All foot mycoses, as a rule, begin with a squamous form, which initially proceeds in the form of barely noticeable peeling in the interdigital folds of the feet (most often between the III and IV, IV and V toes) and on the soles.
In some cases, in the middle of the interdigital fold there is a small surface crack that does not cause the patient any sensations and is usually not noticed by him. Often only one interdigital fold is affected. Patients during this period do not consult a doctor (worn-out form). Gradually, the process becomes clinically more pronounced. In the interdigital folds and on the contacting surfaces of the fingers, slight maceration of the skin appears, peeling intensifies, which extend to the flexion surface of the fingers and adjacent sections of the sole. Inflammations even during this period remain mild, sometimes there is skin hyperemia, cracks in the folds become more prominent, they are surrounded by a clearly defined border from the exfoliated stratum corneum of the epidermis. In the foci of the lesion, itching of the skin appears.
When localized on the arch of the feet or its lateral surfaces, limited foci of peeling are noted, often in the form of a collar from the exfoliated stratum corneum of the epidermis in the absence of pronounced inflammatory phenomena. When scraping the skin, peeling becomes more prominent. The disease in this form can last for many months and even years. The long-existing erased form of mycosis of the feet can be accompanied by the formation of cracks in the interdigital folds, which are the entrance gate for the penetration of pyogenic, most often streptococcal infection, which leads to the development of recurrent erysipelas of the lower extremities.
Squamous (squamous-hyperkeratotic) form of foot mycosis, caused by T. mentagrophytes var. interdigitale (epidermophytosis of the feet), localized on the soles, including their lateral surfaces; in the thumb and little finger, less often in other areas. The defeat of the soles is often combined with more or less pronounced small-plate peeling in the interdigital folds of the feet, most often in the third and fourth. The squamous form is characterized by the formation on the skin of the soles of one or several rather sharply limited foci of different sizes, most often of irregular outlines. The skin of the affected areas has a pinkish or reddish-cyanotic color, is somewhat infiltrated, covered with grayish-white small-plate, less often large-plate scales. At the beginning, peeling appears on a limited area of \u200b\u200bthe skin and can subsequently spread to the entire sole. Along the edges of the lesions, a bordering border of the exfoliated stratum corneum of the epidermis is formed. Subjective sensations manifest as mild itching.
In some patients, along with squamous changes, limited or common hyperkeratotic layers appear, which are most often localized in the anterior third of the medial and lateral parts of the soles. In such cases, painful cracks may occur.
The course of the disease is long. In some cases, the squamous form becomes dyshidrotic or erased. Both squamous and erased forms of mycosis of the feet caused by T. mentagrophytes var. interdigitale, often combined with onychomycosis.
With foot mycosis due to T. rubrum (rubrophytosis, rubromycosis), the process, as well as with foot mycosis caused by T. interdigitale, begins with damage to the interdigital folds of the feet, first one and then the other leg. Skin damage occurs imperceptibly for the patient, gradually and proceeds usually on a dry, squamous-hyperkeratotic type, without exudative phenomena and secondary allergic rashes. Gradually, inflammation passes to the skin of the plantar surface of the fingers and the skin of the soles. The skin of the soles is painted bluish-red and slightly infiltrated, diffuse hyperkeratosis develops; calluses are often formed. Ample flour-like peeling is characteristic, and the scales accumulate mainly in the skin grooves, which creates a kind of mesh pattern. Due to dry skin on the lateral surfaces of the feet and in the area of \u200b\u200bthe heels painful cracks often form. It is extremely rare that separate small vesicles appear at the edges of the feet. In the interdigital folds, peeling is observed, and all folds are affected. A similar clinical picture is observed with the defeat of the palms and the palmar surface of the fingers. Often develops a fungal infection of the nails, and usually there is multiple onychomycosis both on the feet and on the hands.
Mycosis of the feet caused by T. rubrum, as a rule, is characterized by a slow chronic course, the complete absence of any subjective sensations, with the exception of complaints of some patients about dry skin of the soles and soreness when cracks appear. In general, the disease differs from foot mycosis caused by T. mentagrophytes var. interdigitale, significant dryness of the lesions, the severity of hyperkeratosis and flour-like peeling, a sharp underline of the skin furrows, in which peeling is especially pronounced; the absence of weeping and erosive changes in the interdigital folds. Multiple onychomycosis, which is localized not only on the feet, but also on the hands, is also of differential diagnostic value. Dyshidrotic changes with rubrophyte are rare. Exudative changes in this form of mycosis in the form of vesicles, erosion with a weeping surface can be in children, adolescents and young people. When joining the pyococcal flora, as with mycosis caused by T. mentagrophytes var. interdigitale, there are lymphangitis and lymphadenitis, increased hyperemia, swelling and pain in the lesions.
