

2) areas of the beard and mustache;

3) smooth skin;

4) faces;

5) large folds of the body;

6) stop;

7) brushes;

8) nails.

8.1. MYCOSES CAUSED BY DERMATOPHYTES

Mycosis of the scalp

Definition. Mycosis of the scalp is a lesion of long hair with trichophytosis, microsporia and favus.

Trichophytia

Etiology and pathogenesis. Trichophytosis is caused by anthropophilic fungi, zoophilic and geophilic.

Anthropophilic trichophytons are characterized by the fact that when hair is damaged, the fungal elements are located predominantly inside the hair (T. endotrix), without causing a sharp inflammatory reaction from the skin. In this case, the lesion is superficial and has a subacute or chronic course (superficial trichophytosis).

Zoophilic trichophytons are distinguished by their predominant location around the hair and in the epithelium of the internal pilar sheath (T. ectotrix). The skin lesion they cause - infiltrative-suppurative (deep) trichophytosis - is characterized by the formation of a perifollicular inflammatory infiltrate, leading to purulent melting of the hair follicles and surrounding connective tissue.

In Europe and North America, the most common causative agents of the disease are T. mentagrophytes, T. verrucosum, T. ton-surans And T. violaceum(the latter is common in Russia).

Clinical picture. Superficial trichophytosis of the scalp characterized by the formation of several small round bald patches due to hair thinning. Upon careful examination, it is discovered that it is not associated with hair loss, but with hair breaking off at various levels.

Some hairs break off at a height of 2-3 mm and look like grayish stumps, others break off at the mouth of the hair follicle and look like black dots. The skin in the bald patch area is barely noticeably hyperemic and slightly flaky. The disease usually begins in childhood and lasts for years. At the same time, the bald patches slowly increase in size. During puberty, lesions can resolve on their own, and the hairline is completely restored.

Chronic trichophytosis of the scalp observed almost exclusively in women. As a rule, it is a continuation of superficial trichophytosis of childhood, which did not resolve during puberty. Clinical manifestations are so scarce that they remain unnoticed for decades and are detected only during a special examination of mothers and grandmothers, carried out to identify the sources of infection of children, in the form of black dots against the background of slight peeling (black dot trichophytosis). Black dots are stumps of hair broken off at the mouths of the follicles. It is often possible to notice small atrophic scars.

Infiltrative-suppurative trichophytosis of the scalp - this is a painful, dense, sharply limited, tumor-like, elevated inflammatory infiltrate of a hemispherical or tuberous shape, on the surface of which pustules and broken hair are found. Over time, the infiltrate softens and becomes covered with purulent hemorrhagic crusts. By removing them, small follicular openings are revealed, which creates a picture reminiscent of a honeycomb (hence the ancient name of the disease - kerion). When the infiltrate is compressed, drops of pus are released from the holes, as if through a sieve. The affected hair is rejected with crusts and pus.

As a result of peripheral growth, the lesion can reach quite large sizes (6-8 cm in diameter). It is often accompanied by painful regional lymphadenitis, fever, and malaise.

The causative agents of deep trichophytosis (zoophilic trichophytons) cause the development of immunity, therefore, 2-3 months after the formation of the infiltrate, its spontaneous resolution occurs.

Diagnostics. The diagnosis is established based on the detection of fungi in scales or hair under microscopy and cultural diagnostic data.

Microsporia

Etiology. Microsporia is caused by both anthropophilic and zoophilic fungi (M. audouinii, M. ferrugenium, M. canis and etc.). In case of defeat M. canis And M. gypseum The inflammatory component attracts attention.

Clinical picture. Mostly children are affected; During puberty, the disease usually resolves spontaneously. Microsporia is usually superficial. The infiltrative-suppurative form is observed extremely rarely.

Microsporia of the scalp manifests itself in two ways. In cases where the causative agent is a zoophilic fungus, 1-2 large, round or oval, clearly defined lesions are formed, all the hair in which is broken off at the same height (5-8 mm) and therefore looks as if trimmed. Broken hair is white due to the spore muff and is easily pulled out. The skin is densely covered with flour-like scales. Microsporia caused by an anthropophilic fungus is very similar to superficial trichophytosis of the scalp, with the only difference being that the hair breaks off (not all!) higher up and is white in color.

Diagnostics. The diagnosis is established based on the data of cultural diagnostics and microscopy (microspores form a sheath of small spores around the hair, which, unlike the causative agent of infiltrative-suppurative trichophytosis, are not located in chains, but chaotically (mosaic). A greenish glow has an important differential diagnostic value hair affected by microsporum in the rays

Wooda.

Favus

Etiology and pathogenesis. The causative agent of favus is T. schoenleini. T. violaceum may cause an identical clinical picture. Infection occurs from a sick person or, which is extremely rare, from mice, cats and other animals. The most important transmission of infection is through

household items. The disease begins in childhood and continues in adults.

Clinical picture. Specific to the favus is a crust-like, dry, bright yellow, saucer-shaped element called the scutula (scutellum). Skutula is a pure culture of the fungus in the stratum corneum of the mouth of the hair follicle. The initial scutules do not exceed the size of a pinhead; growing and merging with each other, they can form continuous conglomerates. Over time, the sku-tulas acquire a grayish-white color.

When the scalp is affected, ash-gray, dull hair is visible in the center of each scutula. Hair with fa-vus does not break off, but is relatively easily pulled out. Characteristic is the formation of air bubbles inside the hair.

Simultaneously with the peripheral growth of the lesions, their resolution occurs in the central part, which is accompanied by the development of cicatricial atrophy. Eventually, persistent baldness affects the entire scalp. Only along its periphery there remains a corolla of hair.

In rare cases, atypical forms of favus are observed - impetiginous and squamous. In the impetiginous form, instead of scutulae, pustules are formed, which dry out into impetiginous crusts; in the squamous form - grayish-white scales. We must remember that impetigo of the scalp and dandruff, which cannot be treated, may be manifestations of favus. In such cases, it is necessary to very carefully examine the scalp in order to identify hair lesions, barely noticeable scutulles, and cicatricial atrophy. You should pay attention to the nasty mouse smell that is often emitted by a patient with favus.

Diagnostics. The diagnosis is established on the basis of a microscopic examination (a few mycelial threads and spores are found inside the hair, the scutula consists of spores and mycelial threads of different sizes and shapes) and cultural diagnostic data.

Differential diagnosis. Mycoses of the scalp should be differentiated from lesions in this area, manifested by hair loss and thinning, peeling and hyperemia. The following diseases have a similar clinical picture: various types of alopecia (including syphilitic), seborrheic dermatitis, dandruff, psoriasis, impetigo.

Mycosis of the beard and mustache area

Etiology. The disease is most often caused T. mentagrophytes var gypseum.

Diagnostics. In doubtful cases, the diagnosis is confirmed by laboratory examination of hair or pus. Pus is microscoped in a drop of glycerin.

