Mycosis of the feet: symptoms and treatment.

Mycoses of the feet(dermatophytosis,Tinea pedis) is a skin disease of the feet caused by pathogenic or opportunistic fungi.Changes in the skin of the feet are characterized by peeling, which is accompanied by itching.In case of serious injuries, against a background of reddened and swollen skin, deep erosions and cracks appear on the soles of the feet and in the spaces between the toes, which are accompanied by pain and make walking difficult.

The code according to the International Classification of Diseases, tenth revision (ICD-10) is B35.3.

The emergence of modern antifungal drugs has improved the epidemiological situation, but mycosis of the feet remains one of the most important problems in dermatovenerology.The use of some drugs is limited in older people and patients with chronic diseases.

Prevalence of mycosis of the feet.According to the World Health Organization (WHO), approximately 1/3 of the world's population suffers from fungal diseases, of which the most common are mycoses of the feet;The incidence grows every year.

According to dermatologists, between 10 and 20% of the adult population suffers from foot mycosis;In men, the disease occurs 2 times more often than in women, and in older people more often than in young people.From the age of 70, mycosis of the feet is recorded in one out of every two patients, which is associated with an increase in concomitant metabolic and vascular changes (diabetes mellitus, varicose veins, etc.).Mycoses of the feet are increasingly being detected in children.

Currently millions of people are affected by this disease.Workers from various professions are at risk: miners, athletes and soldiers.

Causes of mycosis of the feet.The most common causes of foot mycoses are dermatomycete fungi: Trichophyton rubrum (90%), Trichophyton mentagrophytes and, less frequently, Epidermophyton.Sometimes mycosis of the feet can be caused by fungi of the genus Candida.

Risk factors for foot mycosis:

• Exogenous (external): microtrauma to the skin of the feet (corns, calluses), cracks, increased sweating, wearing tight shoes, shoes made of artificial materials, non-compliance with the rules of personal hygiene, irregular washing of the feet and poor drying with a towel.
• Endogenous (internal) - varicose veins and vegetative-vascular dystonia, causing insufficient blood supply to the skin of the feet;hypovitaminosis;taking glucocorticosteroids, cytostatic, antibacterial and estrogen-progestin drugs, which reduce the general immunity of the body.

Mycosis infection of the feet can occur directly from a sick person, and can also be transmitted through contact and household contact (in a swimming pool, bathhouse, gym, through shoes, towels, carpets, etc.).

If you notice similar symptoms, see your doctor.Do not self-medicate, it is dangerous for your health!

Symptoms of mycosis of the feet.

The main symptoms of foot mycosis:

• itch;
• small cracks;
• erythema;
• peeling;
• bubbles;
• keratinization of the skin;
• unpleasant, pungent odor;
• Burning and painful sensations.

The first signs of mycosis of the feet appear in the form of itching and burning in the interdigital folds of the feet, the skin begins to peel, crack, turn red, and signs of swelling and inflammation appear.Complications may develop in the form of diaper rash and skin eczema.

Types of foot mycosis:

• erasure - manifested by moderate itching and hyperemia (redness) of the skin;
• acute - accompanied by intense itching and damage to the skin in the form of cracks;
• nail mycosis (onychomycosis) - manifested by damage to the nail plates, which become thick and change color;

• diaper-like: crying areas are formed;
• scaly: lamellar scales appear;
• hyperkeratotic - accompanied by rashes in the form of papules and plaques on the arches of the feet;
• Dyshidrotic - occurs with the development of swelling, weeping areas and blisters.

Pathogenesis of mycosis of the feet.

The skin is the largest organ in the human body and represents 15% of the total body weight.It performs many functions, first of all, it protects the body from the effects of external factors of a physical, chemical and biological nature, from water loss, and also participates in thermoregulation.The skin consists of three layers: epidermis, dermis and subcutaneous fat.

The epidermis (outer layer of the skin) is the main barrier for fungi to penetrate the skin.It is a multilayer keratinizing squamous epithelium that, in turn, consists of five layers and functions as a barrier.Keratinocytes are the main cells of the epidermis.They contain the protein keratin, which creates the outer layer of the skin and gives it elasticity and strength.The keratinized cells of the epidermis are constantly exfoliated.

Dermatomycetes produce enzymes, keratinases, that destroy keratin.Because of this, fungi penetrate the superficial layers of the skin, where they continue to exist.The cell wall of dermatomycetes contains mannans, substances that can suppress local cellular immunity.The fungus T. rubrum, due to the action of manans, prevents the proliferation of keratinocytes, as a result, the peeling of horny scales from the surface of the skin slows down and a chronic course of infection develops.

