Mycosis of the feet - symptoms and treatment

Mycosis of the feet(dermatophytosis,Tinea pedis) is a skin disease of the feet caused by pathogenic or opportunistic fungi.Skin changes on the legs are characterized by skin, which is accompanied by itching.In case of severe lesions, on the background of red and swollen skin, erosions and deep cracks appear on the soles and in the spaces between the toes, which are accompanied by pain and make it difficult to walk.

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

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

Prevalence of athlete's foot.According to the World Health Organization (WHO), about 1/3 of the world's population suffers from fungal diseases, among which the most common are foot mycoses;the incidence is increasing every year.

According to dermatologists, 10-20% of the adult population suffer from foot mycoses;in men the disease occurs 2 times more often than in women and in the elderly more often than in the young.At the age of over 70, foot mycosis is registered in every second patient, which is accompanied by an increase in accompanying metabolic and vascular changes (diabetes mellitus, varicose veins, etc.).More and more, foot mycoses are being discovered in children.

Millions of people are currently affected by this disease.Workers in a variety of occupations are at risk: miners, athletes and military personnel.

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

Risk factors for athlete's foot:

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

Infection with mycosis of the feet can occur directly from a sick person, and can also be transmitted through contact and contact with the family (in the pool, bathroom, gym, through shoes, towels, carpets, etc.).

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

Symptoms of mycosis of the feet

The main symptoms of mycosis of the feet:

• itching;
• small cracks;
• erythema;
• peeling;
• bubbles;
• keratinization of the skin;
• unpleasant and pungent smell;
• burning, 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, redden, and signs of swelling and inflammation appear.Complications can develop in the form of diaper rash and skin eczema.

Types of foot mycosis:

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

• diaper-like areas are formed - crying;
• squamous - lamellar scales appear;
• hyperkeratotic - accompanied by redness 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 foot mycosis

The skin is the largest organ in the human body, accounting for 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 (the outer layer of the skin) is the main barrier to the penetration of fungi into the skin.It is a stratified squamous keratinizing epithelium, which, 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.Keratinized cells of the epidermis are constantly cleaned.

Dermatomycetes produce enzymes - keratinases, which destroy keratin.Because of this, fungi penetrate the surface 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 mannans, prevents the proliferation of keratinocytes, as a result, the desquamation of horny scales from the surface of the skin slows down and a chronic course of infection develops.

Classification and stages of development of foot mycosis

Classification depending on the pathogen:

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

Classification according to ICD-10:

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

Classification by location:

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

Classification by clinics:

• Deleted formmanifests as peeling in the interdigital folds III–IV of the feet.Small peeling may also occur on the soles and sides of the feet.
• Intertrigenic formit manifests itself with hyperemia in the interdigital folds of the feet and the appearance of blisters is also possible, which cause the formation of erosions and cracks.Subjectively, itching and burning are observed.
• With dyshidrotic formClustered blisters appear on the skin of the arches and lateral surfaces of the feet.Most often they appear on healthy skin, then increase in size, merge and form larger multi-chamber blisters.When the blisters open, erosions are formed.
• Squamous-hyperkeratotic formcharacterized by local or widespread thickening of the stratum corneum of the lateral and plantar surfaces of the feet.Affected areas of the skin are covered with small scales similar to pityriasis.Peeling is especially visible in skin folds.Cracks cause pain when walking.

Clinical classification is very convenient from a practical point of view for determining further treatment tactics and patient monitoring.

Based on the clinical appearance of the disease, the causative agent of the disease can be judged.For example, the dyshidrotic form often occurs with athlete's foot caused by Trichophyton mentagrophytes var.interdigitale, the squamous-hyperkeratotic form is more often associated with T. rubrum, the chronic course and the widespread process are characteristic of opportunistic fungi Candida spp.and Aspergillus.