N.S. POTEKAEV, corresponding member of RAMS, professor, N.N. POTEKAEV, doctor of medical sciences, professor,MMA them. I.M.Sechenova
The term "foot mycosis" is understood to mean mycotic lesions of the skin and nails of the feet of any nature. As a rule, foot mycosis is caused by dermatophytes: trichophytone red (Tr. Rubrum), trichophytone interdigital (Tr. Interdigitale), inguinal epidermophyton (E. floccosum). The frequency of foot damage due to various dermatophytes varies widely: 70-95% of cases occur in Tr. rubrum, from 7 to 34% - on Tr. interdigitale and only 0.5-1.5% - on E. floccosum.
Clinically, lesions proceed the same way. The site of the primary localization of the pathogenic fungus is, with rare exceptions, interdigital folds; with the progression of the mycotic process, the lesion goes beyond them. There are several clinical forms of mycosis of the feet.
Worn out the form (highlighted by L.N. Mashkilleyson) almost always serves as the beginning of mycosis of the feet. The clinical picture is scarce: slight peeling is noted in the interdigital folds (often in one), sometimes small surface cracks. Neither peeling nor cracks give the patient any worries, so the worn-out form is more often detected when the patient is examined by a doctor.
Squamous the form is manifested by peeling, mainly in the interdigital folds and on the lateral surfaces of the soles. Signs of inflammation are usually absent. Occasionally, flushing of the skin, accompanied by itching. The skin of the soles is stagnantly hyperemic and lichenified; diffusely thickened stratum corneum gives it a luster; skin pattern reinforced; the surface is dry, covered (especially in the area of \u200b\u200bthe skin furrows) with small lamellar scales (Fig. 1). The lesion can capture the interdigital folds, fingers, side and back surfaces of the foot; naturally involved in the mycotic process of nails. Subjectively, the patient does not experience any anxiety. It is proposed to designate this form as the classic form of rubrophytosis of the feet.
Hyperkeratotic the form is manifested by dry flat papules and slightly lichenified nummular plaques of bluish-reddish color, usually located on the arches of the feet. The surface of the rashes (especially in the center), is covered with varying thicknesses by layers of grayish-white flakes; their boundaries are sharp; on the periphery - a border of exfoliating epidermis; upon careful examination, you can notice single bubbles. Rashes, merging, form diffuse foci of large sizes, which can spread to the entire sole, lateral and dorsal surfaces of the feet (Fig. 2). When localized on the interdigital folds of eflorescence, they can occupy the lateral and flexion surfaces of the fingers, the epidermis covering them acquires a whitish color. Along with such flaky foci, hyperkeratotic formations are found in the type of limited or diffuse callosity of yellowish color with cracks on the surface. The clinical picture is similar to that of psoriasis, tylotic eczema and horny syphilis. Subjectively, dry skin, moderate itching, and sometimes soreness are noted. Squamous and hyperkeratotic forms are often combined (squamous-hyperkeratotic form).
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| Fig. 1. Squamous form of mycosis of the feet | Fig. 2. Hyperkeratotic form of foot mycosis |
Intertriginous the form of mycosis of the feet is clinically similar to banal diaper rash (lat. intertrigo - "diaper rash"). The interdigital folds between the III and IV, IV and V fingers are more often affected. The skin of the folds is rich red, swollen, weeping and maceration join, often erosion and rather deep and painful cracks (Fig. 3). From the banal diaper rash, intertriginous mycosis is distinguished by rounded outlines, sharp boundaries and a whitish fringe along the periphery of the exfoliating epidermis. The detection of mycelium by microscopic examination of pathological material helps to make a final diagnosis. Subjectively, itching, burning, soreness are noted.
Dyshidrotic the form is manifested by numerous bubbles with a thick tire. Predominant localization - arches of the feet. Rashes can capture large areas of the soles, as well as interdigital folds and skin of the fingers; merging, they form large multi-chamber bubbles, at the opening of which wet erosion of pink-red color occurs. Usually the vesicles are located on unchanged skin; with an increase in inflammatory phenomena, hyperemia and puffiness of the skin join, giving this variety of mycosis of the feet a resemblance to acute dyshidrotic eczema. With the extinction of inflammation in a large focus of dyshidrotic mycosis, 3 zones are formed on the arch of the foot: the central one is represented by smooth skin of pink-red color with a bluish tint and a few thin scales, in the middle zone numerous erosions prevail on the hyperemic and slightly edematous background with the separation of scanty serous fluid, and vesicles and multicameral bubbles predominate on the periphery. Subjectively, itching is noted.