Mycosis of smooth skin

Definition. Mycosis of smooth skin (see color incl., Fig. 4) is a disease characterized by fungal infections of the skin of the trunk and extremities, with the exception of large folds, palms and soles. Possible involvement of vellus hairs.

Etiology. T. rub-rum, T. mentagrophytes, M. audouinii, M. canis.

Mycosis of smooth skin is represented by rubrophytosis (mycosis caused by red trichophyton), trichophytosis, microsporia, favus.

Rubromycosis

Clinical picture. The pathological process may involve the skin of the buttocks, abdomen, back, and sometimes it becomes very widespread. In this case, rashes of scaly erythema with a bluish tint and follicular nodules are observed. Important differential diagnostic features are the scalloped outlines of the lesions, the discontinuity of their boundaries, the grouping of nodules, the formation of arched, ring-shaped, garland-shaped figures from them

along the periphery of erythematosquamous lesions. In vellus hair, elements of the fungus are often found, located mainly inside the hair, which determines the duration of the disease and its resistance to external fungicidal therapy.

Thus, rubromycosis can simulate a wide variety of dermatoses and therefore poses great difficulties for establishing a diagnosis.

Diagnostics

Differential diagnosis It is carried out mainly with erythemato- and papulosquamous dermatoses: eczematid, psoriasis, nummular eczema, plaque parapsoriasis.

Trichophytosis

Clinical picture. Superficial trichophytosis of smooth skin more often observed in children; characterized by the formation of a hyperemic, slightly edematous, clearly defined, pityriasis-flaky spot, against which small vesicles are visible, drying out into crusts. The spot grows peripherally, eventually resolves in the center and takes on a ring-shaped shape. A new lesion may develop within the ring, resulting in the formation of a ring within a ring. In the case of the formation of several foci of trichophytosis, they merge and acquire a garland-like outline.

Chronic trichophytosis of smooth skin characterized by the formation of scaly, pinkish-purple spots with irregular, blurred boundaries. Against their background, small red nodules may appear, arranged in groups or in the form of ring-shaped figures. The most common localization is the lower legs, buttocks, forearms, and the extensor surface of the knee and elbow joints. The disease lasts for many years, which is associated with invisible damage to vellus hair.

Infiltrative-suppurative trichophytosis of smooth skin characterized by the formation of a round, clearly defined inflammatory plaque of bright red color, rising above the level of the skin. On its surface, multiple pustules are visible, drying into purulent crusts. The plaque gradually increases in size, but after a few weeks its peripheral growth stops and spontaneous resolution occurs. Pigmentation and (sometimes) pinpoint scars remain at the site of the former lesion.

Microsporia

Clinical picture Microsporia of smooth skin is practically no different from superficial trichophytosis of smooth skin.

Favus

Clinical picture. Damage to smooth skin, as a rule, accompanies favus of the scalp, differing from it in the absence of cicatricial atrophy. The most common localization is the face, neck, limbs, scrotum, penis, but sometimes very widespread lesions are observed. Atypical forms are extremely rare.

Mycosis of the face

Definition. Facial mycosis is a variant of smooth skin mycosis with some clinical features.

Etiology. The most common cause of the disease is T. rubrum, T. mentagrophytes, M. audouinii, M. canis.

Clinical picture. In addition to manifestations similar to mycosis of smooth skin, this form can simulate various dermatoses localized on the face: rosacea, seborrheic dermatitis, discoid and disseminated lupus erythematosus.

Diagnostics is carried out on the basis of the clinical picture (mycosis is indicated by the presence of an edematous ridge along the periphery of the lesions) and laboratory tests.

Mycosis of large body folds

Etiology and pathogenesis. The most common cause of the disease is T. rubrum, T. mentagrophytes, E. floccosum. Infection occurs when using a shared bathroom, through washcloths, linen, bedpans and oilcloths, and thermometers. Increased sweating contributes to it.

Clinical picture. The lesions are localized mainly in the inguinal folds. Less commonly, they are observed in the armpits, anogenital folds and under the mammary glands. The disease is characterized by the formation of weakly flaky, sharply defined inflammatory spots of pink color, which, growing along the periphery, merging with each other and resolving in the center, form ring-shaped and garland-shaped figures spreading beyond

folds The lesions may be slightly swollen, their edges ridge-like, covered with small vesicles, crusts or papules.

Mycosis, accompanied by minor itching, lasts for many months.

Diagnostics based on data from microscopic and cultural research methods.

Differential diagnosis carried out with streptococcal and yeast intertrigo, diaper rash, erythrasma, psoriasis and neurodermatitis of the folds.

Mycosis of the feet

Definition. Mycosis of the feet - lesions of the feet by dermatophytes of various clinical manifestations.

Etiology and pathogenesis. In the vast majority of cases, the disease is caused by T. rubrum(up to 80%), less often - E.floccosum. In the domestic literature, mycosis of the feet caused by T. mentagrophytes var. interdigitale, called athlete's foot. At the same time, it should be noted that the same clinical picture can be observed with lesions of different fungi, so cultural diagnosis plays a decisive role.

Infection with athlete's foot occurs through scales that fall on the skin of a healthy person, most often in baths, showers, swimming pools, gyms, as well as through impersonal slippers, sports shoes, hospital shoes, socks, foot wraps. Sometimes infection occurs through direct contact in a shared bed.

Predisposing causes of infection are excessive sweating of the feet, soaking, contamination, abrasions, cracks, vascular disorders associated with prolonged overheating or hypothermia of the feet.

Clinical picture. Skin changes in mycosis of the feet manifest themselves in the following clinical forms - erased, squamous, intertriginous and dyshidrotic.

Erased form characterized by slight peeling in 3-4 interdigital folds.

Squamous form characterized by fine-plate peeling on the sole and in the interdigital folds, more often in IV and III. Sometimes a crack forms deep within the fold. Subjectively - slight itching.

Intertriginous form develops in the interdigital folds of the feet, often from squamous epidermophytosis. The first signs in the form of skin hyperemia and maceration of the stratum corneum appear in folds IV and III. As a result of the rejection of the macerated epidermis, erosion is exposed, bordered by a white collar of the swollen stratum corneum. Gradually, the process spreads to the plantar surface of the fingers and the adjacent part of the sole. Patients complain of itching and pain, making it difficult to walk.

Dyshidrotic athlete's foot localized on the soles, mainly on the arch of the feet, and is characterized by a rash of itchy vesicles the size of a pea, with a thick covering. They can be single or multiple, grouped. Over time, the vesicles either shrink into crusts or open up to form erosions. When they merge, a continuous erosive focus is formed against the background of hyperemia, which has clear scalloped outlines and is bordered by a collar of the stratum corneum. After the lesions have healed, the phenomena of squamous epidermophytosis remain, with exacerbation of which dyshidrotic vesicles reappear.

