Mycosis of the feet(dermatophytosis, ,Tinea pedis) - a disease of the skin of the feet, caused by pathogenic or opportunistic fungi. Changes in the skin on the feet are characterized by peeling, which is accompanied by itching. With severe lesions on the background of red and edematous skin, erosions appear, deep cracks on the soles and in the interdigital spaces, which are accompanied by pain and make walking difficult.
The code for the International Classification of Diseases 10th revision (ICD-10) is B35. 3.
The advent of modern antifungal drugs has made it possible to improve the epidemiological situation, but mycosis of the feet still remains one of the most significant problems in dermatovenereology. The use of some drugs is limited in the elderly and patients with chronic diseases.
Prevalence of foot mycosis.According to the World Health Organization (WHO), about 1/3 of the world's population suffers from fungal diseases, the most common of which are mycoses of the feet, and the incidence is growing every year.
According to dermatologists, 10-20% of the adult population suffers from athlete's foot, in men the disease occurs 2 times more often than in women, in older people more often than in young people. At the age over 70 years, foot mycosis is recorded in every other patient, which is associated with an increase in accompanying metabolic and vascular changes (diabetes mellitus, varicose veins, etc. ). Mycoses of the feet are increasingly being detected in children.
Millions of people are currently affected by this disease. Workers of numerous professions are endangered: miners, athletes and military personnel.
Causes of athlete's foot.The most common causes of athlete's foot are dermatomycete fungi: Trichophyton rubrum (90%), Trichophyton mentagrophytes, rarely Epidermophyton. Sometimes fungal infections of the feet can be caused by fungi of the genus Candida.
Risk factors for athlete's foot:
- Exogenous (external): microtraumas of the skin of the feet (blisters, corns), cracks, excessive sweating, wearing tight shoes, shoes made of artificial materials, non-compliance with the rules of personal hygiene, irregular foot washing and poor towel drying.
- Endogenous (internal): varicose veins and vascular dystonia, which lead to insufficient blood supply to the skin of the feet; hypovitaminosis; taking glucocorticosteroids, cytostatics, antibacterial and estrogen-progestational drugs, which reduce the body's general immunity.
Mycosis infection of the feet can occur directly from a sick person, and can also be transmitted through contact and home (in the pool, bathroom, gym, shoes, towels, mats, etc. ).
If you find similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!
Symptoms of athlete's foot
The main symptoms of athlete's foot:
- small cracks;
- keratinization of the skin;
- unpleasant and pungent odor;
- tingling, painful sensations.
The first signs of mycosis of the feet appear in the form of itching and tingling in the interdigital folds of the feet, the skin begins to peel, crack, redden, and signs of edema and inflammation appear. Complications such as diaper rash and skin eczema can develop.
Types of mycosis of the feet:
- deleted - manifested by moderate itching and hyperemia (redness) of the skin;
- acute - accompanied by severe itching and skin lesions in the form of cracks;
- nail mycosis (onychomycosis) - manifested by damage to the nail plates, which become thicker and change color;
- deformed - weeping areas are formed;
- squamous - lamellar scales appear;
- hyperkeratotic - accompanied by a rash in the form of papules and plaques on the arches of the feet;
- Dyshydrotic - continues to develop bloating, tearful areas and blisters.
Pathogenesis of foot mycosis
The skin is the largest organ in the human body and makes up 15% of the total body weight. It performs many functions, above all, protects the body from the action of external factors of physical, chemical and biological nature, from water loss, and also participates in thermoregulation. The skin consists of three layers: epidermis, dermis and subcutaneous adipose tissue.
The epidermis (outer layer of the skin) is the main obstacle to the penetration of fungi into the skin. It is a stratified squamous keratinizing epithelium, which in turn consists of five layers and performs a barrier function. Keratinocytes are the main cells of the epidermis. They contain the protein keratin, which forms the outer layer of the skin and gives it elasticity and strength. Keratinized epidermal cells are constantly peeling.
Dermatomycetes produce enzymes called keratinases, which break down keratin. As a result, fungi penetrate the surface layers of the skin, where they continue to exist in the future. The cell wall of dermatomycetes contains mannan - substances that can suppress local cellular immunity. The fungus T. rubrum prevents the multiplication of keratinocytes by the action of manna, which slows down the peeling of horny scales from the surface of the skin and develops a chronic course of infection.
Classification and stages of development of foot mycosis
- Keratomycosis (pityriasis versicolor).
