Runny nose

Mycosis of the skin is a current state of the problem. Results of a multicenter study to study the incidence of superficial mycoses of the skin in the regions of the Russian Federation and assess the effectiveness of their treatment with sertaconazole

Dermatophytosis (skin mycoses) -
current problem of modern dermatology

Belousova T. A.
MMA named after I.M. Sechenov

The undisputed leaders in frequency of occurrence and global distribution among other infectious skin diseases are fungal diseases (mycoses). It is no coincidence that they are called “national infection”, “retribution of civilization”.

According to studies conducted by A. Yu. Sergeev and co-authors, the average prevalence of dermatophytosis over 10 years (1990-99) among patients in the clinic of the Medical Center of the Administration of the President of the Russian Federation (PMC) was 63.9 per 1000 examined. At the same time, from 1997 to 1999, there was an increase in the number of registered cases of dermatophytosis. Onychomycosis (fungal infection of the nails) was predominant among all diagnoses of dermatophytosis, accounting for 24% of all dermatological pathologies. Mycosis of the feet was in second place in terms of occurrence, and mycosis of smooth skin was in third place. Dermatophytosis of the nails was recorded more than three times more often than dermatophytosis of other localizations. The authors point to a higher prevalence of fungal nail diseases among men, although according to the Hotline Project conducted by the National Academy of Mycology, two-thirds of all those contacted about onychomycosis were women. The incidence rate increases significantly in patients in older age groups, regardless of gender. According to foreign researchers, onychomycosis affects from 2% to 18.5% of the total population of the planet, and in the age group of 70 years and older, 50% of the world's population is affected by this disease. Thus, a significant increase in the incidence of dermatophytosis can be primarily associated with the aging of the world's population. In this case, the main factor predisposing to onychomycosis in the elderly is the rate of nail regrowth that decreases with age.

Very original in this regard is the theory of autosomal dominant inheritance of susceptibility to fungal infection proposed in 1996 by N. Zaias. Even earlier, in 1928, domestic scientists also spoke out in favor of a possible family predisposition to infection with dermatophytosis. Professional and social factors have a great influence on the incidence of fungal infection. Much more often than among other professional groups, onychomycosis occurs in miners, metallurgists, military personnel, and athletes. Factors predisposing to infection in these cases are the confinement of production areas, common showers and locker rooms, as well as the wearing of special clothing and footwear: military uniforms, overalls, boots, heavy closed boots. Clinical and epidemiological studies within the framework of the national project “Hotline” (2001-2002) revealed that 28% of patients with mycoses became infected in public places: baths, swimming pools, gyms. About a third of those surveyed noted people with foot mycoses in their environment, usually among older family members. This indicates the presence of a large stratum among the population of the older and elderly age groups, who avoid active treatment of their disease and are a reservoir and a constant source of spread of infection for others.

The causative agents of fungal infections have extraordinary vitality, which distinguishes them from other pathogenic microorganisms. Dermatophytes, which cause fungal infections of the skin and its appendages, can survive in the environment for more than 2 years. These microorganisms are widespread in nature and are found everywhere: in the ground, sand, stones, including coastal pebbles, as well as on old or diseased trees and wooden objects (flooring, seats, trestle beds). Having a rich set of enzymes, fungi have adapted to various living conditions. Their different types can grow in the dark and in bright sunlight, in pH ranges from 3 to 8 and temperatures from 1 to 60 ° C, withstand freezing in liquid nitrogen, drying and heating to a temperature of about 100 ° C, and freeze-dried them spores remain viable for more than 10 years.

The penetration of pathogenic fungi into the skin depends on the massiveness of the infectious dose of the fungus, its survival time in the environment, the presence of fungal receptors that promote adhesion to the receptors of keratinocytes of the skin and mucous membrane, skin pH, serum fungal inhibition factors, the content of organic fatty acids in sebum, phagocytic activity of macrophages, activity of T-lymphocytes, etc. It should be noted that the human body has specific and nonspecific factors of protection against invasion of microorganisms, including fungi. These include:

barrier function of the skin and mucous membranes;
acid mantle of the skin (undecylenic acid of sebum);
lysozyme, lactoferrin, myeloperoxidase system and other factors influencing the phagocytic activity of macro- and microphages;
functional activity of T and B cellular immunity - the body's specific defense system.

Mushrooms have specific enzymes - “aggression factors” that help overcome the body’s protective barriers. Thus, proteolytic enzymes, especially keratinase, decompose proteins into peptones and amino acids, not only ensure their assimilation by fungal cells, but also promote the rejection of the epidermis from the dermis and the melting of host tissues, facilitating the penetration of the fungus between the layers of keratin of the hair, epidermis and nails. Lipolytic enzymes break down sebum, which is one of the skin's protective mechanisms. The optimal temperature for the development of dermatophytons is between 25 and 30°C. Within these limits there is a fluctuation in the temperature of the scalp and feet in a healthy person, which explains the favorite localization of fungal skin lesions. These pathogens remain viable at low temperatures, but die almost instantly at high temperatures, especially high humidity. Dermatophytes are quite resistant to ultraviolet rays, but an acidic pH has a detrimental effect on them, since a slightly alkaline or neutral environment is optimal for them. A necessary condition for their development and growth is a humid environment and constant high temperature. That is why infection with this infection and its exacerbation occurs in the summer, when sweating increases.

The introduction of fungal infections into the nail plates and skin is facilitated by a variety of chronic diseases, which create conditions for the introduction of fungi from the outside by reducing the activity of metabolic processes, immune reactions and blood flow intensity. These include: chronic venous insufficiency (varicose veins), atherosclerosis of the vessels of the lower extremities, diabetes mellitus with severe microangiopathy (diabetic foot), osteoarticular pathology (flat feet, arthritis and arthrosis), excessive sweating (vegetative hyperhidrosis), excess weight, immunodeficiency states. Mycoses of the feet with damage to the nail plates are observed in a third of patients with diabetes mellitus due to frequent trauma to the surrounding skin and nails of the feet. According to the pan-European Achilles study, among the named causes in patients of the middle and older age groups, vascular diseases are in first place (21%), obesity in second (17%) and foot pathology in third (15%). The development of fungal infection is played by constant traumatization of the skin and nail plates (wearing tight and uncomfortable shoes, household and sports injuries, especially often occurring among football players and athletes), as well as traumatization of the eponychium and nail folds during manicure and pedicure procedures. These factors, as well as atopic status, dominate among the predisposing causes in the development of dermatomycosis among young people.

According to research by A. Yu. Sergeev and Yu. V. Sergeev, three quarters of all registered forms of dermatophytosis are onychomycosis and mycosis of the feet. These forms of fungal infection are characterized by a long, persistent course with periods of exacerbations (mainly in the warm season) and remissions in the cold season. The bulk of foot mycoses is rubrophytosis. It accounts for 70 to 90% of cases of fungal foot diseases registered in our country. Much less often - from 10 to 30% - the cause of mycoses of the feet is athlete's foot. In one fifth of patients suffering from mycoses of the feet for a long time, the infectious process spreads to the skin and nail plates of the hands. In this case, one of the palms is affected first, and then the second.