It should be noted that dyshidrotic athlete's foot may be accompanied by similar rashes on the palms, reflecting eczematization of the mycotic process (mycids). Therefore, in cases where patients complain of damage to the hands, it is absolutely necessary to examine the skin of the feet. There are no mushrooms in mykids.

For rubromycosis The most typical clinical picture is the following: the skin of the palms and soles is rough, dry, thickened due to diffuse hyperkeratosis, often leading to the formation of calluses with deep painful cracks. Flourous peeling in the skin grooves is very characteristic.

Diagnostics is based on laboratory research data. Branching threads of mycelium are found in the scales, macerated stratum corneum and in the caps of the vesicles.

Differential diagnosis carried out with interdigital diaper rash, dermatitis, toxicoderma, eczema. In addition, it should be borne in mind that if not treated in a timely manner, mycosis of the feet can be complicated by pyococcal infection, which leads to increased and spreading hyperemia, the appearance of edema, the transformation of vesicles into pustules, the development of lymphangitis, lymphadenitis, recurrent erysipelas, and thrombophlebitis.

Mycosis of the hands

Definition. Mycosis of the hands - lesions of the hands by dermatophytes of various clinical manifestations.

Etiology and pathogenesis. The disease causes in the vast majority of cases T. rubrum. The routes and conditions of infection are the same as for mycosis of the feet. In addition, transmission of infection through towels and gloves is possible.

Clinical picture. The disease manifests itself as diffuse hyperkeratosis in the area of the palms and palmar surfaces of the fingers. The skin is dry, characterized by floury peeling over the entire palmar surface with an emphasis on the skin furrows.

Diagnostics based on data from microscopic and cultural research methods.

Differential diagnosis carried out with psoriasis, secondary syphilides, keratoderma.

Mycosis of nails

Definition. Mycosis of the nails (onychomycosis) is a fungal infection of the nail plates. They can occur in patients with rubromycosis (on the feet and hands), athlete's foot, chronic trichophytosis and favus (mainly on the hands), and extremely rarely with microsporia.

According to various authors, on average 90% of cases of onychomycosis are caused by dermatophytes, among which the most important are Tr. rubrum(detected in 90-95% of cases) and Tr. mentagrophytes. Modern features of the manifestation of onychomycosis indicate that cases of nail damage caused by yeast-like fungi have become more frequent Candida spp. which can occur in 10-15% of patients, mainly on the hands. "Non-dermatophyte" molds such as Scopulariopis brevicaulis, Scytalidium spp., Aspergillus spp., Fusarium spp., Acremonium spp. and some others, can cause about 5% of onychomycosis.

Molds can also accompany dermatophyte infection in 10-15% of cases, causing the mixed nature of the disease.

Onychomycosis is often considered a minor disease that does not require timely treatment. It should, however, be emphasized that it can significantly degrade the quality

life of the patient, as it leads to nail destruction, feelings of concern, anxiety, depression, and impaired performance. In addition, onychomycosis can cause the following complications: disturbance of peripheral microcirculation, exacerbation of recurrent thrombophlebitis, erysipelas, bacterial infection, sensitization of the body.

Clinical picture. According to the modern classification, distal subungual onychomycosis, proximal subungual onychomycosis, white superficial onychomycosis and total dystrophic onychomycosis are distinguished.

Distal subungual onychomycosis is the most common and is usually caused by Tr. rubrum.

Fungi penetrate into the distal areas of the nail bed from the stratum corneum of the surrounding skin and affect both fingernails and toenails, the latter being 4 times more common. The clinical picture is characterized by thickening of the nail plate and, in some cases, its separation from the hyperkeratotic nail bed.

Proximal subungual onychomycosis occurs mainly in immunocompromised patients, especially often in HIV-infected patients. The causative agent (usually Tr. rub-rum) first affects the nail plate and infects the proximal part of the nail bed.

White superficial onychomycosis is a rare form of the disease. The main pathogens are Tr. mentagrophytes and various molds that penetrate the surface layers of the nail plates, which turn white and crumble.

Total dystrophic onychomycosis can be a consequence of distal or proximal onychomycosis and is usually caused by dermatophytes, but in patients with chronic mucocutaneous candidiasis the causative agent is C. albicans in these cases, complete destruction of the nail plate is possible.

Diagnostics onychomycosis is based on the clinical picture with mandatory confirmation of the diagnosis by microscopic and cultural methods of examination. In exceptional cases, it is possible to conduct a histological examination of sections of the nail plate to identify fungi.

8.2. MYCOSES DUE TO

YEAST-LIKE MUSHROOMS

Superficial candidiasis

Definition. Candidiasis (candidosis)- a disease of the skin, mucous membranes, nails and internal organs caused by yeast-like fungi of the genus Candida. Superficial candidiasis includes lesions of the skin, visible mucous membranes and nails.

Etiology and pathogenesis. Superficial candidiasis is usually caused by Candida albicans. The pathogen belongs to the conditionally pathogenic microflora and is found in the folds of the skin, on the mucous membrane of the oral cavity and vagina, and in the intestines; its pathogenicity is determined by virulence and the state of the macroorganism. The following provoking factors in the development of candidiasis are identified:

1) long-term use of antibiotics, glucocorticosteroids and cytostatics;

2) malignant tumors, lymphoproliferative diseases;

3) HIV infection;

4) diabetes mellitus;

5) endocrine dysfunctions;

6) increased humidity and ambient temperature, microtraumas;

7) early childhood and old age.

Candidiasis of the mucous membranes

Clinical picture. Candidiasis of the mucous membranes (“thrush”) is most often observed in the oral cavity, less often in the vagina (vulvovaginal candidiasis). The process begins with the appearance of a white crumbly coating, reminiscent of semolina, against the background of hyperemia. A film gradually forms, which at first is easily removed, and then thickens, acquires a dirty gray color and is firmly held on the surface of the mucous membrane (once it is removed, bleeding erosion remains). Thrush is often observed in newborns. Vulvovaginitis is accompanied by painful itching and crumbly vaginal discharge. Yeast-like fungi can be transmitted sexually. Candidiasis balanoposthitis is characterized by

It is caused by maceration of limited areas of the glans penis and the inner layer of the foreskin, followed by the formation of erosions. Diabetes mellitus plays an important role in the development of balanoposthitis and vulvovaginitis: sugar excreted in the urine serves as a good nutrient medium for yeast-like fungi.

Diagnostics based on clinical and laboratory data.

Differential diagnosis if the oral mucosa is affected, it is carried out with leukoplakia (found only in adults), lichen planus, secondary syphilides, hairy leukoplakia; with vaginal involvement - with gonorrhea, trichomoniasis. Candidal balanoposthitis should be differentiated from balanoposthitis and psoriasis.