- Dermatophytosis (microsporia, superficial trichophytosis, mycosis of the feet, mycosis of smooth skin, mycosis of the inguinal folds, onychomycosis).
- Candidiasis (candidiasis of the skin, nails).
- Deep mycoses (blastomycosis, sporotrichosis, chromomycosis).
Classification according to ICD-10:
- B35. 1 - Mycosis of the nail.
- B35. 2 - Mycosis of the hand.
- B35. 3 - Mycosis of the feet.
- B37. 2 - Candidiasis of the skin and nails.
- Mycosis of the skin.
- Mycosis folds.
- Mycosis of the hand.
- Mycosis of the feet (squamous, hyperkeratotic, intertriginous, dyshydrotic form).
- Onychomycosis (distal, superficial, proximal).
- Deleted formit is manifested by desquamation in III - IV interdigital folds of the feet. Slight peeling can also be found on the soles and side surfaces of the feet.
- Intertriginous formmanifested by hyperemia in the interdigital folds of the feet, the appearance of bubbles that cause the formation of erosions and cracks is also possible. Itching and burning are subjectively noticed.
- With a dyshydrotic formgrouped bubbles appear on the skin of the arches and lateral surfaces of the feet. They most often appear on healthy skin, then enlarge, merge and form larger multi-chamber bubbles. When the bubbles open, erosion occurs.
- Squamous-hyperkeratotic formcharacterized by local or widespread thickening of the stratum cornea of the lateral and plantar surfaces of the foot. The affected areas of the skin are covered with tiny scales of pityriasis. Peeling is especially noticeable in skin folds. Cracks cause pain when walking.
The clinical classification is very convenient from a practical point of view for determining further treatment tactics and monitoring the patient.
The cause of the disease can be judged on the basis of the clinical picture of the disease. For example, the dyshidrotic form often occurs in foot mycoses caused by Trichophyton mentagrophytes var. interdigitale, the squamous-hyperkeratotic form is more often associated with T. rubrum, the chronic course and widespread process are characteristic of opportunistic Candida spp. and Aspergillus.
Complications of foot mycosis
- Fungal allergy.Under the influence of fungi, polyvalent sensitization occurs, ie the organism becomes more sensitive to waste products of fungi, which are foreign to us and are strong allergens. The body reacts more sharply, which is manifested by various skin rashes and reactions, chronic diseases of allergic nature, for example, skin eczema. The development or worsening of the course of pathologies such as bronchial asthma, allergic dermatitis, seborrheic dermatitis and psoriasis is possible. In addition, a person is more likely to develop occupational allergic complications and drug intolerance.
- Pyoderma- pustular skin diseases (cellulitis, lymphangitis, phlegmon and osteomyelitis of the bones of the feet), which can lead to deep, long-lasting wounds on the skin. Pyoderma occurs due to the fact that bacteria easily penetrate through erosions and cracks on the skin ("door of infection"). At the same time the temperature increases, weakness appears, weakness, which requires urgent surgical correction.
- Increasing the number of viral complicationsin the form of warts due to the presence of hyperkeratosis and cracks. The reason is the violation of the protective function of the skin, due to which it becomes more susceptible to any infection, including viral.
- General decrease in immunityand impaired microcirculation in the lower extremities in patients with concomitant somatic diseases such as diabetes mellitus and varicose veins.
- Spread of the disease to the nails and skin of the hands.In the case of nail fungi, their deformation occurs, the appearance of an ingrown nail, panaritium (purulent inflammation of the finger tissue), paronychia (inflammation of the periungual fold) and complete separation of the nail plates are possible.
- Deterioration of quality of life.Acute forms of mycoses of the feet are painful, make it difficult to wear shoes, and the development of lymphadenitis is accompanied by poor general health and fever.
Diagnosis of foot mycosis
The diagnosis of foot mycosis is made on the basis of patient complaints, anamnesis data, clinical picture and laboratory results. Mycoses of the feet are among those diseases that necessarily require laboratory research to confirm the clinical diagnosis.
The main method of confirming the diagnosis of foot mycosis is microscopic examination and culture. The material is leather scales, which are scraped from the lesion on the skin with a scalpel or glass, less often a test strip is used.