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| Fig. 3. Intertriginous form of foot mycosis | Fig. 4. Atrophic form of onychomycosis |
An indispensable companion of foot mycosis is nail damage (onychomycosis). In domestic mycology, there are 3 types of onychomycosis: normo-, hyper- and atrophic (onycholytic). In the 1st case, only the color of the nails changes (spots and stripes from white to ocher-yellow in color appear in their lateral sections, gradually the entire nail changes color, preserving its luster and unchanged thickness), in the 2nd, the growing subungual hyperkeratosis joins (the nail loses shine, becomes dull, thickens and deforms until the formation of onychogryphosis, partially collapses, especially from the sides; often patients experience pain when walking). The onycholytic type of the disease is characterized by a dull brownish-gray color of the affected part of the nail, its atrophy and rejection from the bed; the exposed area is covered with loose hyperkeratotic layers; the proximal part of the nail remains without significant changes for a long time (Fig. 4).
The classification of onychomycosis adopted abroad is based on the topical criterion - localization of the mycotic process in the nail: distal onychomycosis with pachyonychia or onycholysis; lateral with onycholysis, hypertrophy or the formation of transverse grooves; proximal; total. In addition, white superficial onychomycosis (mycotic leukonichia) is distinguished, characterized by opal-white spots at the back of the nail, and then over its entire surface. Similar onychomycosis is typical for HIV-infected people. Nail damage does not occur simultaneously; different variants of onychomycosis are possible in the same patient (Fig. 5, 6).
Exacerbation of exudative intertriginous or dyshidrotic mycosis of the feet can lead (depending on the type of fungus) to acute epidermophytosis or acute rubrofitia, which can be considered as manifestations of high sensitization to pathogen fungi and interpreted as acute mycosis of the feet. The disease begins with the rapid progression of exudative mycosis, combined with hypertrophic onychomycosis. The skin of the feet and legs becomes saturated hyperemic and sharply edematous; abundant vesicles and blisters with serous and serous-purulent contents appear, the opening of which leads to numerous erosions and erosive surfaces; maceration goes beyond the interdigital folds, complicated by erosion and cracks (Fig. 7). Erythematous-squamous spots and papular vesicular eruptions spread throughout the skin. High body temperature, bilateral inguinal-femoral lymphadenitis, lymphangitis, ulceration are noted; general weakness, headache, malaise, difficulty walking.
Fig. 7. The acute form of mycosis of the feet
The course of mycosis of the feet
Mycosis of the feet is characterized by a chronic course with frequent exacerbations. Exacerbations and exudative clinical manifestations are inherent in patients of young and mature age, the monotonous course of the "dry type" is in elderly and senile patients.
Mycosis of the feet in the elderly is usually a long-term mycotic process (a disease acquired in young years, lasts a lifetime). Soles and interdigital folds are mainly affected; their skin is pinkish-bluish in color, dry, covered with small scales, especially along the furrows. The lesion captures the skin of the fingers, the lateral (often back) surfaces of the feet. In places of pressure and friction with poorly fitting shoes much more often than at a young age, foci of hyperkeratosis with cracks (sometimes deep and painful, especially in the heel and Achilles tendon) arise. With mycosis of the feet in the elderly, especially with rubrophyte, there are multiple lesions of the nails, often proceeding as a total dystrophy. This is due to the fact that 40% of patients with onychomycosis are persons older than 65% of years.
With rubrophyte (pathogen - Tr. Rubrum), the lesion is not always limited to the feet.
Treatment of foot mycosis is often carried out in 2 stages. The purpose of the preparatory phase is the regression of acute inflammation with intertriginous and dyshidrotic forms and the removal of horny layers with squamous-hyperkeratotic. With extensive maceration, profuse weeping and continuous erosive surfaces, warm foot baths from a weak solution of potassium permanganate and lotions from a 2% solution of boric acid are shown. During the bath, carefully (preferably with fingers) to remove the macerated epidermis and crusts. Then, having dried the skin of the feet, a cream is applied to the affected areas (but not ointment!) Containing corticosteroid hormones and antibiotics (exudative mycosis is rich in coccal flora). First shown are Triderm creams (betamethasone dipropionate, clotrimazole, gentamicin), Diprogent (betamethasone dipropionate, gentamicin), Celestoderm B with Garamycin (betamethasone valerate, gentamicin). With the extinction of acute inflammation (rejection of the macerated epidermis, cessation of wetness, epithelization of erosion), foot baths are stopped and the creams listed above are replaced with ointments containing the same components and having the same trade names. In severe inflammation with extensive exudative manifestations, including diffuse swelling of the feet, corticosteroid hormones are prescribed inside. This is especially advisable, in our opinion, in the presence of numerous and common dermatophytids. The most effective diprospan, which has a prolonged effect (betamethasone dipropionate and betamethasone disodium phosphate; intramuscularly at a dose of 1 ml - 1 ampoule). With a patient weighing more than 80 kg, it is preferable to administer a double dose (2 ml). Usually, the severity of inflammation can be stopped with 1-2 injections.