Candidiasis of the corners of the mouth

Clinical picture. Candidiasis of the corners of the mouth (candidiasis) is observed more often in people who have the habit of licking their lips or sleeping with their mouth open, from which saliva flows, moisturizing the corners of the mouth. The lesion is an erosion surrounded by a collar of swollen stratum corneum. A crack appears deep within the fold. Honey-yellow crusts that form around streptococcal erosion are absent with yeast infection.

Diagnostics based on laboratory data.

Differential diagnosis carried out with streptococcal infection, secondary syphilides.

Intertriginous candidiasis

Clinical picture. Intertriginous candidiasis (yeast diaper rash) in its clinical picture is practically no different from intertriginous streptoderma. Very characteristic of yeast skin lesions is interdigital erosion, which usually develops between the third and fourth fingers of the hands of housewives who deal with vegetables and fruits, and of workers in confectionery, fruit and vegetable and similar industries. In the interdigital fold and on the adjacent lateral surfaces of the fingers, maceration and rejection of the stratum corneum occur, resulting in the formation of a cherry-red erosion bordered by a white collar of swollen horn.

Diagnostics based on microscopy data and, if necessary, culture.

Differential diagnosis carried out with streptococcal intertrigo, with simple intertrigo, with lesions caused by dermatophytes.

Candidal paronychia and onychia

Clinical picture. The process starts from the back of the nail fold, moves to the sides, and then spreads to the nail plate. The ridges become swollen, bright red, and sharply painful. Often it is possible to squeeze out a drop of pus from under the posterior cushion. The adjacent part of the nail plate becomes cloudy and discolors, forming a hole.

Diagnostics carried out according to clinical manifestations and laboratory research methods.

Differential diagnosis carried out with onychodystrophies, lesions of the nail plates and other types of fungi.

Pityriasis versicolor (lichen versicolor)

Definition. Pityriasis versicolor (pityriasis versicolor)(see color incl., Fig. 5) is characterized by damage only to the horny substance of the epidermis, the absence of inflammatory phenomena and very slight contagiousness.

Etiology and pathogenesis. The causative agent of pityriasis versicolor is a dimorphic, lipophilic yeast-like fungus Malassezia. A predisposing cause for the development of mycosis is increased sweating.

Clinical picture. The disease is localized mainly on the torso, mainly on the chest and back, less often on the neck, outer surface of the shoulders, and scalp. Skin lesions begin with the appearance of small spots of various shades of brown (hence the name - pityriasis versicolor). The spots increase in size, merge with each other, forming more or less large lesions with finely scalloped outlines. On their surface there is a barely noticeable pityriasis-like peeling associated with loosening of the stratum corneum by the fungus. The disease lasts for many months and years. In tanned people, the lesions appear lighter than healthy skin (pseudo-leukoderma). This is explained by the fact that under the influence of the sun they resolve, but through the loosened stratum corneum the skin receives an insufficient dose of insolation for tanning. Necessary

Remember that white spots on the neck and upper chest and back may be a sign of syphilis.

Diagnostics. Pityriasis peeling in doubtful cases can be identified by scraping the spot with a fingernail: the horny masses are removed in the form of shavings. Another method is to lubricate the spot and surrounding skin with an alcohol solution of iodine or aniline dye: as a result of intensive absorption of the solution by the loosened stratum corneum, the affected skin is colored much brighter than healthy skin (Balzer test). In the diagnosis of pityriasis versicolor of the scalp, the luminescent method is important: under Wood's rays (ultraviolet rays of a quartz lamp passed through glass impregnated with nickel salts) in a darkened room, the spots acquire a reddish-yellow or brown glow.

Differential diagnosis carried out with vitiligo, erythrasma, seborrheic dermatitis, syphilitic leukoderma.

8.3. MYCOSES CAUSED BY MOLDS

Molds cause black pedera, characterized by the appearance of small, very dense nodules on the surface of the hair, and lichen black, appears on the palms and soles as scaly patches of dark brown or black color. The development of onychomycosis and otomycosis is possible.

8.4. TREATMENT OF FUNGAL SKIN DISEASES

The history of treatment of fungal skin diseases for a long time was associated mainly with external means. General therapy was carried out with drugs of nonspecific action of low effectiveness.

According to the modern classification of antifungal agents, there are polyenes, azoles, allylamines, morpholines and a separate group of agents, which includes substances of different chemical structures.

1. Polyenes are used in general and external therapy (amphotericin B, nystatin, natamycin - “pimafucin”).

2. Generally active azoles - triazoles (itraconazole - "orungal", fluconazole - "diflucan", "mikosist"), imidazoles are used for external treatment (bifonazole - "miko-

dispute", clotrimazole - "canesten", isoconazole - "travogen", sertaconazole - "zalain", ketoconazole - "nizoral", miconazole - "mikozolon", oxiconazole - "mifungar", etc.).

3. Allylamines are prescribed for general treatment (terbina-fin - "lamisil", "terbizil", "fungoterbin") and local (terbinafine - "lamisil" (dermgel, cream and spray), "terbizil", "fungoterbin" and naftifine - "exoderil").

4. Morpholines (amorolfine - "loceryl") are used topically.

5. From the group of drugs with different chemical structures, drugs with specific action (cyclopirox - “batrafen”) and non-specific (Castellani paint, propylene glycol, etc.) are recommended for external treatment.

Treatment of mycoses of smooth skin is carried out with external means; if vellus hair is involved in the process, as well as if long hair is affected, general medications are prescribed.

For the treatment of onychomycosis, mainly 3 methods are used: local antifungal therapy, removal of the affected nail plates and oral therapy.

Local therapy for onychomycosis without prescribing tableted drugs is effective when using modern varnishes only when the area of damage to the nail plate is insignificant (up to 1/3).

Removal of affected nail plates, both surgical and chemical, leads to recovery only in combination with oral therapy; in this case, it is often necessary to hospitalize the patient for surgery, which is currently impractical for economic reasons.

Oral therapy with antifungals is most effective, although it has certain indications and contraindications. The indications are:

1) damage to more than one third of the nail plate;

2) involvement of more than 2-3 nail plates in the process;

3) lack of effect from local therapy;

4) combination of onychomycosis with hair damage. Contraindications:

1) pregnancy;

2) liver disease, including a history (if laboratory signs of liver damage appear during therapy, treatment must be stopped).

Local therapy

Modern fungicidal varnishes have the following indications: damage to the marginal zone or one third of the nail, as well as the presence of intercurrent diseases of the kidneys, liver and cardiovascular system, which do not allow the use of oral general therapy.

One of the most effective local treatment methods is the use of antifungal varnishes.

"Batrafen" (active substance - ciclopirox). The drug quickly penetrates the nail plate, destroying fungi. The protective film that forms on the nail prevents the further spread of infection and protects the nail from penetrating into an existing lesion. Before treating the nail plate with varnish, it is imperative to remove the affected area of the nail mechanically or using a keratolytic patch. The treatment regimen is as follows: 1st month - varnish is applied to the nails every other day, 2nd month - 2 times a week, 3rd month - 1 time a week. Treatment with Batrafen must be continued until the healthy nail plate grows completely. Combination therapy (oral + nail polish) or sequential therapy (first oral, then "batrafen") increases the effectiveness of treatment by 10-15% and reduces the risk of relapses.