Laboratory diagnosticsmycosis involves microscopic and cultural examination of the material for fungi.Microscopic examination- This is an express method for diagnosing pathogens, which allows you to identify the structure of the fungus within a few hours. Microscopic examination can reveal elements of the fungus in the form of filaments of mycelium and spores. The disadvantage of this method is that it is possible to obtain both false positive and false negative results, which depends on many factors: the technique of taking the material, the characteristics of storage and transport, etc.
Cultural methodis the most accurate diagnostic method that allows you to identify the type of fungus for naming pathogenetic therapy. To prepare for the analysis, the patient is not recommended to use any antifungal agents on their own within 1 month.
When prescribing systemic antifungal therapy, it is recommended thatbiochemical blood testto determine bilirubin, AST and ALT levels in relation to the need to control liver and biliary tract function, as well as to prevent possible complications.
Differential diagnosis of athlete's foot:
- The squamous form differs from psoriasis, eczema, keratoderma.
- The interdigital form differs from impetigo, diaper rash and candidiasis.
- The dihydrotic form differs from palmar-plantar pustulosis.
Treatment of athlete's foot
Treatment should be carried out under the supervision of a dermatologist.
The primary task in the fight against athlete's foot is its timely detection, recognition and treatment before the development of nail fungus, which requires a longer and more complex therapy (systemic antifungal therapy). At the same time, it is important to have effective medications that correspond to the modern clinical characteristics of foot mycosis.
Before starting treatment for the disease, the dermatologist chooses between possible treatment options. In most cases, local preparations are prescribed. Treatment is based on the use of antifungal drugs that have multiple effects. Blood circulation stimulants are also used, and medications are used to relieve the main symptoms:
- Antifungal agents for external therapy: applied externally 1-2 times a day for 4 weeks.
- In case of significant hyperkeratosis of the feet, peeling therapy is previously performed: a drug from the group of azole derivatives, once a day for 3-4 days, which has a keratolytic effect, ie removes the rough layer, which prepares the skin and improves the penetration of antifungal agents into the dermis. . .
- In the presence of bubbles, Castellani liquid is used, the solution is applied externally 1-2 times a day for 2-3 days. Then the combined preparations are prescribed 2 times a day outside for 7-10 days.
- In severe itching, antihistamines are prescribed: H histamine blocker1-receptors - ethanolamine derivative 0, 001 g 2 times a day orally for 10-15 days.
- You can use foot disinfectant once a month until complete healing with a spray, whose active ingredient is undecylenamidopropyltrimonium metosulfate.
- In case of damage to the nail plates, systemic antifungal therapy is prescribed orally for 3 to 4 months. This therapy requires the supervision of a dermatologist, because self-medication can lead to complications from internal organs, primarily the liver, bile ducts, stomach, as well as to the ineffectiveness of therapy and the formation of resistance to treatment.
It is necessary to treat mycosis of the feet, because if the fungus has settled in the skin, then without treatment it will not go anywhere, which means that waste products of the fungus will enter the surrounding tissues and blood all the time, causing sensitization and development of chronic allergic diseases.
The presence of the fungus indicates a decrease in immunity, and the skin damaged by mycosis practically does not perform a protective function. This creates all the conditions for adding the accompanying bacterial infection.
A patient with mycosis of the feet is an active source of infection for the surrounding people, and especially for family members, so treatment in this case is an effective means of preventing fungal infection in healthy relatives and people around them.
A moist environment is a favorable environment for the development of a fungal infection on the skin of the feet, so you must make sure that the skin of the feet is always dry. To do this, wash your feet every night with soap and dry the skin with a disposable paper towel, paying special attention to the space between the toes.
The prognosis for cutaneous mycoses largely depends on the stage of the disease in which treatment is initiated. Therefore, once you have noticed changes in the skin, you should not delay a visit to the doctor. With timely and proper treatment of foot mycosisforecastfavorable: there is a complete recovery from the fungal infection, the patient recovers.
If left untreated, the fungus can lead to complications that not only deform the shape of the nail, but also affect the condition of the body as a whole.
- Public prevention includes the treatment of public places: baths, saunas, swimming pools, showers. Floors, inventory and household items should be disinfected. Staff and those who often visit public baths, saunas, etc. they should undergo regular preventive examinations.
Primary personal prevention:
- adhere to the rules of personal hygiene when visiting public places;
- avoid damage and constant moisture to the skin and toenails;
- wear loose, comfortable shoes;
- avoid contact with infected people.
Secondary personal prevention:
- adhere to the hygienic regime of the skin of the feet;
- disinfect shoes, showers and bathrooms;
- improve immunity.