With moderate inflammation (scanty weeping, limited erosion), the need for foot baths disappears; treatment can begin with the use of creams, and then ointments. In old and senile age, the preparatory stage is reduced to the removal of horny layers by various keratolytic agents. So, 5-15% salicylic petrolatum is applied to the soles 1-2 times a day (at night you can under waxed paper) until the horn masses are completely removed. Arievich's detachment is more effective (repeated if necessary): on the soles (in the hospital - for 2 days, and outpatient - at night for 4-5 days), ointment containing salicylic (12.0), milk (6 0) acid and petroleum jelly (82.0). A good effect is obtained by lactic salicylic collodion (lactic and salicylic acid - 10.0 each, collodion - 80.0), which lubricate the soles in the morning and evening for 6-8 days, then apply 5% salicylic petroleum jelly at night under a compress, after what is prescribed foot soap and soda baths; exfoliating epidermis is removed by scraping with pumice. The softening of the thickened (especially with rubrophytia) stratum corneum of the epidermis facilitates the penetration of external antifungal agents into the affected tissues.
At the main stage of treatment of foot mycosis, numerous local antifungals are used (clotrimazole, exoderil, mycospore, nizoral, batrafen, etc.), however, Lamisil ® is the drug of choice. Its active substance (terbinafine) is most effective against the main pathogens of the disease - dermatophytes. Antifungal ointments (creams) are used 2 times a day (lamisil - 1 time), gently rubbing into the affected skin and surrounding areas. The use of local forms of Lamisil® once a day ensures more accurate patient compliance with the doctor’s recommendations. Local treatment is carried out with intact nail plates; in case of involvement in the process of nails, therapy with systemic antimycotics is carried out.
Treatment onychomycosis is associated with certain difficulties, especially in elderly and elderly patients, often burdened with various diseases. From these positions, Lamisil® is shown primarily, which has a very high activity against dermatophytes, good tolerance and minimal risk of side effects.
MAIN CHARACTERISTICS OF THE PRODUCT LAMISIL ®
| Mechanism of action | Fungicidal. The action is carried out by inhibiting the squalene epoxidase enzyme located on the cell membrane of the fungus. This leads to a deficiency of ergosterol and intracellular accumulation of squalene, which leads to the death of the fungus. |
| Action spectrum | Wide. Efficiency against yeast is less than that of azoles (60-70%). Efficiency against molds is comparable with azoles. The effectiveness against dermatophytes is very high and amounts to 80-96%. |
| Safety |
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| Persistence in tissues and organs | In the blood - 12-14 weeks, in the nail plate - 36-48 weeks. When applied topically, it remains at a fungicidal concentration in the stratum corneum of the epidermis for at least another 7-10 days, which reduces the likelihood of recurrence of dermatophytosis. |
| Application in children's practice | Acceptance of oral forms is allowed from 2 years. Experience with the use of local forms in children is insufficient, and therefore their use in children is not recommended. |
| Contraindications | Individual intolerance to the drug |
| Dependence on nutritional factors | The level of the drug in the blood does not depend:
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In addition to the antifungal effect, local forms of Lamisil® have antibacterial and anti-inflammatory effects.
Particular attention should be paid to two forms of the drug: Lamisil® Dermgel, which is quickly absorbed into the skin, does not leave greasy spots, has a cooling and epithelizing effect, and Lamisil® spray, which can be applied without touching the skin affected by a fungal infection.
With onychomycosis of the feet and hands, Lamisil® is used at 250 mg / day for 12 and 6 weeks, respectively. In nails and blood plasma, the drug remains in a therapeutic concentration for a long time after the end of its administration. Mycological cure occurs earlier than clinical, as Lamisil® diffuses into the nail from the nail bed, causing the death of the fungus; Clinical cure for total and proximal onychomycosis requires a complete change of the nail plate, which takes 12-18 months on the legs and up to 6 months on the hands. Mycological cure immediately at the end of the course of Lamisil® is noted in 80% of cases, and after 6 months the effect, gradually increasing, reaches 94%.
In the treatment of dermatophytosis of the skin (limited options) without nail damage, Lamisil® take 1 tablet per day for 2 weeks. Lamisil® preparations for external use (cream, Dermgel, spray) are applied to the lesions once a day for 7 days, which provides a therapeutic effect. When skin dermatophytosis is generalized and long hair is damaged (which, however, is rare in the absence of nail damage), Lamisil® oral administration of 250 mg / day is required for at least 4 weeks. In an effort to achieve a 100% cure for onychomycosis, we compiled a therapeutic program based on the results of studies published in recent years, as well as our own many years of experience in the treatment of dermatophytosis and, in particular, onychomycosis. The proposed tactics include the following:
- the diagnosis of onychomycosis should be confirmed microscopically;
- it is necessary to carefully collect an allergic history relating to drug and nutritional tolerance;
- perform a general clinical and biochemical blood test;
- limit the intake of drugs, with the exception of vital;
- adhere to a hypoallergenic diet;
- exclude foods that cause flatulence from food;
- treat with Lamisil® at 250 mg / day for 12 weeks with onychomycosis of the feet and 6 weeks with onychomycosis of the hands (additional use of keratolytic agents is possible);
- to carry out clinical control in the form of examination of the patient: the 1st time - after 2 weeks, then 1 time per month;
- microscopy - 6 months after the end of treatment; if pathogenic fungal mycelia is detected, surgical removal of the affected nails and a second course of Lamisil® are necessary.