"Loceril" (active substance - amorolfine hydrochloride). The drug has a fungistatic effect, having a wide spectrum of action. Nail polish "Loceryl" is applied to the affected nail plates 1-2 times a week. Treatment should be continued until the nail regenerates and the affected area is completely healed. The average treatment duration is 6 months for fingernails and 9-12 months for toenails.

The disadvantage of local therapy is that when drugs are applied to the surface of the nail, they do not always reach the pathogen localized in the nail bed, and even more so in the matrix.

Surgery

Surgical removal of the nail plates is carried out in combination with the subsequent administration of general oral fungicidal therapy and topical fungicidal agents.

The disadvantages of the surgical treatment method are the discomfort of the patient who is forced to undergo surgery and hospitalization in a hospital.

Oral therapy

Oral therapy is the most effective and reliable way to treat onychomycosis.

The main criterion determining the choice of a systemic antimycotic is its spectrum of action. The spectrum should include fungi isolated from affected nails. Therefore, the etiology of onychomycosis, according to cultural studies, should be well known to the doctor. If the etiology is unknown or several pathogens have been isolated, a broad-spectrum drug is prescribed, acting on both dermatophytes and fungi of the genus Candida, as well as for non-dermatophyte mold fungi (Table 1).

Table 1

Therapeutic spectrum of action of systemic therapy for onychomycosis

The second criterion is the clinical form of onychomycosis, the degree and location of the lesion.

The following basic drug prescription regimens are generally used.

1. Standard scheme providing for daily administration of the usual dose of the drug throughout the entire treatment period. The duration of treatment corresponds to the time of growth of the nail plates. The standard regimen for the treatment of onychomycosis of the feet with Lamisil is 12 weeks.

2. Pulse therapy scheme. According to this scheme, an increased dose of the drug is prescribed in short courses at intervals exceeding the duration of the courses themselves. The duration of treatment can be 2-4 months when using "orungal".

"Lamisil." The drug is produced in tablets containing 125 or 250 mg of terbinafine, which is highly active against dermatophytes and significantly less active against molds.

Lamisil is generally well tolerated. Side effects are usually mild or moderate and transient

character. The most commonly observed symptoms are from the gastrointestinal tract (a feeling of fullness in the stomach, loss of appetite, dyspepsia, nausea, mild abdominal pain, diarrhea), and sometimes skin reactions. Patients with concomitant stable liver dysfunction should be prescribed half the usual recommended dose of the drug. The drug is contraindicated in case of hypersensitivity to terbinafine.

"Orungal" are produced in the form of capsules containing 100 mg of itraconazole (a triazole derivative), active against dermatophytes, yeast and mold fungi. The drug is prescribed orally in the form of pulse therapy, 2 capsules per day (morning and evening) for 7 days, after 3 weeks the course of treatment is repeated. When taking Orungal with food, its absorption improves. For onychomycosis of the hands, two courses of treatment are sufficient, for onychomycosis of the feet - 3. The effectiveness of therapy is assessed after 9-12 months.

The main contraindication to the use of the drug is pregnancy. The most common side effects: nausea, epigastric discomfort and abdominal pain, constipation. If nausea or vomiting occurs, liver function tests should be performed. A small proportion of patients may experience a transient increase in liver transaminases.

In conclusion, it should be noted that the treatment of onychomycosis is a relatively complex and lengthy procedure. The basis of success is an individual approach to the patient, in which it is necessary to take into account factors such as the number of affected nails, the degree of involvement of the nail plates in the pathological process, the patient’s age, his attitude to the disease and financial capabilities, as well as concomitant diseases.

8.5. PREVENTION OF MYCOSES

Prevention of fungal diseases includes targeting the source of infection, the susceptible organism, and eliminating transmission routes. To this end, the following activities are carried out:

1) active identification of patients (if necessary, their isolation) and timely, complete treatment;

2) registration and accounting of some mycoses by filling out a notification form? 089/у (2 copies), one copy is sent within 3 days to the district (city, regional) KVD, the second to the sanitary and epidemiological station at the patient’s place of residence;

3) a thorough epidemiological analysis of each case of fungal disease, taking into account the clinical form of mycosis, history of the disease, the type of pathogen and, accordingly, the ways and means of spread in order to eliminate them;

4) disinfection (if necessary);

5) elimination of factors predisposing to the development of the disease in humans: combating excessive sweating of the feet, microtrauma, hardening the body, etc.;

6) sanitary educational work.

information for specialists
Mycoses of the upper respiratory tract: current status and problems

Medicine entered the new century with the developed field of medical mycology. The last decades have even been called the “golden age” of medical mycology, meaning the successes achieved in the diagnosis and treatment of mycoses - fungal infections of humans.

The actualization of the problem of mycoses, which has become especially noticeable since the middle of the 20th century, is due to a number of reasons: first of all, the increase in the number of diseases accompanied by immunodeficiency states, the success of antibacterial therapy (micromycetes take the place of bacteria in the ecosystem), the introduction of new medical technologies, etc. At the moment About 100 species of pathogenic and 400 opportunistic fungi have already been described.

In the last two decades, in non-CIS countries, Russia, Kazakhstan and Ukraine, an increase in the number of superficial and deep mycoses, including those of the ENT organs, has been recorded. There is no such data in our republic. Currently in the Republic of Belarus there is a problem of organizing and developing laboratory mycological services and clinical mycology (training and training). The development of transplantology, oncohematology and oncology in general, the deterioration of the environmental situation (exposure to ionizing radiation) ultimately leads to the formation of a population of people with secondary immunodeficiencies and increased susceptibility to fungal diseases. The problem of mycoses primarily affects infectious disease specialists, gynecologists, dermatovenerologists, hematologists, oncologists, pulmonologists, and otorhinolaryngologists. There is a need for wider introduction and coverage of medical mycology issues in medical universities of the republic.

The problem of identifying and treating mycoses in otorhinolaryngology is becoming increasingly important for a number of reasons: widespread distribution, more severe course of this pathology, changes in the spectrum of mycobiota and increasing resistance of micromycetes to antimycotic drugs. Fungal diseases of the upper respiratory tract (VDP) occur much more often than they are diagnosed. The mucous membrane of the upper respiratory tract and the skin are the first barrier and the most common site of colonization for mycotic infection. Often, the etiological role of fungi in inflammatory diseases of the upper respiratory tract is not sufficiently assessed, which reflects a misconception about the nature of the pathology and, consequently, leads to irrational treatment. The diagnosis of these diseases presents certain difficulties, since there are no pathognomonic clinical signs, and the main evidence of mycosis is the detection of the pathogen in the patient’s substrates. Over the past decade, there has been a change in the spectrum of mycobiota and an increasing level of resistance of Candida albicans and Candida non-albicans strains to fluconazole, which is the drug of choice for the treatment of most clinical forms of candidiasis. For effective therapy of mycoses of the upper respiratory tract, a necessary condition is to carry out species identification and determine the sensitivity of pathogens to antifungal drugs. The lack of modern data in the domestic literature on micromycetes that cause damage to the upper respiratory tract often leads to incorrect diagnosis of mycoses and the choice of antimycotic drug.