The favorite initial localization of rubrophytosis is the closest 3rd and 4th interdigital folds of the feet. Gradually, all the interdigital folds of the feet, the skin of the sole, its lateral areas and the back of the foot are affected. For rubrophytia, predominantly “dry” manifestations of mycosis are typical in the form of squamous (flaky) and squamous-keratotic (keratinizing) forms. Rarely, usually with exacerbations of “dry” forms, exudative varieties of rubrophytosis occur - intertriginous (opreloid), dyshidrotic (with the formation of blisters) and intertriginous-dyshidrotic.

The most meager clinical manifestations are observed with the so-called erased, squamous rubrophytosis. With this form, barely noticeable peeling is found in the interdigital folds of the feet in the form of small, flour-like scales and small surface cracks. Patients either do not experience any sensations or are bothered by mild itching. In this form, rubrophytosis can exist indefinitely. The dryness of the skin of the feet gradually increases, it becomes rough, yellowish-gray (dirty) in color, rough, and peeling increases. The stratum corneum of the skin thickens significantly up to rough calluses, especially in places of pressure and friction of the skin of the feet (sole, anterolateral areas of the feet), deep painful cracks appear, most pronounced in the heel area. These changes are characteristic of more pronounced and advanced forms of mycosis of the feet - squamous-keratotic and hyperkeratotic, observed in 70-80% of elderly patients. The presence of three types of peeling in the foci of rubrophytosis is characteristic:

Mucoid, which makes the natural skin grooves on the soles appear as if they were sprinkled with flour.
Ring-shaped or collar, resulting from the opening of isolated or confluent surface bubbles; “rings” look like slightly hyperemic erythematous spots surrounded by a fimbria of exfoliated epithelium.
Large-lamellar peeling, found in areas of more pronounced hyperkeratosis in the form of scales tightly attached to the surface.

Patients are concerned about itching, burning, and soreness. The process either ends when antifungal therapy is started in a timely manner, or goes into an intertriginous-dyshidrotic form. With it, multiple small blisters appear on the reddened skin, merging into larger blisters, which open to form erosions bordered by a fringe of exfoliated whitish epidermis. Itching, burning and pain become especially significant when moving. In approximately 20% of patients suffering from rubrophytosis of the feet, the hands may also be involved in the pathological process. Usually one arm is affected, rarely both. More often there is a squamous-keratotic, less often a dyshidrotic form of the lesion. All types of peeling are identified more clearly than on the feet. The boundaries of the foci of mycosis are sharp - due to the intermittent peripheral ridge, which is especially clearly visible when the foci of mycosis move to the lateral and dorsal areas of the hands.

After a more or less long period of illness with rubrophytosis of the skin of the feet, 80-100% of patients experience damage to the nails of the feet, and 20% have damage to the nails of the hands. The nail plates become thickened, crumble, resemble wood eaten by bugs, and acquire yellowish-grayish-brownish shades. Sometimes the affected nail is separated from the nail bed from the free edge (onycholysis), sometimes the appearance of opal-white spots in them, initially pinpoint ones, which, expanding and merging, can cover the entire nail, indicates that the nails are affected by fungi. Sometimes a spot appears in the area of the nail lunula and the part adjacent to it, gradually moving towards its distal (free) part. This form is more often observed with onychomycosis of the hands.

As a rule, nails changed due to rubrophytosis do not cause any subjective sensations. However, with severe deformation of the nails like onychogryphosis (“birds claw”), as well as with the development of subungual hyperkeratosis, subungual granuloma, complications in the form of paronychia and ingrown nails, pain occurs, making it difficult to wear regular shoes and move.

Unlike rubrophytosis, the pathological process in epidermophytosis is usually limited only to the skin and only in isolated cases affects the toenails. This mycosis occurs acutely, mainly in the form of exudative forms - intertriginous and dyshidrotic, and is accompanied 4 times more often than rubrophytia by allergic rashes that occur on areas of the skin remote from the main focus (torso, upper limbs). Among the rare and relatively easy forms of epidermophytosis, the squamous form should be mentioned. With it, fine-plate, sometimes pronounced, sometimes barely noticeable peeling is observed in the interdigital folds of the feet and on their arch. The disease sometimes bothers patients with mild and intermittent itching. It is these forms of epidermophytosis that escape the attention of patients and doctors and are the cause of the spread of infection in the environment.

With intertriginous epidermophytosis, between the 3rd and 4th toes closely adjacent to each other, as well as the 4th and 5th toes, maceration of the skin of the contacting toes and their plantar surface is observed. In the depths of the folds, peeling, undermined, macerated epidermis or cracks bordered by exfoliated whitish epidermis are visible. Gradually, the cracks turn into erosions with a weeping surface. With the addition of pyococcal flora, inflammatory phenomena increase. Severe itching is replaced by pain, which intensifies with movement. Exacerbations often occur in the warm season, and the process subsides in the cold season. In the dyshidrotic form of epidermophytosis, on the arch of the feet, their outer and inner edges, as well as in the interdigital folds and under the fingers, vesicles of various sizes appear, located either superficially or quite deep in the skin, translucent in the form of sago grains. Bubbles, located isolated or merged into multi-chamber bubbles, open with the formation of erosions bordered by a fringe of exfoliated epidermis. The associated pyococcal infection contributes to the formation of more or less thick purulent-bloody crusts on their surface. The disease is severe and is accompanied by pain, which intensifies with movement.

Epidermophytic onychomycosis occurs in only 15-20% of patients. Only the toenails, usually injured by shoes, and the 1st and 5th toes are affected. Nails, as a rule, do not thicken, but lose their usual pink color and shine, become dull, streaked, grayish or whitish-yellow, with a floury dustiness on the surface, more pronounced in the lunula area. Less commonly, thickening of the affected nail in its free part occurs due to subungual hyperkeratosis, or loosening and destruction of it from the free edge. The nails of the hands are not affected.

In addition to its favorite localization on the feet and hands, foci of dermatophytosis can be located on any part of the skin. Most often, large folds are affected (inguinal-femoral, intergluteal), less often - the skin of the legs, torso and limbs. The casuistic localization of dermatophytosis is the skin of the face and neck.

Mycosis on smooth skin manifests itself as pinkish or reddish spots with a bluish tint of rounded outlines, clearly demarcated from healthy skin; the surface of the spots is covered with small scales; along their periphery there is an intermittent ridge consisting of small papules, less often small bubbles and crusts, which can alternate with papules (cord symptom). The initial sizes of the spots are small: from one to 2-3 cm in diameter. However, over time, the rashes increase in size due to peripheral growth and merging with each other, forming continuous extensive areas of skin lesions with bizarre scalloped outlines. Over time, active inflammatory phenomena fade, the peripheral ridge becomes flattened, the color of the lesions becomes more faded with a predominance of brownish, bluish and yellowish shades. Peeling becomes barely noticeable, and at times there is slight itching. Vellus hair may be involved in the process. They lose their shine, become dull, break off, remnants of hair can be visible on the surface of the skin in the form of a stump or a black dot, nodules and nodules can develop around them, sometimes reaching large sizes (Majocca granuloma). With a long duration of existence of foci of mycosis on smooth skin against the background of immunodeficiency states, the development of erythroderma is observed in a number of patients. Clinical features of mycotic erythroderma are the absence of acute inflammatory phenomena in the form of bright erythema and edema (of the dry type), a yellowish tint of the rash, scanty pityriasis-like peeling, and mild itching.