Complications of foot mycosis

• Allergy to mushrooms.Under the influence of mushrooms, polyvalent sensitization is formed, that is, the body becomes more sensitive to the remains of mushrooms, which are foreign to us and are strong allergens.The body reacts more severely, which is manifested by redness and various skin reactions, chronic diseases of an allergic nature, such as skin eczema.It is possible to develop or worsen pathologies such as bronchial asthma, allergic dermatitis, seborrheic dermatitis and psoriasis.In addition, a person may develop occupational allergic complications and drug intolerance more often.

• Pyoderma- Pustular skin diseases (cellulitis, lymphangitis, phlegm and osteomyelitis of the leg bones), which can lead to deep and long-term skin wounds that do not heal.Pyoderma appears due to the fact that bacteria easily penetrate through erosions and cracks in the skin ("gateway of infection").At the same time, the temperature rises, weakness and malaise appear, which requires immediate surgical correction.
• Increased 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 infection, including viral ones.
• General decrease of immunityand impaired microcirculation in the lower extremities in patients with concomitant somatic diseases, such as diabetes mellitus and varicose veins.
• The spread of the disease to the nails and skin of the hands.When nail fungi appear, they are deformed, an ingrown nail, 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 the quality of life.Acute forms of mycosis of the feet are painful, make it difficult to put on shoes, and when lymphadenitis develops, they are accompanied by poor general health and fever.

Diagnosis of foot mycosis

The diagnosis of mycosis of the feet is based on the patient's complaints, medical history, clinical appearance 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 foot mycosis 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 duct tape test is used.

Laboratory diagnosismycoses include microscopic and cultural examination of the material for fungi.Microscopic examinationis an express method for diagnosing the pathogen, allowing one to identify the structure of the fungus within a few hours.Microscopic examination can reveal fungal elements in the form of filaments and mycelial spores.The disadvantage of the method is that it is possible to get false-positive and false-negative results, which depends on many factors: material acquisition technique, storage and transport features, etc.

Culture methodis the most accurate diagnostic method, which allows you to identify the type of fungus to prescribe pathogenetic therapy.To prepare for the analysis, the patient is not recommended to use any antifungal agents on their own for 1 month.

When prescribing systemic antifungal therapy, it is recommended thatbiochemical blood analysisto 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 foot mycosis:

• The squamous form is distinguished from psoriasis, eczema and keratoderma.
• The interdigital form is distinguished from impetigo, diaper rash and candidiasis.
• The dyshidrotic form is distinguished 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 to detect, recognize and treat it in time before the development of nail fungus, which requires 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 features of foot mycoses.

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

• Antifungal agents for external therapy: applied externally 1-2 times a day for 4 weeks.
• In case of pronounced 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, i.e., removes 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 10-15 days.
• Disinfect the shoes once a month until they are completely healed;you can use a spray whose active ingredient is undecylenamidopropyltrimonium methosulfate.
• If the nail plates are affected, systemic antifungal therapy should be prescribed orally for a duration of 3 to 4 months.This therapy requires supervision by a dermatologist, as self-medication can lead to complications from internal organs, mainly the liver, biliary tract, stomach, as well as the ineffectiveness of therapy and the formation of resistance to treatment.

It is necessary to treat mycosis of the feet, because if the fungus is located 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.Thus, all conditions are created for the addition of a concomitant bacterial infection.

A patient with athlete's foot is an active source of infection for people around him and especially family members, so 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 moist environment, so you should try to keep the skin of the feet always dry.To do this, every evening you should wash your feet with soap and dry the skin with a disposable paper towel, paying special attention to the space between the toes.

The prediction.Preventing

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

If not treated, the fungus can lead to complications that not only deform the shape of the nails, but also affect the condition of the body as a whole.

Preventingfungal infection:

1. Public prevention includes treatment of public places: baths, saunas, swimming pools, showers.Floors, equipment and household items must be disinfected.Personnel and persons who frequently visit public baths, saunas, etc.must undergo regular preventive checks.

2. Personal primary prevention:

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

3. Personal secondary prevention:

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