Since the publication of the monograph by V.Ya. Kunelskaya “Mycoses in otorhinolaryngology” (1989) 20 years have passed: many issues of etiopathogenesis, diagnosis and treatment require revision. Selection of a suitable antimycotic based on determining the sensitivity of the pathogen in vitro is more cost-effective than empirical replacement of one drug with another. The lack of an available method for determining the sensitivity of fungi and insufficient technical equipment does not allow them to be carried out in every clinical microbiology laboratory.

Purpose of the study: studying the spectrum of mycobiota of the URT in diseases of the ENT organs and the level of resistance to the main antifungal drugs of clinically significant strains for rational empirical therapy of fungal infections in otorhinolaryngology.

Materials and methods

We conducted a mycological examination of 147 patients aged 18 to 64 years with clinical signs of fungal infection of the upper respiratory tract, who were examined and treated at the ENT clinic of the State Medical University and the consultative and outpatient department of the Republican Scientific and Practical Center for Radiation Medicine and Human Ecology in 2006-2008. The material was collected before the start of antibacterial and antimycotic therapy. Transportation was carried out for 2-3 hours in a test tube with Amies transport medium. Identification, determination of the sensitivity of fungi and analysis of the data obtained were carried out using a miniAPI microbiological analyzer from bioMerieux (France). For identification, plates (strips) containing dehydrogenated biochemical substrates (from 16 to 32 tests) were used. Cultures without clinical significance were excluded. Determination of sensitivity to antifungal drugs (flucytosine, amphotericin B, fluconazole, itraconazole and voriconazole) was carried out on strips (ATB FUNGUS-3) from bioMerieux (France) in a semi-liquid medium adapted to the requirements of the standard dilution method of the Clinical Laboratory Standards Institute (CLSI) - NCCLS M- 44, USA. To control the quality of susceptibility testing, control strains of the American Collection of Microorganisms (ATCC) were used.

Results and discussion

Patients are distributed according to nosological forms as follows: laryngomycosis - 41 (27.9%), pharyngomycosis - 45 (30.6%), pharyngolaryngomycosis - 35 (23.8%), fungal rhinosinusitis - 26 (30.6%) (Fig. .1).

Basic demographic characteristics of the patients are presented in Table 1.

			Average age (years)
Pharyngomycosis
laryngomycosis
pharyngolaryngomycosis
fungal rhinosinusitis

It should be noted that in the group of patients with laryngo- and pharyngolaryngomycosis, men predominate (87.8% and 74.3%, respectively) at the age of 51±4.5 years. This fact is most likely due to similar reasons as chronic hyperplastic laryngitis.

The dominant species in laryngo- and pharyngomycosis are Candida albicans (72%), C. krusei (10%). Less commonly isolated are C. parapsilosis (2.8%), C. valida (2.8%), C. tropicalis (1.4%) and C. glabrata (1.4%), Geotrichum capitatum (4%), Aspergillus spp. and Penicillium spp. (5.5%) (Fig. 2). In fungal rhinosinusitis, mold mycobiota becomes more important: Aspergillus fumigatus (niger, flavus) (60%), Penicillium spp. (20%), Alternaria (3.3%); C. albicans (10%) and C. non-albicans (6.7%) are less common (Fig. 3).

As a result of determining sensitivity to antifungal drugs, the following results were obtained. As a leading causative agent of candidiasis, C. albicans remains highly sensitive to fluconazole (86%) and itraconazole (82%). Against the background of increasing etiological significance in pharyngolaryngomycosis of fungi of the Candida non-albicans group (18.4%), a fairly high level of their resistance to fluconazole was noted: C. krusei (100%), C. valida (67%), C. tropicalis (60% ) and C.glabrata (33%). The resistance of Candida non-albicans to itraconazole does not exceed 17%. All isolated strains of fungi of the genus Candida (100%) are sensitive to amphotericin B and voriconazole. Geotrichum capitatum is sensitive only to amphotericin B and voriconazole. Molds are resistant (100%) to fluconazole, sensitive to amphotericin B (100%), voriconazole (100%), itraconazole (98%). Based on the data obtained on the etiology and antimycotic resistance of pathogens of URT mycoses, as well as taking into account our own clinical experience, we can conclude about the feasibility, effectiveness and safety of using itraconazole ( mycotrox) in the treatment of this pathology.

conclusions

1. Considering the prevalence of candidiasis of the upper respiratory tract, it is necessary to introduce available standard methods for identifying and determining the sensitivity of candidiasis pathogens into the practice of clinical microbiology laboratories.

2. For pharyngolaryngomycosis, the leading etiological agent in our region is C. albicans (72%) and C. krusei (10%). Mold mycobiota (Aspergillus spp., Penicillium spp.) is dominant in fungal rhinosinusitis (83.3%).

3. The data obtained on the activity of fluconazole in vitro allow us to continue its use as the drug of choice for the treatment of most forms of candidiasis of the upper respiratory tract.

4. For antimycotic therapy when mold mycobiota is detected, the drug of choice is itraconazole. Reserve drugs for the treatment of mycoses of the upper respiratory tract in modern conditions are voriconazole and amphotericin B.

Literature:

Sergeev, A.Yu. Fungal infections: a guide for doctors / A.Yu. Sergeev, Yu.V. Sergeev - M.: Binompress LLC, 2004. - 440 p.

Kryukov, A.I. Mycoses in otorhinolaryngology/ A.I. Kryukov [and others] // Consillium Medicum. Otorhinolaryngology. - 2004. - volume 6. - No. 4. - P.46-58.

Zabolotny, D.I. The role of fungi in the pathology of the upper respiratory tract and ear / D.I. Zabolotny, I.S. Zaritskaya, O.G. Volskaya // Journal. ear nose. and throat Bol.-2002.-No.5.-P.2-15.

Tastanbekova, L.K. Species spectrum and biological properties of mold fungi in mycoses of the ENT organs: abstract. dis...candidate of medical sciences: 03.00.07/ L.K. Tastanbekova, Kazakh. national honey. univ. - Almaty, 2004.- 29 p.

Burkutbaeva, T.N. Diagnosis and treatment of mycotic lesions of the upper respiratory tract caused by mycelial micromycetes/ T.N. Burkutbaeva // Ross. otorhinolaryngology. - 2005.-№3.- P.40-43.