Clinical signs of fungal infection are of great importance in the diagnosis of dermatophytosis. However, a mandatory stage of the diagnostic process is laboratory research, which at the present stage consists of two components - microscopy and cultural examination. Microscopy makes it possible to detect threads of dermatophytic mycelium or spores of pathogenic fungi, which confirms the diagnosis. A cultural study consists of inoculating pathogenic material on a nutrient medium and isolating a culture of the causative agent of mycosis to determine therapeutic tactics by determining sensitivity to antimycotics. In most medical institutions in Russia, direct microscopy is the only means of laboratory diagnosis of mycoses. The material for this study is scales from lesions, hair, pieces of the nail plate or scrapings from under it, as well as from the skin near the nail folds. To clarify keratinized structures, simple or compound solutions of caustic alkali (KOH test) are used. Microscopic examination reveals a cluster of threads of septate mycelium, on the sides of which there are oval or pear-shaped microconidia. Their number is very variable: from a few to numerous. Macroconidia are rare. They are narrow and long branches with thin walls and the presence of 2-8 chambers. In old cultures it is possible to find arthrospores and chlamydiospores.

Modern principles of treatment of dermatophytosis should be aimed at the speedy removal of the causative factor - a pathogenic fungus from the affected areas of the skin and nails, as well as, if possible, the elimination of predisposing factors (excessive sweating, trauma, concomitant diseases, etc.). Currently, there are a large number of remedies and methods for treating fungal diseases. However, etiotropic therapy is the only effective approach to the treatment of mycoses. It can be carried out externally, when an antifungal drug is applied to the affected area of the skin or nail plate, as well as systemically, when the drug is prescribed orally.

Systemic therapy is prescribed for damage to nails, hair, and large areas of skin in conditions close to partial or complete erythroderma. Systemic therapy ensures the penetration and accumulation of antifungal agents in the horny substances through the blood. Systemic drugs accumulate at sites of fungal infection in concentrations that far exceed the minimum concentrations that inhibit fungal growth and are able to remain there after the end of taking the drug. In modern medical practice, the following drugs are widely used: griseofulvin - mainly in pediatric practice, as the safest; terbinafine (Lamisil); ketoconazole (nizoral); itraconazole (Orungal). The choice of drug is determined primarily by the type of fungal infection (if the type of pathogen is not established, a broad-spectrum drug is prescribed). Important criteria are the location, prevalence, and severity of the disease. The use of systemic antifungal agents is associated with the risk of developing toxic and side effects associated with long-term use of the drug for many months. A very important selection criterion is the safety of treatment, i.e. minimizing the risk of side and toxic effects. Therefore, systemic therapy is not indicated for pregnant and nursing mothers, as well as persons with concomitant liver and kidney diseases, manifestations of drug allergies.

Local treatment is an integral part of the treatment of any fungal disease. External antifungal preparations contain very high concentrations of active substances against pathogens of mycoses, which are created on the surface of the lesions, where the most viable fungi are located. With local treatment, the development of adverse reactions is rarely observed, even with long-term use of antifungal drugs.

The prescription of external therapy is not limited by concomitant somatic pathology, the patient’s age, or the possible development of undesirable interactions when taking other medications simultaneously. In most cases, local antimycotics have a wide spectrum of not only antifungal, but also antimicrobial and anti-inflammatory effects, which is very significant, since the bacterial flora very often accompanies the fungal flora and complicates the course of mycosis.

Currently, practitioners have a wide selection of topical antifungal drugs in the form of solutions, creams, ointments, and powders. The most popular drugs are official drugs, used mainly in the form of creams and solutions: clotrimazole, ketoconazole, terbinafine, bifonazole, oxiconazole, miconazole, econazole. Almost each of the listed drugs has high activity against most types of mycoses, and the concentration of the antifungal agent created on the surface of the lesion is sufficient to suppress the vital activity of all pathogenic fungi. However, given that treatment should be carried out for a sufficiently long time (for 3-4 weeks) in a regimen of 2 times a day, an important selection criterion is the cost and, consequently, the availability of the medicine for the patient. In particular, econazole has a wide spectrum of antifungal activity, is highly effective in the treatment of dermatophytosis of the skin, and is affordable.

According to a study conducted by E. A. Batkaev and I. M. Korsunskaya at the Department of Dermatovenerology of the Russian Medical Academy of Postgraduate Education, in 22 patients with mycoses of the feet and smooth skin, the use of 1% cream with econazole for three weeks led to clinical and etiological cure in all patients. Only one patient in this group had a slight increase in itching and hyperemia at the beginning of treatment, which regressed independently during treatment. The use of 1% Ecodax cream in 11 children with microsporia of smooth skin (8 of them with lesions on the scalp), who received griseofulvin in age-specific dosages in parallel with local treatment, after three weeks of treatment, it was possible to achieve clinical and mycological cure in all patients. No adverse reactions were noted in any case.

Treatment of skin mycoses often includes two stages: preparatory and main.

The purpose of the preparatory stage in the treatment of mycosis of the feet is the regression of acute inflammation in the intertriginous and dyshidrotic form and the removal of horny layers in the squamous-hyperkeratotic form. In case of extensive maceration, excessive weeping and the presence of continuous erosive surfaces, warm foot baths from a weak solution of potassium permanganate and lotions from a 2% solution of boric acid are recommended. Then a cream containing corticosteroid hormones and antibiotics is applied to the affected areas: exudative mycosis is rich in coccal flora. First of all, creams containing combinations of betamethasone dipropionate + clotrimazole + gentamicin, betamethasone valerate + gentamicin, natamycin + neomycin + hydrocortisone are indicated. When acute inflammation subsides (rejection of macerated epidermis, cessation of oozing, epithelization of erosions), foot baths should be stopped and creams should be replaced with ointments containing the same components. In case of severe inflammation with extensive exudative manifestations, including severe swelling of the feet, the presence of numerous and widespread dermatophytis, systemic corticosteroid therapy should be prescribed. With moderate inflammation (scanty weeping, limited erosion), treatment can begin with the use of creams and then ointments. Such a preparatory stage is carried out, as a rule, in young and mature people, in whom, as already noted, intertriginous and dyshidrotic mycosis of the feet most often occur. In old and senile age, the preparatory stage is carried out much less frequently and is reduced to the removal of horny layers. For this purpose, they resort to various keratolytic agents (5%–10% salicylic ointment, Arievich ointment, lactic salicylic collodion). Softening the stratum corneum and removing hyperkeratotic layers, especially with mycosis of the feet, promotes deeper penetration of local antifungal agents into the affected tissues.

As with any other infection, personal prevention is of great importance to prevent infection. Preventive measures are especially relevant for people who regularly visit baths, swimming pools, saunas, sports clubs, fitness clubs, as well as for people in certain professions (athletes, military personnel, miners, etc.). Regular use of creams that are well absorbed and do not stain clothes for the purpose of prevention is a reliable guarantee of preventing infection with mycosis.