- selection of comfortable shoes.
Such tactics can enhance the therapeutic effect of Lamisil®, reduce its side effects, timely identify possible deviations in the patient’s condition and in all cases achieve success.
LITERATURE
1. Rukavishnikova V.M. Mycosis of the feet. - M: MSD. - 1999. - 317 p.2. Rakhmanov V.Α., Potekaev N.S., Ivanov O.L. Modern aspects of the clinic and treatment of rubrophyte // Cov. medicine. - 1966. - No. 11. - S.117-122.
3. Rakhmanov V.Α., Potekaev N.S., Ivanov O.L. Acute rubrophytia is a new clinical variant of rubrophytia. Materials of the II conference of dermatovenereologists of Kuzbass. - Novokuznetsk, 1966.
4. Fitzpatrick T., Johnson R., Wolf K. et al. Dermatology. with. 700. "Practice", 1999, 1044.
5. Drake Lynn A., Shear Richard. Onychomycosis: a significant and important disease. Proceedings of the II International Symposium on Onychomycosis, Florence. - 1995. - P.3-6.
6. Roberts D.T. The clinical efficacy of terbinafine in the treatment of fungal infections of the nails // Rev. in Contemporasy Pharmacoth. - 1997; 8, LAS 787: 299-312.
Mycosis is the common name for all types of fungal infections. The most common types of foot fungus are dermatomycosis and onychomycosis. The first means skin damage, in the second case, microorganisms penetrate under the nail. Other classifications of fungi are distinguished by the causative agent of the disease and the main symptoms.
Views
The type of fungus on the legs depends primarily on the causative agent of the disease. Pathogenic microorganisms are divided into several types: mold, yeast, dermatophytes. They lead to the most common types of lesions:
- rubrophytes;
- epidermophytosis;
- candidiasis of the feet;
- onychomycosis.
Pathologies are combined under the general name "rubromycosis", which means damage to the feet. Also, the disease is divided into several groups according to clinical manifestations: membrane, moccasin-like, vesicular types.
Rubrofitiya
The disease has a second name - rubromycosis. It is characterized by blood vessel overcrowding, dryness and peeling. Pathology develops gradually and imperceptibly for the carrier of infection.
The first signs of itching and burning manifest themselves in the later stages of the disease. At the same stage, nail damage occurs.
External signs of the disease: blisters, crusts, plaques and pustules covering the entire area of \u200b\u200bthe sole. If there are too many bubbles and plaques, a person experiences pain when walking.
In the treatment of foot fungus, the type of disease plays a key role. Rubrophytia treatment is prescribed after microscopy and examination of the clinical picture.
Foci of lesion are eliminated with the help of keratolytic (exfoliating) drugs. These include salicylic acid ointments and creams. Therapy is supplemented by antifungal agents, which include: Ketoconazole, Nizoral, Mycosolone, Triderm.
In severe forms of the disease, tablet forms of medication are prescribed. Nail damage is treated by their removal using emollients:,.
This type of mycosis is highly contagious. To “pick up” the fungus, it is enough to use things that the carrier of the infection has touched. If you have excessive sweating, damage to the feet or a weakened immune system, the likelihood of getting sick increases many times.
The causative agent is Tr. mentagrophytesvar. It penetrates the horny or granular layer of the skin, spreads and causes severe allergic and other reactions:
- rash of bubbles with a dense crust;
- the appearance of edema, pustules;
- maceration (skin erosion);
- the spread of painful cracks, scales, crusts;
- yellowing and deformation of nails;
- severe itching, burning, soreness when walking.
When diagnosing the disease, the doctor studies the clinical picture and external signs. Clinical studies, for example, microscopic examination of a scraper, are used if the pathogen is in doubt.
In the acute form of the disease, silver nitrate 0.25%, resorcinol 1% and calcium 10% are prescribed. Allergic reactions are eliminated by antihistamine drugs: Diazolin, Suprastin, Diphenhydramine.
Diazolin Suprastin
This type of fungus is an order of magnitude less common than rubromycosis or epidermophytosis. The pathology is caused by fungi of the genus Candida.
Microorganisms of this type are present in the body of each person, but are considered conditionally pathogenic. This means that in small quantities they do not pose a threat, but when reproduced they cause unpleasant symptoms and consequences for the body. The latter occurs under the influence of factors leading to a decrease in immunity: hypothermia, frequent stress, overwork, etc.
External factors include:
- frequent maceration of the skin (separation of skin layers from each other with prolonged contact with water);
- injuries sustained in everyday life or at work;
- wearing uncomfortable shoes, especially in summer (in hot climates).