Profloration center RMAPO [Electronic resource] / Mycotic infection and antifungal immunity in otorhinolaryngological pathology / Arefieva N.A. [etc.] Access mode: http:// - www.lorcentr.ru - Access date: 01/05/2009

Vennewald I., Hencer M., Klemm E., Seebacher C. Fungal colonization of paranasal sinuses // Mycoses. - 1999. -- No. 42, Suppl.2. - P.33-36.

Arabian, R.A. Diagnosis of mycoses/ R.A. Arabian, N.N. Klimko, N.V. Vasilyeva - St. Petersburg: Publishing house SPbMAPO, 2004. - 186 p.

Veselov, A.V. Epidemiology of candidiasis pathogens and their sensitivity to azoles: results of the ARTEMIS Disk study/ A.V. Veselov [et al.]// Clinical microbiol. antimicrobial chemotherapy, 2005.—vol. 7. - No. 1. - P.68-76.

Elinov, N.P. Aspergillus infection: approaches to diagnosis and treatment / N.P. Elinov, V.S. Mitrofanov, R.M. Chernopyatova // Problems of medical mycology. - 2002. - T.4.-No.1.-S.1-14.

Kunelskaya, V.Ya. Mycoses in otorhinolaryngology / V.Ya. Kunelskaya. - M.: Medicine, 1989. - 320 p.

Redko, D.D. Systemic antimycotic therapy of chronic fungal rhinosinusitis/ D.D. Redko, I.D. Shlyaga, N.I. Shevchenko // Medical panorama. - 2008. - No. 7. - P. 12-16.

Shlyaga I.D., Redko D.D., Osipov V.A., Shevchenko N.I., Zhavoronok S.V.

Medical panorama No. 13, 2008

Reading time: 6 min

The term "skin mycoses" doctors refer to a broad group of infectious diseases characterized by damage to the skin by fungi. Mycosis of the skin in most people begins with minor discomfort - the skin of the toes or hands is slightly itchy and itchy.

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

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

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

Ringworm is a common type of mycosis, often transmitted from domestic animals, and children often suffer from this disease.

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

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

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

Malassezia furfur mushrooms cause tinea versicolor. In total, biologists have identified approximately 500 species of fungi that cause skin diseases.

Types and types of mycosis

Based on the location of the infection, doctors classify mycoses into the following types:

mycosis of the trunk;
mycosis of the feet;
mycosis of the skin of the hands;
mycosis of nails;
mycosis of smooth scalp;
mycosis of the scalp (the latter is quite rare).

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

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

Symptoms

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

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

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

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

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

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

Transfer methods

“Don’t even try to pet a stray cat, you’ll get shingles,” every child who cares about animals hears a stern warning from their parents. And it’s good if you listen to your elders: skin mycosis is easily transmitted to humans from infected animals; carriers of the disease can be cats, dogs, small rodents, cows, pigs.

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

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

Mycosis of the skin is easily transmitted through direct contact with a sick person using shared household items. If such a nuisance has happened to someone in your family, under no circumstances share household items with the patient - dishes, towels, clothes, bed linen. Otherwise, the whole family will have to undergo treatment.

The fungi that cause mycosis are quite tenacious in the external environment. Particularly favorable conditions have been created for them in public baths, saunas, swimming pools, and showers. In a warm and humid environment, mushrooms reproduce well, so when visiting such establishments it is advisable to bring your own hygiene items - soap, towels, sheets, flip-flops.

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

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

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

The main function of our skin is barrier and protective. That is why it is recommended to disinfect injuries and wounds as soon as possible and prevent dirt from entering. Otherwise, microorganisms can enter directly into the bloodstream, rather than being localized on the outer integument.

To protect yourself from fungal infections, doctors recommend carefully monitoring the condition of your skin, wiping yourself dry after a bath or shower (mycosis of the skin develops in the cavities of the toes and hands), and immediately contacting a specialist at the first signs of disturbances in the normal functioning of the skin.

Treatment

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

First of all, the doctor should refer the patient to have a sample of the affected skin examined in a laboratory. This is necessary to identify a specific pathogen. The doctor’s choice of medication will also be influenced by factors such as the depth and area of the affected area, the location of the disease, the degree of its development, general health and immunity, the presence of chronic diseases, the patient’s age, and the possibility of an allergic reaction to medications.

If you consult a doctor at an early stage of the disease, the external use of antifungal ointments will help you defeat mycosis of smooth skin. Both local treatment and oral medications will be required in cases where the disease has affected a large area of skin.

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

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

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

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

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

Prevention of mycosis

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

strictly observe hygiene, take your own towels, sheets, slippers to a public pool, bathhouse, sauna, and dry yourself thoroughly after a shower. It is advisable not to wear tight shoes and prevent your feet from sweating;
disinfect wounds and skin lesions;
strengthen the immune system, monitor the condition of the skin and consult a doctor in time if it changes.

Skin mycoses are fungal diseases caused by infectious microorganisms. They affect the skin and subcutaneous tissue, penetrating through scratches and microtraumas. Then the fungal spores enter the respiratory tract through the mucous membrane and accumulate in the lungs. The stage of the disease depends on the source of infection and the specific fungus. The development of this disease can be triggered by any disease that weakens the body’s immune system.

From the site of injury, microbes spread to other areas of the skin and infect the mucous membrane, genitals, digestive system, and lungs. The disease affects the face, hair, torso, arms, legs and even nails.

The danger of the disease is that it often has a chronic form. The sooner you contact a medical facility for help with mycosis, the faster the treatment will take place and the sooner the recovery will occur. This disease can disfigure the skin of the face, arms, legs and other parts of the body, affect any organs and cause associated diseases (allergies, mycids). The risk group for mycosis is children and the elderly, although a person of any gender and age can contract the infection.

Types of mycosis of the skin

Mycosis is a large group of diseases. Different subtypes of pathology differ in location and extent of damage. There are two main groups. Deep mycoses - opportunistic and subcutaneous, sporotrichosis, chromoblastomycosis. Superficial – candidiasis, dermatomycosis and keratomycosis.

keratomycosis. Of this group, the most common is the one, which is characterized by the appearance of spots on the body and face, which, as the pathological process progresses, begin to peel off;
ringworm. This group includes several types of skin diseases. The appearance of dermatomycosis is indicated when characteristic red spots appear on the body, the skin becomes inflamed, and active peeling occurs;
candidiasis- These are diseases caused by yeast fungi. Ailments of this type spread throughout the tissues of all organs and parts of the body, with the exception of hair. The infection most often develops in skin folds. The most dangerous places are in the armpit, in the interdigital spaces;
histoplasmosis, chromomycosis, cryptococcosis, etc. This group of infectious diseases is characterized by infection of the deep layers of the skin, and therefore they are the most dangerous and severe, but are quite rare. In this case, it is necessary to promptly and thoroughly diagnose and prescribe adequate treatment. As a rule, treating these pathologies is very difficult.