Literature:

Sergeev A. Yu. Fungal diseases of nails. Moscow, “Medicine for all”. National Academy of Mycology, 2001.
Kubanova A. A., Potekaev N. S., Potekaev N. N. Guide to practical mycology. –Moscow, Financial Publishing House “Business Express”, 2001.
Leshchenko V. M. Morphology, physiology, ecology of fungi (fundamental provisions). Materia medica, 1997, No. 2, p. 5-9.
Rukavishnikova V. M. Epidemiology, pathogenesis, clinical picture, treatment and prevention of mycoses of the feet. Materia medica, 1997, No. 2, p. 11-40.
Burova S. A., Buslaeva G. N., Shakhmeister I. Ya. Fungal diseases. Supplement to the magazine “Health”, 1999, No. 6.
Stepanova Zh. V. Fungal diseases. Moscow, Kron-press, 1966.
Sergeev A. Yu., Ivanov O. L., Sergeev A. Yu., et al. Study of modern epidemiology of onychomycosis. Bulletin of Dermatology and Venereology, 2002, No. 3, pp. 31-35.
Rodionov A. N. Fungal skin diseases. St. Petersburg: Peter, 1998.
Sergeev A. Yu. Systemic therapy of onychomycosis. Moscow. National Academy of Mycology. 2000.
Sergeev Yu. V., Sergeev A. Yu. Project “Hotline”: results and results. Advances in medical mycology, 2003, volume No. 2, pp. 153-154. Moscow, National Academy of Mycology.
Sergeev A. Yu., Sergeev Yu. V. What do studies of the epidemiology of dermatomycosis teach a clinician? Advances in medical mycology, 2003, volume No. 2, pp. 154-155. Moscow, National Academy of Mycology.
Batkaev E. A., Korsunskaya I. M. Treatment of mycoses in adults and children. Bulletin of Postgraduate Education, 2000, No. 3, pp. 12-13.
Zaias N. Onychomycosis. //Ach. Dermatol. – 1972.Vol. 105 (No. 2) – P.263-274.
Baran R., Onychomycosis: the current approach to diagnosis and therapy. London: Malden MA:1999.
Gill D., Marks R. A review of the epidemiology of tinea unguinum in the community/ Austral. J Dermatol 1999; 40:1:6-13.

This information is intended for healthcare and pharmaceutical professionals. Patients should not use this information as medical advice or recommendations.

Dermatophytosis is a pressing problem of modern dermatology

Ph.D. T.A. Belousova
MMA named after I.M. Sechenov

The undisputed leaders in frequency of occurrence and global distribution among other infectious skin diseases are fungal diseases. It is no coincidence that they are called “national infection”, “retribution of civilization”. According to research conducted by A.Yu. Sergeev et al. , the average prevalence of dermatophytosis over 10 years (1990–99) among patients in the clinic of the Medical Center of the Administration of the President of the Russian Federation (PMC) was 63.9 per 1000 examined. At the same time, from 1997 to 1999, there was an increase in the number of registered cases of dermatophytosis. Onychomycosis (dermatophytosis of the nails) was predominant among all diagnoses of dermatophytosis, accounting for 24% of all pathologies of the dermatological profile. Mycosis of the feet was in second place in terms of occurrence, and mycosis of smooth skin was in third place. Dermatophytosis of the nails was recorded more than three times more often than dermatophytosis of other localizations. The authors point to a higher prevalence of fungal nail diseases among men, although according to the Hotline Project conducted by the National Academy of Mycology, two-thirds of all those contacted about onychomycosis were women. The incidence rate increases significantly in patients in older age groups, regardless of gender. According to foreign researchers, onychomycosis affects from 2% to 18.5% of the total population of the planet, and in the age group of 70 years and older, 50% of the world's population is affected by this disease. Thus, a significant increase in the incidence of dermatophytosis can be primarily associated with the aging of the world's population. In this case, the main factor predisposing to onychomycosis in the elderly is the rate of nail regrowth that decreases with age.

Susceptibility to fungal infection varies from person to person. Dermatophytes, being quite active pathogens capable of destroying keratin substances, are much more likely to invade initially damaged areas of the skin or nail plates. Among practicing dermatologists, there is, and not without reason, such a common saying - “don’t get fungus on a healthy nail.” Very original in this regard is the theory of autosomal dominant inheritance of susceptibility to fungal infection proposed in 1996 by N. Zaias. Even earlier, in 1928, domestic scientists also spoke out in favor of a possible family predisposition to infection with dermatophytosis. Professional and social factors have a great influence on the incidence of fungal infection. Much more often than among other professional groups, onychomycosis occurs in miners, metallurgists, military personnel, and athletes. Factors predisposing to infection in these cases are the confinement of production areas, common showers and locker rooms, as well as the wearing of special clothing and footwear: military uniforms, overalls, boots, heavy closed boots. Clinical and epidemiological studies within the framework of the national project “Hotline” (2001–2002) revealed that 28% of patients with mycoses became infected in public places: baths, swimming pools, gyms. About a third of those surveyed noted people with foot mycoses in their environment, usually among older family members. This indicates the presence of a large stratum among the population of the older and elderly age groups, who avoid active treatment of their disease and are a reservoir and constant source of the spread of infection for others.

The causative agents of fungal infections have extraordinary vitality, which distinguishes them from other pathogenic microorganisms. Dermatophytes, which cause fungal infections of the skin and its appendages, can survive in the environment for more than 2 years. These microorganisms are widespread in nature and are found everywhere: in the ground, sand, stones, including coastal pebbles, as well as on old or diseased trees and wooden objects (flooring, seats, trestle beds). Having a rich set of enzymes, fungi have adapted to various living conditions. Their different types can grow in the dark and in bright sunlight, in pH ranges from 3 to 8 and temperatures from 1 to 60°C, withstand freezing in liquid nitrogen, drying and heating to a temperature of about 100°C, and lipophilically dried them spores remain viable for more than 10 years.

– barrier function of the skin and mucous membranes;

– acid mantle of the skin (undecylenic acid of sebum);

– lysozyme, lactoferin, myeloperoxidase system and other factors influencing the phagocytic activity of macro- and microphages;

– functional activity of T and B cellular immunity – the body’s specific defense system.

The introduction of fungal infections into the nail plates and skin is facilitated by a variety of chronic diseases, which create a “predisposition” to the introduction of fungi from the outside by reducing the activity of metabolic processes, immune reactions and blood flow intensity. These include: chronic venous insufficiency (varicose veins), atherosclerosis of the vessels of the lower extremities, diabetes mellitus with severe microangiopathy (diabetic foot), osteoarticular pathology (flat feet, arthritis and arthrosis), excessive sweating (vegetative hyperhidrosis), excess weight, immunodeficiency states. Mycoses of the feet with damage to the nail plates are observed in a third of patients with diabetes mellitus due to frequent trauma to the surrounding skin and nails of the feet. According to the pan-European Achilles study, among the named causes in patients of the middle and older age groups, vascular diseases are in first place (21%), obesity in second (17%) and foot pathology in third (15%). The development of fungal infection is played by constant traumatization of the skin and nail plates (wearing tight and uncomfortable shoes, household and sports injuries, especially often occurring among football players and athletes), as well as traumatization of the eponychium and nail folds during manicure and pedicure procedures. These factors, as well as atopic status, dominate among the predisposing causes in the development of dermatomycosis among young people.