Candidiasis of the feet is vesicular-pustular or hyperkeratotic. In the first case, the disease manifests itself as hyperemia (overflow of blood vessels), maceration and severe swelling. The skin in the affected area is covered with pustules and small flat vesicles. As soon as inflammatory processes die away, peeling appears.
The hyperkeratotic form of candidiasis is characterized by a thickening of the stratum corneum of the dermis. On it appear wide peeling furrows of a brownish color. Diagnosis of such a disease is carried out with exfoliation - fungi of the genus Candida are detected in detached scales.
Treatment is prescribed by a doctor after an accurate diagnosis. Medicines are prescribed individually. As a rule, these are systemic and local medicines:,.
Fluconazole Itraconazole
Pathology in which fungal infection of the nail plate occurs. Infection is possible in public pools, saunas, showers. Pathology is no less infectious than skin mycosis.
Flakes with microorganisms are easily separated from the nails, get on carpets, floors, bedding and unpainted benches. In conditions of high humidity, they not only survive, but actively multiply, which increases the risk of infection.
Initially, the infection gets on the skin of the feet, causing severe itching. A person begins to comb the affected area in the hope of easing the discomfort, but only exacerbates the situation.
The skin affected by the fungus is covered with small cracks, scratches, and microorganisms spread and penetrate under the nail, where they actively multiply.
The risk of getting sick increases with nail injuries, poor blood supply, and serious illnesses (HIV, diabetes mellitus).
Onychomycosis is divided into 3 types:
- Normotrophic. The color of the nail changes from normal to yellowish brown. Thickness, shape and natural luster remain the same.
- Hypertrophic. The nail plate finally changes color. The shine disappears, the shape of the nail becomes irregular, there is a thickening, partial destruction. With this type of onychomycosis, it becomes very painful to move around, especially in uncomfortable shoes.
- Onycholytic. The affected nail becomes brown, thinned, and gradually begins to separate from the bed. The open part of the nail bed is covered with uneven layers.
Treatment with local antifungal agents for onychomycosis is ineffective, since the spores of the fungi are hidden under the nail. Before treatment, it must be removed. This is done with the help of keratolytic drugs and plasters.
In some cases, it is possible to remove the affected nail mechanically - the dead parts of the nail are cut off with nippers or a nail file. Please note that instruments must be sterile.
The combination of keratolytic patches and mechanical removal is the most effective way to get rid of a diseased nail plate. As a keratolytic agent, the ready-made Mycospore kit is suitable, which contains a special ointment, patch and nail files for scraping. After removal of the nail, systemic antimycotics are prescribed:, Itraconazole,.
One of the most frequent and most unpleasant types of this pathology. Often occurs in the warm season, begins with an interval between 3 and 4 fingers. Later, the infection goes beyond this area and affects the remaining interdigital zones.
In the crease between the fingers there is a crack, sore or funnel surrounded by flaky greenish skin or diaper rash. The damage is wet, in some cases purulent contents are released from it.
With the erased type of fungus, peeling becomes pronounced flour-like, the surface of the finger as if sprinkled with flour. This impression is created due to the many affected scales that have separated from the skin. Itching is present, but does not cause severe discomfort.
The advanced form of the disease is characterized by:
- pronounced yellowing;
- horny seal resembling corns;
- strong coarsening, multiple cracks;
- stratification of nails.
In more rare cases (about 8% of patients), a “wet” type of disease develops - an exudative fungus. It differs in rashes of vesicles - bubbles filled with liquid.
Complex therapy includes local remedies:,. Nails are treated with Loceryl, Batrafen,. In advanced cases, systemic drugs are prescribed: Lamisil, Fluconazole, Terbinafine. Drugs are taken until the fungus completely disappears.
Squamosis is the penetration of pathogenic microorganisms into the outer skin cells. Hyperkeratosis is a seal of the dermis due to the formation of a stratum corneum. For this reason, in the squamous-hyperkeratotic form of mycosis, there are 2 more names: “athlete's foot” and “moccasin fungus”.
With the squamous-hyperkeratotic type of mycosis, the following symptoms are observed:
- the sole of the foot is covered with a thick keratinized layer of skin, which makes it appear that moccasins are worn on the leg;
- the sole is so coarse that it is covered with thick and wide corns;
- calluses are covered with painful cracks;
- the pattern on the skin is visible to the naked eye, and peeling becomes flour-like;
- itching becomes almost unbearable;
- nails become thinner over time, break, crumble.
When treating a moccasin fungus, it is important first of all to get rid of the stratum corneum. This is done with the help of soap and soda baths, ichthyol ointment, salicylic compresses, wraps. For this purpose, salicylic ointment (up to 10%), creams with petroleum jelly or ointments with lactic acid are used.