Classification and stages of development of mycosis of the feet.

Classification according to the pathogen:

• Keratomycosis (pityriasis versicolor).
• Dermatophytosis (microsporia, superficial trichophytosis, mycosis of the feet, mycosis of smooth skin, mycosis of inguinal folds, onychomycosis).
• Candidiasis (candidiasis of the skin, nails).
• Deep mycoses (blastomycosis, sporotrichosis, chromomycosis).

Classification according to ICD-10:

• B35.1 - Mycoses of the nails.
• B35.2 - Mycosis of the hands.
• B35.3 - Mycosis of the feet.
• B37.2 - Candidiasis of the skin and nails.

Classification by location:

• Skin mycosis.
• Mycoses of the folds.
• Mycosis of the hands.
• Mycoses of the feet (squamous, hyperkeratotic, intertriginous, Dyshidrotic form).
• Onychomycosis (distal, superficial, proximal).

Classification by clinic:

• erased formIt manifests itself as peeling in the III-IV interdigital folds of the feet.Minor peeling may also occur on the soles and sides of the feet.
• intertriginous formIt is manifested by hyperemia in the interdigital folds of the feet, and the appearance of bubbles is also possible, which cause the formation of erosions and cracks.Subjectively, itching and burning are noted.
• With Dyshidrotic shapeClustered blisters appear on the skin of the arches and lateral surfaces of the feet.More often they appear on healthy skin, then increase in size, merge and form larger multi-chambered blisters.When the blisters open, erosions form.
• Squamous-hyperkeratotic formIt is characterized by a local or generalized thickening of the stratum corneum of the lateral and plantar surfaces of the feet.The affected areas of the skin are covered with small scales similar to pityriasis.Peeling is especially noticeable in skin folds.The cracks cause pain when walking.

Classification by clinic is very convenient from a practical point of view to determine additional treatment tactics and monitor the patient.

According to the clinical picture of the disease, the causative agent of the disease can be judged.For example, the Dyshidrotic form often occurs with mycosis of the feet caused by Trichophyton mentagrophytes var.interdigitale, the squamous-hyperkeratotic form is more often associated with T. rubrum, the chronic course and generalized process are characteristic of the opportunistic fungi Candida spp.and Aspergillus.

Complications of mycosis of the feet.

• Allergy to mushrooms.Under the influence of fungi, polyvalent sensitization is formed, that is, the body becomes more sensitive to the waste products of the fungus, which are foreign to us and are strong allergens.The body reacts more sharply, which is manifested by various rashes and skin reactions, chronic diseases of an allergic nature, such as skin eczema.The development or worsening of pathologies such as bronchial asthma, allergic dermatitis, seborrheic dermatitis and psoriasis is possible.In addition, a person may more frequently develop occupational allergic complications and drug intolerance.

• pyoderma- pustular skin diseases (cellulitis, lymphangitis, phlegmon and osteomyelitis of the bones of the foot), which can cause deep and long-lasting skin wounds that do not heal.Pyoderma occurs due to the fact that bacteria easily penetrate through erosions and cracks in the skin (the "gate of infection").At the same time, the temperature rises, weakness and discomfort appear, which requires immediate surgical correction.
• Increase in viral complicationsin the form of warts due to the presence of hyperkeratosis and cracks.The reason is a violation of the protective function of the skin, as a result of which it becomes more susceptible to any infections, including viral ones.
• General decrease in immunity.and 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.When fungus appears on the nails, they are deformed, an ingrown toenail, panaritium (purulent inflammation of the tissues of the fingers), paronychia (inflammation of the periungual fold) and complete detachment of the nail plates are possible.
• Deterioration of quality of life.Acute forms of mycosis of the feet are painful, make it difficult to wear shoes, and when lymphadenitis develops, they are accompanied by poor general health and fever.

Diagnosis of mycosis of the feet.

The diagnosis of mycosis of the feet is based on the patient's complaints, medical history, clinical picture and laboratory results.Mycoses of the feet are among those diseases that necessarily require laboratory tests to confirm the clinical diagnosis.

The main method to confirm the diagnosis of mycosis of the feet is microscopic examination and culture.The material is skin flakes, which are scraped from the skin lesion with a scalpel or glass;less commonly, a tape test is used.