According to research by A.Yu. Sergeeva and Yu.V. Sergeev, three quarters of all registered forms of dermatophytosis occur in onychomycosis And mycoses of the feet . These forms of fungal infection are characterized by a long, persistent course with periods of exacerbations (mainly in the warm season) and remissions in the cold season. The bulk of foot mycoses is rubrophytia. It accounts for 70 to 90% of cases of fungal foot diseases registered in our country. Much less often - from 10 to 30% - the cause of mycoses of the feet is athlete's foot. In one fifth of patients suffering from mycoses of the feet for a long time, the infectious process spreads to the skin and nail plates of the hands. In this case, one of the palms is affected first, and then the second.

Favorite initial localization rubrophytia The 3rd and 4th interdigital folds of the feet are the closest. Gradually, all the interdigital folds of the feet, the skin of the sole, its lateral areas and the back of the foot are affected. For rubrophytia, predominantly “dry” manifestations of mycosis are typical in the form of squamous (flaky) and squamous-keratotic (keratinizing) forms. Rarely, usually with exacerbations of “dry” forms, exudative varieties of rubrophytosis occur - intertriginous (opreloid), dyshidrotic (with the formation of blisters) and intertriginous-dyshidrotic.

The most meager clinical manifestations are observed with the so-called erased, squamous rubrophytosis . With this form, barely noticeable peeling in the form of small mealy scales and small surface cracks are found in the interdigital folds of the feet. Patients either do not experience any sensations or are bothered by mild itching. In this form, rubrophytosis can exist indefinitely. The dryness of the skin of the feet gradually increases, it becomes rough, yellowish-gray (dirty) in color, rough, and peeling increases. The stratum corneum of the skin thickens significantly up to rough calluses, especially in places of pressure and friction of the skin of the feet (sole, anterolateral areas of the feet), deep painful cracks appear, most pronounced in the heel area. These changes are typical for more pronounced and advanced forms of mycosis of the feet - squamous-keratotic And hyperkeratotic observed in 70–80% of elderly patients. Characterized by the presence three types of peeling in areas of rubrophytosis:

1. Mucoid , causing the natural skin grooves on the soles to look as if they were sprinkled with flour.

2. Ring or collar resulting from the opening of isolated or confluent surface bubbles; “rings” look like slightly hyperemic erythematous spots surrounded by a fimbria of exfoliated epithelium.

3. Large-plate peeling , found in areas of more pronounced hyperkeratosis in the form of scales tightly attached to the surface.

Exudative manifestations of rubrophytosis rarely occur from the very beginning. More often, erased (squamous) forms become exudative with increased physical and emotional stress, with long walks, wearing closed, poorly ventilated shoes, as well as with inadequate therapy with corticosteroid creams and ointments. Rubrophytosis of interdigital folds (intertriginous) is characterized by swelling and maceration of the stratum corneum in the depths of the interdigital folds of the feet and on the lateral surfaces of the fingers. Due to the detachment of the stratum corneum, superficial erosions and rather deep cracks are formed. Patients are concerned about itching, burning, and soreness. The process either ends when antifungal therapy is started in a timely manner, or goes into an intertriginous-dyshidrotic form. With it, multiple small blisters appear on the reddened skin, merging into larger blisters, which open to form erosions bordered by a fringe of exfoliated whitish epidermis. Itching, burning and pain become especially significant when moving. In approximately 20% of patients suffering from rubrophytosis of the feet, the hands may also be involved in the pathological process. Usually one arm is affected, rarely both. More often, a squamous-keratotic, less often a dyshidrotic form of the lesion is observed. All types of peeling are identified more clearly than on the feet. The boundaries of the foci of mycosis are sharp - due to the intermittent peripheral ridge, which is especially clearly visible when the foci of mycosis move to the lateral and dorsal areas of the hands.

After a more or less long period of disease with rubrophytosis of the skin of the feet, 80–100% of patients experience damage to the nails of the feet, and 20% have damage to the nails of the hands. The nail plates become thickened, crumble, resemble wood eaten by bugs, and acquire yellowish-grayish-brownish shades. Sometimes the affected nail is separated from the nail bed from the free edge (onycholysis); sometimes, fungal infection of the nails is indicated by the appearance of opal-white spots in them, initially dotted, which, expanding and merging, can cover the entire nail. Sometimes a spot appears in the area of the nail lunula and the part adjacent to it, gradually moving towards its distal (free) part. This form is more often observed with onochomycosis of the hands.

Unlike rubrophytosis, the pathological process with athlete's foot It is usually limited only to the skin and only in isolated cases affects the toenails. This mycosis occurs acutely, mainly in the form exudative forms - intertriginous And dyshidrotic , and is accompanied 4 times more often than rubrophytia by allergic rashes that occur on areas of the skin remote from the main focus (torso, upper limbs). Of the rare and relatively easy forms of epidermophytosis, one should name squamous form . With it, fine-plate, sometimes pronounced, sometimes barely noticeable peeling is observed in the interdigital folds of the feet and on their arch. The disease sometimes bothers patients with mild and intermittent itching. It is these forms of epidermophytosis that escape the attention of patients and doctors and are the cause of the spread of infection in the environment.

Epidermophytic onychomycosis occurs in only 15–20% of patients. Only the toenails, usually injured by shoes, and the 1st and 5th toes are affected. Nails, as a rule, do not thicken, but lose their usual pink color and shine, become dull, streaked, grayish or whitish-yellow, with a floury dustiness on the surface, more pronounced in the lunula area. Less commonly, thickening of the affected nail in its free part occurs due to subungual hyperkeratosis, or loosening and destruction of it from the free edge. The nails of the hands are not affected.

In addition to its favorite localization on the feet and hands, foci of dermatophytosis can be located on any part of the skin. Most often, large folds are affected (inguino-femoral, intergluteal), less often - the skin of the legs, torso and limbs. The casuistic localization of dermatophytosis is the skin of the face and neck.

Mycosis on smooth skin appears as pinkish or reddish spots with a bluish tint of rounded outlines, clearly demarcated from healthy skin; the surface of the spots is covered with small scales; along their periphery there is an intermittent ridge consisting of small papules, less often small bubbles and crusts, which can alternate with papules (cord symptom). The initial sizes of the spots are small: from one to 2–3 cm in diameter. However, over time, the rashes increase in size due to peripheral growth and merging with each other, forming continuous extensive areas of skin lesions with bizarre scalloped outlines. Over time, active inflammatory phenomena fade, the peripheral ridge becomes flattened, the color of the lesions becomes more faded with a predominance of brownish, bluish and yellowish shades. Peeling becomes barely noticeable, and at times there is slight itching. Vellus hair may be involved in the process. They lose their shine, become dull, break off, remnants of hair can be visible on the surface of the skin in the form of a stump or a black dot, peripillary nodules and nodes can develop, sometimes reaching large sizes (Majocca granuloma). With a long duration of existence of foci of mycosis on smooth skin against the background of immunodeficiency states, a number of patients experience the development erythroderma . Clinical features of mycotic erythroderma are the absence of acute inflammatory phenomena in the form of bright erythema and edema (dry type), a yellowish tint of the rash, scanty pityriasis-like peeling, mild itching.