If you cannot cope with this task at home, contact the podology center. Using a hardware pedicure, experts gently remove the keratinized dermis.
Further treatment depends on the pathogen and is prescribed after an accurate diagnosis. It is not recommended to do this without removing dead skin - the components of the medicine will not be able to reach the lesion, which will nullify all efforts in the treatment of mycosis.
In another way, a vesicular fungus is the most rare type of disease. The main symptom is numerous vesicles that combine into conglomerates. These are bubbles filled with fluid or pus.
When their fluid begins to cloud, the vesicles burst, leaving ulcers. The latter merge into one line and form pronounced scars on the skin. This happens due to the fact that the skin dries and exfoliates.
In 70% of cases, people with a vesicular fungus have allergic rashes. Various viruses and bacteria penetrate into ulcers, due to which the disease becomes mixed and it becomes much more difficult to determine the initial pathogen. For this reason, a doctor should be visited at the first sign of illness.
Treatment should be started immediately. Before treating the feet with antimycotic drugs, you need to remove the acute process. It is better to entrust this task to a specialist: the doctor will carefully pierce the vesicles, treat the remaining ulcers with boric acid (2%) and smear it with methylene blue or brilliant green solution.
When the disease is neglected, corticosteroid ointments are prescribed. When the inflammatory process is removed, local antimycotic drugs are prescribed to suppress the causative agent of the disease.
Worn out form
This type of mycosis is almost imperceptible and is marked by minimal symptoms. This is a flaky peeling, microcracks in the interdigital zones, slight burning, itching. If you do not consult a doctor at the first sign of an erased fungus, the pathology goes into another form - onychomycosis. This type of lesion is much more difficult to treat, and the exfoliated nail grows from a month to six months.
Treatment is carried out with the help of local preparations: ointments, creams, foam. With their help, a layer is created on the foot that protects against infection with new infections.
Systemic therapy is prescribed in extreme cases. The fact is that such drugs are toxic and have a negative effect on internal organs, in particular, on the liver. If a local remedy copes with the lesion, you do not need to take pills.
To prevent the disease, follow the simplest preventive measures. Use only personal belongings, clean your nails with sterile tools and visit public places (showers, pools, beaches) in shales. Make sure your shoes are comfortable to wear, allow your feet to breathe and always stay clean.
The term mycosis of the feet unites a whole group of diseases, the causative agents of which are hyphomycetes, as well as yeast and mold fungi (less often).
Mycosis of the feet - types of disease:
- Epidermophytosis of the feet. A type that is characterized as mycosis of the skin of the feet and hands. It has 4 forms that can occur together and affect other parts of the smooth skin of the body.
- Rubrophytia. The most common type is mycosis of the feet and nails. Almost no painful symptoms or signs that cause discomfort. It is determined solely by external manifestations.
- Inguinal epidermophytosis. It is localized in the inguinal folds, eventually spreading to the inner surface of the thighs and buttocks.
Existing forms:
Epidermophytosis:
- Intertriginous.
- Squamous-hyperkeratotic.
- Dyshidrotic.
- Erased.
Rubrophytia:
- Normotrophic.
- Hypertrophic.
- Onycholytic.
Mycosis of the feet - symptoms
Common clinical signs of the disease:
- cracks and itchy vesicles appear on the affected skin;
- coarsening of the upper skin occurs;
- diaper rash appears;
- damaged skin becomes softer over time and exfoliates with large scales.
Symptoms of intertriginous form of foot mycosis:
- cracks and peeling of the skin of the feet;
- itching and burning of the soles;
- vesicles are often filled with pus due to infection and ulcers remain after opening.
Symptoms of squamous-hyperkeratotic form of foot mycosis:
- strong coarsening of the entire surface of the sole of the foot;
- deep cracks on or near the heels;
- defeat of both feet at the same time.
Signs of a dyshidrotic form:
- severely itchy watery vesicles appear on the skin, which then merge;
- after opening the rashes, extensive ulcers (skin erosion) occur;
- mycosis also occurs on the hands.
Signs of the erased form of mycosis of the feet:
- minor microcracks between the toes;
- flaky peeling of the epidermis on the soles of the feet.
This type of disease has so poorly expressed symptoms that it often goes unnoticed for a long time.
Inguinal epidermophytosis
Symptoms of this type of foot mycosis are identical to the common clinical prognosis of the entire group of diseases.
RubrofitiyaNormotrophic the form manifests itself as a change in the color of the nails to yellow.
Hypertrophic the form is characterized by a thickening of the nail platins and their acquisition of a dark gray color.
Onicholithic the form causes not only a change in the color of the nail, but also its significant deformation with subsequent rejection.
How to treat foot mycosis?
Mycosis of the feet - treatment with folk remedies:
- At night, apply a gauze bandage soaked in novocaine to the affected areas.
- Make baths of strong coffee (15-20 minutes in the evening).
- Lubricate affected skin with propolis alcohol tincture.