Mycosis of the skin can be acute and chronic, deep and superficial, focal and widespread.

Causes

The main cause of all skin mycoses is a fungus that develops and affects the tissues of organs and parts of the body. The danger of the disease is that all patients are sick differently. Some become infected immediately, in others the disease proceeds latently, and in others, the presence of infection in the body does not cause the development of pathology and they become carriers of fungal spores.

The mechanism of disease development depends on the protective factors of the individual person’s body. If a person has a weak immune system or takes antibiotics or has skin lesions or poor hygiene, then the risk of developing this fungal disease is very high. To this you can also add trophic ulcers. The fungus reproduces and grows best in a moist and warm environment.

Infectious microorganisms can penetrate inside during medical procedures. When the body's defenses are weakened, conditions for invasive fungal growth appear.

Since mycoses of the skin of the face, hands, feet and other parts of the body develop in a weakened body, this infection can progress during immunodeficiency, if there is a malignant neoplasm or after excessive use of antibiotics and steroids.

If the infection is minor, then mycosis may not be accompanied by numerous symptoms. But systemic mycoses spread widely and affect any part of the body: from the scalp and face to the tips of the nails. Systemic ones include candemia and visceral candidiasis, infant meningitis, streptococcal pneumonia and disseminated candidiasis, aspergillosis of the brain, lungs and middle ear.

A variety of fungi that cause mycosis of the skin affect both people and animals. They enter the body in various ways. The main routes are microcracks and significant damage to the skin, medical manipulations. Factors contributing to their further development in the human body are radiation, chronic diseases and various disorders of body processes.

So, the most common causes of infection with fungal spores:

weakened immune system;
chronic illnesses;
poor hygiene;
long-term use of medications;
poor diet and consumption of low-quality foods;
bad habits;
spoiled medicines, etc.

Symptoms

With mycosis of the skin, there are various symptoms, but they do not appear immediately. Symptoms largely depend on which part of the body was affected by this infectious disease. If itching appears and pieces of skin peel off on the face, arms, stomach, back, legs - these are the first symptoms of mycosis. The patient should immediately contact a qualified professional for diagnosis and treatment. This stage of the disease responds very well to treatment with antifungal drugs and, as a rule, does not cause complications.

Mycosis of smooth skin of the follicular-nodular form is characterized by a pustular rash. The infection can even affect vellus hair. Diaper rash appears quite often between the fingers. This is how mycosis of the skin of the hands and feet begins. As the pathology progresses, corns appear and the skin on the feet becomes rough. In addition to peeling, symptoms such as painful purulent blisters may appear, nails begin to peel, turn yellow and can be significantly destroyed.

Mycosis of the scalp is manifested not only by peeling, but also by dullness and weakening of the hair. Facial skin disease is especially unpleasant. In general, the patient may experience increased body temperature, pain and general weakness.

The problem is that the primary symptoms are so insignificant that the person himself does not pay attention to them and does not consult a doctor. At this time, the disease gradually progresses and then it is more difficult to cure it. If the disease is detected at an early stage, then there is a greater chance of curing mycosis completely without the likelihood of relapses. But without proper and timely treatment, the disease can lead to a large number of complications.

Diagnosis and treatment

Dermatologists or mycologists can diagnose this disease. First of all, you need to come for a consultation with a doctor. He must examine lesions on the skin of the face, limbs and other parts of the body, and take superficial scales for laboratory examination under a microscope. To prescribe the correct treatment, you need to determine the cause of the disease using cultural methods.

As for the treatment itself, there is no single method, since it must be comprehensive and aimed not only at recovery, but also at eliminating the causes of the disease. Therefore, the course of treatment is developed depending on the following factors:

duration of the disease;
type of infectious fungus;
location of the outbreak;
level of infection;
the state of the body as a whole;
the possibility of an allergic reaction to any drugs;
age and characteristics of the patient’s body.

Therapeutic therapy is selected by a highly specialized doctor (dermatologist or mycologist). Medications accumulate in the blood and help restore the skin. Most often doctors prescribe Griseofulvin. It is safe and has virtually no side effects. Therefore, it is most often prescribed for treatment in children. The following drugs are no less effective:

"Ketoconazole";
"Itraconazole";
"Fluconazole";
"Terbinafil".

To decide on a drug, you first need to determine the type of fungus. The doctor will then prescribe the most effective medicine.

Doctors can also prescribe broad-spectrum medications. All of them must have an antifungal effect. To avoid side effects, the patient needs to be constantly under the supervision of a doctor. During pregnancy and lactation, women are prohibited from taking antifungal medications. Treatment should be selected very carefully for patients who have liver disease or allergies.

In addition to medications, it is necessary to use ointments, sprays and creams with antifungal components in treatment: Econazole, Miconazole, Oxiconazole. Beneficial substances penetrate to the source of proliferation of infectious bacteria and kill them. Ointments are also selected taking into account the individual characteristics of the patient. Sometimes you need to cover the source of infection with an adhesive bandage. If the infection has spread to vellus hair, it must be removed by hair removal.

After completing the full course of treatment, you need to be tested for the presence of fungus. This will help the doctor determine whether the patient is completely cured of mycosis. If the result is negative, it means the treatment was successful. If the result is positive, the doctor needs to develop a new treatment plan that is more effective. Since skin mycoses can reappear, prevention should be carried out.

Treatment with folk remedies

If a person has symptoms of mycosis of the skin, first of all, you need to go to the hospital for a consultation with a doctor who will diagnose and prescribe a course of treatment. But traditional medicine will help significantly alleviate the condition. They do not guarantee complete recovery, but will only be an auxiliary option. All procedures must be performed at night.

The affected area is washed well with running water. After this, it needs to be treated with a cotton swab with iodine or brilliant green. Damaged areas of the skin can also be treated with herbs - white hellebore or yew, black nightshade or clematis. You can also use ointments based on pork fat, Vaseline and herbs. But when choosing dried flowers, you should definitely consult a doctor.

Plants such as speedwell, licorice, celandine, and duckweed have immunomodulatory properties. Also widely used in folk medicine are mustard, mint, yarrow, hops, dandelion and zoster. Celandine, colchicum, and yew have antifungal properties. The use of folk remedies will help eliminate the unpleasant symptoms of the disease. But you can use them for treatment only with the permission of your attending physician.

Prevention

There is a possibility of recurrence of mycosis of the skin. If a person experiences the first symptoms indicating mycosis, that is, redness and itching, he should immediately visit a medical facility. To avoid becoming infected with fungal spores, preventive measures should be taken, the main thing is to improve hygiene. When visiting the sauna, swimming pool, or public shower, you must wear removable shoes. After this, it is recommended to treat the shoes with salicylic alcohol. It is also worth remembering that in a healthy body, a fungal infection cannot take root, so it is necessary to strengthen your immune system every day.

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