Clinical signs of fungal infection are of great importance in diagnostics dermatophytosis. However, a mandatory stage of the diagnostic process is laboratory tests , which at the present stage consist of two components - microscopy and cultural research. Microscopy makes it possible to detect threads of dermatophytic mycelium or spores of pathogenic fungi, which confirms the diagnosis. A cultural study consists of inoculating pathogenic material on a nutrient medium and isolating a culture of the causative agent of mycosis to determine therapeutic tactics by determining sensitivity to antimycotics. In most medical institutions in Russia, direct microscopy is the only means of laboratory diagnosis of mycoses. The material for this study is scales from lesions, hair, pieces of the nail plate or scrapings from under it, as well as from the skin near the nail folds. To clarify keratinized structures, simple or compound solutions of caustic alkali (KOH test) are used. Microscopic examination reveals a cluster of threads of septate mycelium, on the sides of which there are oval or pear-shaped microconidia. Their number is very variable: from a few to numerous. Macroconidia are rare. They are narrow and long branches with thin walls and the presence of 2–8 chambers. In old cultures it is possible to find arthro- and chlamydiospores.

Modern principles of therapy dermatophytosis should be aimed at the speedy removal of the causative factor - a pathogenic fungus from the affected areas of the skin and nails, as well as, if possible, the elimination of predisposing factors (excessive sweating, trauma, concomitant diseases, etc.). Currently, there are a large number of remedies and methods for treating fungal diseases. However, etiotropic therapy is the only effective approach to the treatment of mycoses. It can be carried out externally, when the antifungal drug is applied to the affected area of the skin or nail plate, as well as systemically, when the drug is prescribed orally.

Systemic therapy is prescribed for damage to nails, hair, and large areas of skin in conditions close to partial or complete erythroderma. Systemic therapy ensures the penetration and accumulation of antimycotics in horny substances through the blood. Systemic drugs accumulate at sites of fungal infection in concentrations that far exceed the minimum concentrations that inhibit fungal growth and are able to remain there after the end of drug administration. In modern medical practice, the following drugs are widely used: griseofulvin – mainly in pediatric practice, as the safest; terbinafine; ketoconazole; itraconazole . The choice of drug is determined primarily by the type of fungal infection (if the type of pathogen is not established, a broad-spectrum drug is prescribed). Important criteria are the location, prevalence, and severity of the disease. The use of systemic antimycotics is associated with the risk of developing toxic and side effects associated with long-term use of the drug for many months. A very important selection criterion is the safety of treatment, i.e. minimizing the risk of side and toxic effects. Therefore, systemic therapy is not indicated for pregnant and nursing mothers, as well as persons with concomitant liver and kidney diseases, manifestations of drug allergies.

Local treatment is an integral part of the treatment of any fungal disease. External antimycotic drugs contain very high concentrations of active substances against the causative agents of dermatophytosis, which are created on the surface of the lesions, where the most viable fungi are located. With local treatment, the development of adverse reactions is rarely observed, even with long-term use of antimycotics. The prescription of external therapy is not limited by concomitant somatic pathology, the patient’s age, or the possible development of interactions when taking other medications simultaneously. In most cases, local antimycotics have a wide spectrum of not only antifungal, but also antimicrobial and anti-inflammatory effects, which is very significant, since the bacterial flora very often accompanies the fungal flora and complicates the course of mycosis. Currently, practitioners have a wide selection of topical antifungal drugs in the form of solutions, creams, ointments, and powders. The most in demand official drugs, used mainly in the form of creams and solutions: clotrimazole, ketoconazole, terbinafine, bifonazole, oxyconazole, miconazole, econazole (Ecodax). Almost each of the listed drugs has high activity against most types of mycoses, and the concentration of the antifungal agent created on the surface of the lesion is sufficient to suppress the vital activity of all pathogenic fungi. However, given that treatment should be carried out for a sufficiently long time (for 3–4 weeks) in a 2-fold application per day regimen, an important selection criterion is the cost and, therefore, the availability of the medicine for the patient. In particular, econazole (Ecodax ) has a wide spectrum of antifungal activity, is highly effective in the treatment of dermatophytosis of the skin and is affordable. According to a study conducted by E.A. Batkaev and I.M. Korsunskaya at the Department of Dermatovenerology of the Russian Medical Academy of Postgraduate Education, in 22 patients with mycoses of the feet and smooth skin, the use of 1% Ecodax cream for three weeks led to clinical and etiological cure in all patients. Only one patient in this group had a slight increase in itching and hyperemia at the beginning of treatment, which regressed independently during treatment. The use of 1% Ecodax cream in 11 children with microsporia of smooth skin (8 of them with lesions on the scalp), who received griseofulvin in age-specific dosages in parallel with local treatment, after three weeks of treatment, it was possible to achieve clinical and mycological cure in all patients. No adverse reactions were noted in any case.

Treatment of dermatophytosis often includes two stages: preparatory and main. The purpose of the preparatory stage in the treatment of mycosis of the feet is the regression of acute inflammation in the intertriginous and dyshidrotic form and the removal of horny layers in the squamous-hyperkeratotic form. In case of extensive maceration, excessive weeping and the presence of continuous erosive surfaces, warm foot baths from a weak solution of potassium permanganate and lotions from a 2% solution of boric acid are recommended. Then a cream containing corticosteroid hormones and antibiotics is applied to the affected areas: exudative mycosis is rich in coccal flora. First of all, creams containing combinations of betamethasone dipropionate + clotrimazole + gentamicin, betamethasone valerate + gentamicin, natamycin + neomycin + hydrocortisone are indicated. When acute inflammation subsides (rejection of macerated epidermis, cessation of oozing, epithelization of erosions), foot baths should be stopped and creams should be replaced with ointments containing the same components. In case of severe inflammation with extensive exudative manifestations, including severe swelling of the feet, the presence of numerous and widespread dermatophytis, systemic corticosteroid therapy should be prescribed. With moderate inflammation (scanty weeping, limited erosion), treatment can begin with the use of creams and then ointments. Such a preparatory stage is carried out, as a rule, in young and mature people, in whom, as already noted, intertriginous and dyshidrotic mycosis of the feet most often occur. In old and senile age, the preparatory stage is carried out much less frequently and is reduced to the removal of horny layers. For this purpose, they resort to various keratolytic agents (5%–10% salicylic ointment, Arievich ointment, lactic salicylic collodion). Softening the stratum corneum and removing hyperkeratotic layers, especially with mycosis of the feet, promotes deeper penetration of local antimycotics into the affected tissues.