- Wipe painful areas with onion juice.
- Make fir oil compresses (30 minutes).
Traditional medicine
Mycosis of the feet in any form requires treatment, which is carried out in two stages: preparatory and local main.
During the preparatory phase, dead cells of the affected epidermis with fungal spores are removed. In addition, with the help of special tools, possible infections are eliminated and inflammatory processes are stopped. Sometimes, with a significant destruction of the nail plates, they have to be mechanically removed.
The main stage of treatment for foot mycosis is the application and internal administration of antimycotic drugs. Complex medicines are used - ointment or cream for foot mycosis (Kanespor, Mikospor).
O. L. Ivanov, A. N. Lvov
"Reference dermatologist"
STOP EPIDERMOPHYTHIA - dermatomycosis caused by Trichophyton mcntagrophytes var. interdigitale. Epidermophytosis of the feet is the most typical variant of mycosis of this localization.
There are five main forms:
- erased
- squamous-hyperkeratotic,
- intertriginous,
- dyshidrotic
- epidermophytosis of nails.
Worn out form almost always serves as the beginning of the epidermophytosis of the feet.
The clinical picture is scarce: slight peeling is noted in the interdigital folds (often only in one) or on the soles, sometimes with the presence of small surface cracks.
Squamous hyperkeratotic the form of epidermophytosis is manifested by dry flat papules and slightly lichenified nummular plaques of bluish-reddish color, located on the arches and lateral surfaces of the feet.
The surface of the rashes, especially in the center, is covered with varying thicknesses by layers of grayish-white flakes; their boundaries are sharp, on the periphery there is a border of exfoliating epidermis: upon careful examination, single bubbles can be seen.
When localized in the interdigital folds, rashes can occupy the lateral and flexion surfaces of the fingers, the epidermis covering them acquires a whitish color. Along with such flaky foci, hyperkeratotic formations are found in the type of limited or diffuse callosity of a yellowish color, often with cracks on the surface.
The clinical picture of the squamous-hyperkeratotic form of epidermophytosis can be very similar to:
- horny syphilis.
Subjectively, dry skin, moderate itching, and sometimes soreness are noted.
Intertriginous form epidermophytosis is clinically similar to banal diaper rash.
The interdigital folds are affected, more often between the III and IV, IV and V fingers. It is characterized by rich redness, swelling, weeping and maceration, erosions and cracks, quite deep and painful, often join.
Intertriginous form of epidermophytosis from banal diaper rash is distinguished by:
- rounded shape
- sharp boundaries
- whitish fringe on the periphery of the exfoliating epidermis.
These signs make it possible to suspect the mycotic nature of the disease; detection of mycelium by microscopy of pathological material helps to make a final diagnosis.
Subjectively, itching, burning, soreness are noted.
Dyshidrotic form epidermophytosis manifests itself in numerous vesicles with a thick tire.
Predominant localization - arches of the feet. Rashes can capture large areas of the soles, as well as interdigital folds and skin of the fingers; merging, they form large multi-chamber bubbles, at the opening of which wet erosion of pink-red color occurs.
Usually the vesicles are located on unchanged skin; with an increase in inflammatory phenomena, hyperemia and swelling of the skin join, which makes this type of epidermophytosis similar to acute dyshidrotic eczema. Subjectively, itching is noted.
Damage to nails (usually I and V fingers) occurs in approximately 20-30% of patients. In the thickness of the nail, as a rule, from the free edge, yellowish spots and stripes appear; slowly increasing in size, they can eventually spread to the entire nail. The configuration of the nail does not change for a long time, however, over the years, due to slowly growing subungual hyperkeratosis, the nail thickens, deforms and crumbles, becoming as if pitted in the distal part; sometimes separated from the bed.
Epidermophytosis of the feet, especially dyshidrotic and intertriginous, is often (in about 60% of cases) accompanied by allergic rashes, called epidermophytids . They can be regional, located near the foci of epidermophytosis, distant, affecting mainly kisgi, and generalized, occupying vast areas of the skin. Epidermophytids are symmetrical and polymorphic: erythematous and hemorrhagic spots, papules and, most often, vesicles, especially on the palms and fingers of hands.
The manifestation of high sensitization to interdigital trichophyton can be considered acute epidermophytosis of Podvysotskaya . This form is characterized by hyperemia and swelling of the skin of the feet, especially the fingers, an abundance of vesiculobullous rashes, the opening of which leads to weeping erosion and erosive surfaces, maceration of the interdigital folds; changes in the feet are accompanied by inguinal lymphadenitis, generalized epidermophytids, fever, headache. Subjectively, general weakness, malaise, difficulty walking are noted.
Treatment, prevention epidermophytosis - see. Mycoses of feet.
Back to the list of articles about skin diseases
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O. L. Ivanov, A. N. Lvov
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Department of Dermatovenereology, St. Petersburg State Medical Academy