Laboratory diagnosisMycoses include microscopic and cultural examination of the material in search of fungi.microscopic examinationIt is a rapid method to diagnose the pathogen, which allows the structure of the fungi to be identified in a few hours.Microscopic examination may reveal fungal elements in the form of mycelial threads and spores.The disadvantage of the 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 peculiarities of storage and transportation, etc.

Cultivation methodIt is the most accurate diagnostic method, which allows identifying the type of fungus to prescribe pathogenic therapy.To prepare for the analysis, it is not recommended that the patient use any antifungal agents on their own for 1 month.

When prescribing systemic antifungal therapy, it is recommendedbiochemical blood testto determine the level of bilirubin, AST and ALT in connection with the need to monitor the function of the liver and biliary tract, as well as to prevent possible complications.

Differential diagnosis of mycosis of the feet:

• The scaly form is differentiated from psoriasis, eczema and keratoderma.
• The interdigital form is differentiated from impetigo, diaper rash and candidiasis.
• The Dyshidrotic form is differentiated from palmoplantar pustulosis.

Treatment of mycosis of the feet.

The treatment should be carried out under the supervision of a dermatologist.

The main task in the fight against mycosis of the feet 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 drugs that correspond to the modern clinical characteristics of foot mycoses.

Before starting treatment for a disease, the dermatologist chooses between possible treatment options.In most cases, medications are prescribed for topical use.The basis of treatment is the use of antifungal agents that have various effects.Medicines that stimulate blood circulation and medicines to eliminate the main symptoms are also used:

• Antifungal agents for external therapy: applied externally 1-2 times a day for 4 weeks.
• In case of significant hyperkeratosis of the feet, exfoliation therapy is first performed: a drug from the group of azole derivatives, 1 time per day for 3-4 days, which acts as a keratolytic, that is, it eliminates the rough layer, thus preparing the skin and improving the penetration of antifungal agents into the dermis.
• If there are bubbles, use Castellani liquid;the solution is applied externally 1-2 times a day for 2-3 days.Then the combined drugs are prescribed 2 times a day externally for 7-10 days.
• For severe itching, antihistamines are prescribed: histamine H blocker₁-receptors – ethanolamine derivative 0.001 g 2 times a day orally for 10 to 15 days.
• Disinfect shoes once a month until completely cured;You can use a spray whose active ingredient is undecylamidopropyltrimonium methosulfate.
• If the nail plates are affected, oral systemic antifungal therapy should be prescribed for 3 to 4 months.This therapy requires the supervision of a dermatologist, since self-medication can lead to complications in internal organs, primarily the liver, bile ducts and stomach, as well as 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 on the skin, then without treatment it will not go anywhere, which means that the waste products of the fungus will always enter the surrounding tissues and blood, causing sensitization of the body and the development of chronic diseases of an allergic nature.

The presence of fungi indicates a decrease in immunity, and the skin damaged by mycosis practically does not perform a protective function.Therefore, all conditions are created for the addition of a concomitant bacterial infection.

A patient with mycosis of the feet is an active source of infection for those around him and especially his relatives, therefore treatment in this case is an effective means of preventing fungal infection among healthy relatives and people around him.

A favorable environment for the development of fungal infections on the skin of the feet is a humid environment, so you should always try to keep the skin of your feet dry.To do this, every night you need to wash your feet with soap and dry the skin with a disposable paper towel, paying special attention to the space between the toes.

Forecast.Prevention

The prognosis of cutaneous mycoses largely depends on the stage of the disease at which treatment was started.Therefore, if you notice changes in your skin, you should not postpone your visit to the doctor.With timely and correct treatment of mycosis of the feet.forecastfavorable: a complete recovery from the fungal infection occurs, the patient recovers.

If left untreated, the fungus can cause complications that not only deform the shape of the nails, but also affect the condition of the body as a whole.

Preventionfungal infection:

1. Public prevention involves the treatment of public places: baths, saunas, swimming pools, showers.Floors, equipment and household items should be disinfected.Staff and people who frequently visit public baths, saunas, etc.They must periodically undergo preventive examinations.

2. Primary personal prevention:

   • observe the rules of personal hygiene when visiting public places;
   • avoid damage and constant moisture to the skin and nails of the feet;
   • wear loose, comfortable shoes;
   • Avoid contact with infected people.

3. Secondary personal prevention:

   • maintain a hygienic regime for the skin of the feet;
   • disinfect shoes, showers and bathrooms;
   • increase immunity.