As with any other infection, personal prevention . Preventive measures are especially relevant for people who regularly visit baths, swimming pools, saunas, sports clubs, fitness clubs, as well as for people in certain professions (athletes, military personnel, miners, etc.). Regular use of well-absorbed and non-staining creams (Ecodax, etc.) for the purpose of prevention is a reliable guarantee of preventing infection with mycosis.

Literature:

1. Sergeev A.Yu. Fungal diseases of nails. Moscow, “Medicine for all”. National Academy of Mycology, 2001.

2. Kubanova A.A., Potekaev N.S., Potekaev N.N. Guide to practical mycology. –Moscow, Financial Publishing House “Business Express”, 2001.

3. Leshchenko V.M. Morphology, physiology, ecology of fungi (fundamental provisions). Materia medica, 1997, No. 2, p. 5–9.

4. Rukavishnikova V.M. Epidemiology, pathogenesis, clinical picture, treatment and prevention of mycoses of the feet. Materia medica, 1997, No. 2, p. 11–40.

5. Burova S.A., Buslaeva G.N., Shakhmeister I.Ya. Fungal diseases. Supplement to the magazine “Health”, 1999, No. 6.

6. Stepanova Zh.V. Fungal diseases. Moscow, Kron-press, 1966.

7. Sergeev A.Yu., Ivanov O.L., Sergeev A.Yu., et al. Study of modern epidemiology of onychomycosis. Bulletin of Dermatology and Venereology, 2002, No. 3, pp. 31–35.

8. Rodionov A.N. Fungal skin diseases. St. Petersburg: Peter, 1998.

9. Sergeev A.Yu. Systemic therapy of onychomycosis. Moscow. National Academy of Mycology. 2000.

10. Sergeev Yu.V., Sergeev A.Yu. Project "Hotline": results and results. Advances in medical mycology, 2003, volume No. 2, pp. 153–154. Moscow, National Academy of Mycology.

11. Sergeev A.Yu., Sergeev Yu.V. What does research into the epidemiology of dermatomycosis teach the clinician? Advances in medical mycology, 2003, volume No. 2, pp. 154–155. Moscow, National Academy of Mycology.

12. Batkaev E.A., Korsunskaya I.M. Treatment of mycoses with ecodax in adults and children. Bulletin of Postgraduate Education, 2000, No. 3, pp. 12–13.

13. Zaias N. Onychomycosis. //Ach. Dermatol. – 1972.Vol. 105 (No. 2) – P.263–274.

14. Baran R., Onychomycosis: the current approach to diagnosis and therapy. London: Malden MA:1999.

15. Gill D., Marks R. A review of the epidemiology of tinea unguinum in the community/ Austral. J Dermatol 1999; 40:1:6–13.

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 mycoses of the upper respiratory tract, as well as taking into account our own clinical experience, we can draw a conclusion 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 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. - volume 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

A. Yu. Sergeev, Candidate of Medical Sciences,

O. L. Ivanov, Doctor of Medical Sciences, Professor

Fungal infections of the skin, hair and nails are classified as superficial mycoses. At the same time, skin lesions can be observed in both subcutaneous and deep mycoses, which occurs much less frequently. About half of the more than 400 fungal pathogens cause skin infections.

According to the largest epidemiological study, Achilles, conducted in 1997-1998 and covering 11 European countries, including Russia, mycoses of smooth skin account for about 2%, and mycoses of the feet and onychomycosis (mycoses of the nails) account for 22% of the reasons for visiting a doctor. About a third of dermatologists' patients come to see them about mycoses of the feet, and almost half come to see them about onychomycosis.

Modern classifications distinguish various superficial mycoses depending on the location of the lesion or the type (group) of the pathogen.

Mycoses of the feet

Mycoses of the feet (Tinea pedis) are widespread and occur more often than any other mycoses of the skin. According to various sources, up to 1/5 of the entire population suffers from them. The main causative agent of mycosis of the feet is T. rubrum; much less often, mycosis of the feet is caused by T. mentagrophytes var.interdigitale, and even more rarely by other dermatophytes. Foot mycoses caused by T. rubrum and T. Mentagrophytes have epidemiological and clinical features. At the same time, variants of mycosis of the feet are possible, typical for one pathogen, but caused by another.

Infection with mycosis of the feet caused by T. rubrum (rubrophytosis of the feet) most often occurs in the family, through direct contact with the patient, as well as through shoes, clothing or common household items. The infection is characterized by a chronic course, affecting both feet, and often spreading to smooth skin and nail plates. With a long course, the skin of the palms, usually the right (working) hand, is characterized by involvement of the skin - the “two feet and one hand” syndrome (Tinea pedum et manuum). Typically, T. rubrum causes a chronic squamous-hyperkeratotic form of mycosis of the feet, the so-called “moccasin type”. With this form, the plantar surface of the foot is affected. The affected area exhibits mild erythema, moderate to severe peeling, and in some cases a thick layer of hyperkeratosis. Hyperkeratosis is most pronounced in points that bear the greatest load. In cases where the lesion is continuous and covers the entire surface of the sole, the foot becomes as if dressed in a layer of erythema and hyperkeratosis, like a moccasin. The disease, as a rule, is not accompanied by subjective sensations. Sometimes the manifestations of rubrophytosis of the feet are minimal, represented by slight peeling and cracks on the sole - the so-called erased form.

Infection with mycosis of the feet caused by T. mentagrophytes (athlete's foot) most often occurs in public places - gyms, baths, saunas, swimming pools. With athlete's foot, the interdigital form of Tinea pedis is usually observed. In the 3rd, 4th, and sometimes in the 1st interdigital fold, a crack appears, bordered along the edges by white stripes of macerated epidermis, against the background of surrounding erythema. These phenomena may be accompanied by an unpleasant odor (especially when a secondary bacterial infection is associated) and are usually painful. In some cases, the surrounding skin and nails of the nearest toes (I and V) are affected. T. mentagrophytes is a strong sensitizer and sometimes causes a vesicular form of athlete's foot. In this case, small bubbles form on the toes, in the interdigital folds, on the arch and lateral surfaces of the foot. In rare cases, they merge, forming blisters (bullous form).

In the treatment of mycosis of the feet, both local and systemic antifungal agents are used. Local therapy is most effective for erased and interdigital forms of mycosis of the feet. Modern antimycotics for topical use include creams (for example, Lamisil, Exoderil, Nizoral), aerosols (Lamisil, Daktarin), ointments (for example, various preparations of clotrimazole). If these funds are not available, use local antiseptics (Castellani liquid, fucorcin, etc.). The duration of treatment ranges from two weeks when using modern drugs to four when using traditional drugs. In case of chronic squamous-hyperkeratotic form of mycosis of the feet, involvement of the hands or smooth skin, or damage to the nails, local therapy is often doomed to failure. In these cases, systemic drugs are prescribed - terbinafine (Lamisil, Exifin) - 250 mg per day for at least two weeks, itraconazole (Orungal) - 200 mg twice a day for one week. If nails are affected, the treatment period is extended. Systemic therapy is also indicated for acute inflammatory phenomena and vesiculobullous forms of infection. Externally in these cases, lotions, antiseptic solutions, aerosols, as well as combination products that combine corticosteroid hormones and antimycotics (Triderm, Lorinden C, Candide B, Mycozolon) are used. Desensitizing therapy is indicated.

Onychomycosis

Onychomycosis affects about 1/10 of the entire population and is widespread. The incidence increases with age (up to 30% after 65 years), which is primarily associated with vascular pathology, obesity, osteoarthropathy of the foot, and diabetes mellitus. The main provoking factor is damage to the nails and skin of the foot, most often when wearing tight shoes. Onychomycosis on the feet occurs three to seven times more often than on the hands. The main causative agent of onychomycosis is T. rubrum. However, up to 1/4 of nail infections can be caused by molds and yeasts that are resistant to a number of antifungals.

There are three main clinical forms of onychomycosis: distal-lateral, proximal and superficial, depending on the location of the pathogen. The most common is the distal form. In this case, elements of the fungus penetrate into the nail from the affected skin in the area of the broken connection of the distal (free) end of the nail and the skin. The infection spreads to the root of the nail, and for its advancement the rate of growth of the fungus must exceed the rate of natural growth of the nail in the opposite direction. Nail growth slows down with age (up to 50% after 65-70 years), and therefore onychomycosis predominates in older people. Clinical manifestations of the distal form are loss of transparency of the nail plate (onycholysis), manifested as whitish or yellow spots in the thickness of the nail and subungual hyperkeratosis, in which the nail appears thickened. In the rare proximal form, the fungi penetrate through the proximal nail fold. White or yellow spots appear in the thickness of the nail at its root. In the superficial form, onychomycosis is represented by spots on the surface of the nail plate. Each form of onychomycosis over time can lead to damage to all parts of the nail, destruction of the nail plate and loss of nail function. Such variants of onychomycosis are classified as the so-called total dystrophic form.

Nail candidiasis is usually accompanied by paronychia - inflammation of the periungual fold. As a result of periodic exacerbations of paronychia, dystrophic changes in the nail occur, manifested by transverse grooves on the nail plate.

The main means of confirming the diagnosis is microscopy of pathological material (fragments of the nail plate and material scraped out from under it) and its culture with isolation of culture. The latter is not always possible and is not available to all domestic laboratories.

In the treatment of onychomycosis, local and systemic therapy or their combination - combination therapy - is also used. Local therapy is applicable mainly only for the superficial form, the initial phenomena of the distal form, or lesions of single nails. In other cases, systemic therapy is more effective. Modern local remedies for the treatment of onychomycosis include antifungal nail varnishes, in particular the drug Loceryl with a convenient application regimen (once a week). Local therapy is carried out until clinical and mycological cure. Systemic therapy includes terbinafine (Lamisil, Exifin tablets), itraconazole (Orungal capsules) and fluconazole (Diflucan capsules). Terbinafine preparations are effective against onychomycosis caused by dermatophytes T. rubrum and T. mentagrophytes, Diflucan - dermatophytes and Candida yeast fungi, and orungal - for onychomycosis of any etiology. Lamisil or exifin is prescribed 250 mg per day for 6 weeks or more for onychomycosis of the hands and from 12 weeks for onychomycosis of the feet. Orungal is prescribed in pulse therapy mode at 200 mg twice a day for one week with a three-week interval, and then this cycle is repeated once for onychomycosis of the hands and at least twice for onychomycosis of the feet. The duration of treatment with any drug depends on the clinical form of onychomycosis, the extent of the lesion, the degree of subungual hyperkeratosis, the affected nail and the age of the patient. To calculate the duration, a special KIOTOS index is currently used [Sergeev A. Yu., 1999]. Combination therapy may be prescribed in cases where systemic therapy alone is insufficient or has a long duration. An effective and convenient combination therapy regimen is the combination of Diflucan (150 mg once a week) with simultaneous or subsequent administration of Loceryl varnish, also once a week, until clinical cure.

Mycoses of smooth skin and large folds

Mycoses of smooth skin (Tinea corporis s. circinata) are less common than mycoses of the feet or onychomycosis. As a rule, in Russia they are caused by T. rubrum (rubrophytosis of smooth skin) or Microsporum canis (microsporia of smooth skin). There are also zoonotic mycoses of smooth skin caused by rarer species of dermatophytes. Mycoses of large folds (Tinea cruris) are usually caused by T. rubrum and Epidermophyton floccosum; candidiasis of large folds also occurs.

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

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

Mycoses of large folds caused by dermatophytes (Tinea cruris) also retain characteristic features: peripheral ridge, central resolution and polycyclic outlines. The most typical localization is the inguinal folds and the inner side of the thigh.

Candidiasis in this localization is characterized by cracks, erosions and areas of macerated skin in the depths of the fold, merging erosions, papules and pustules that make up the lesion, and similar screening elements along the edges of the lesion. All rashes in the groin area are usually accompanied by itching.

In the treatment of mycoses of smooth skin and folds, the same principles are used as in the treatment of mycoses of the feet. For isolated lesions, local antifungal agents are prescribed, for widespread lesions, systemic drugs are prescribed according to similar regimens, and when combined with lesions of the nails or hair, systemic therapy is prescribed according to the regimens adopted for these localizations. Treatment with local drugs is carried out until clinical and mycological cure, after which another week is added.

Tinea versicolor

Pityriasis versicolor (pityriasis versicolor) is caused by the fungus Pityrosporum orbiculare (syn. Malassezia furfur). The disease is common in hot countries, and in our climate it affects up to 5-10% of the population. Lichen versicolor develops more often in people with excessive sweating; exacerbations are typical in the hot season.

Elements of multi-colored lichen are located on the skin of the chest, upper back, and shoulders. Small spots appear in this area, first pink and then yellow or coffee, light brown. Against the background of tanned skin, the spots look lighter. The spots tend to merge to form large foci, but can exist in isolation. There are no inflammatory phenomena, there is slight pityriasis-like peeling.

In the diagnosis of pityriasis versicolor, the Balser iodine test is used: the spots are smeared with tincture of iodine, after which they acquire a dark brown color. Under a Wood's lamp, foci of lichen versicolor give off a yellow glow.

Treatment of lichen versicolor is usually carried out with local antimycotics: creams (nizoral, lamisil), aerosols (lamisil, daktarin). These products are used twice a day for two weeks. A convenient form is the antifungal shampoo Nizoral. It is used once a day for 5-7 days. For widespread lesions and frequent relapses of lichen versicolor, systemic antimycotics are prescribed: nizoral or orungal 200 mg per day for one week.

Literature

1. Rodionov A. N. Fungal skin diseases. St. Petersburg: Peter, 1998.

2. Rukavishnikova V. M. Mycoses of the feet. M.: MSD, 1999.

3. Sergeev Yu. V., Sergeev A. Yu. Onychomycosis: fungal infections of the nails. M.: Geotar-medicine, 1998.

4. Sergeev A. Yu., Sergeev Yu. V. Candidiasis: nature of infection, mechanisms of aggression and defense, diagnosis and treatment. M.: Triada-X, 2000.

5. Stepanova Zh. V. Fungal diseases. M.: Kron-Press, 1996.

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 fungi of the genus Candida, 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: mycosis of the skin 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 multiply 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 getting 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 repeat laboratory test to make sure 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 swimming 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.