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VERIFIED CONTENTAuthor: Natalia Młyńska

Dermatophytosis is one of the common infectious skin diseases. This group includes infections caused by dermatophytes, i.e. imperfect fungi. Due to the prevalence of risk factors, the number of cases is constantly increasing. What are the types and symptoms of dermaphytosis? How to effectively treat such infections?

Dermatophytosismost often affects the scalp, feet, smooth skin and nails. It is estimated that in recent years the number of dermatophytoses has increased, which is influenced by many factors, including conditions with decreased immunity: AIDS, immunosuppression with the use of gicocorticosteroids, cytostatic or immunosuppressive drugs.

Non-immune factors such as diabetes, obesity, and hypothyroidism also play an important role. Being in public places, high temperatures and humidity also contribute to the development of dermatophytosis.

Dermatophytosis of the scalp

Dermatophytosis of the scalp is a fungus infection that affects mainly children, it occurs sporadically in adults. In mycosis, we can distinguish the superficial form, caused mainly by anthropophilic dermatophytes (their natural reservoir is humans), and the deep form, in the case of infection with zoophilic dermatophytes. The wax form may persist after puberty, but it is even infected in adults.

This happens through the use of common everyday items or through direct contact. Superficial dermatophytosis caused by anthropophilic fungi is characterized by three forms:

  • small spore mycosis

There are exfoliating outbreaks, slight inflammation, hair can break, usually a few millimeters above the skin surface. If left untreated, changes usually resolve spontaneously during puberty.

  • shearing mycosis

There are exfoliating foci with a slight inflammation. The hair is broken off unevenly and black spots appear, which gives the impression of hair trimmed.

  • wax mycosis

A variety of dermatophytosis in which the outbreaks are characterized by earwax discs with yellow scabs that arefungus colony. After their removal, there is scarring and hair loss.

The most common pathogen causing dermatophytosis of the scalp isMicrosporum audouiniiand more and more often -Trichophyton endotrix . hair that shortens the time needed to heal.

Due to the high infectivity of dermatophytoses, children infected with anthropophilic dermatophytes should stay at home for about a week, while patients after infection by a zoophilic dermatophyte (causing e.g. an inflammatory variety) after the introduction of treatment, may contact others.

The treatment includes substances such as Terbinafine in the following doses - 62.5 mg / 24h in children up to 20 kg bw, 125 mg / 24h in children 20-40 kg bw, 250 mg / 24h in children over 40 kg bw and in adults.

Treatment should be continued for at least 4 weeks ( Trichophyton ) or extended to 8-10 weeks forMicrosporum . Local treatment is of auxiliary and complementary importance. Solutions, gels and shampoos are available.

Foot dermatophytosis

Dermatophytosis of the feet is manifested by changes on the soles of the feet, in the spaces between the toes and on the lateral surfaces of the feet. These are erythematous-exfoliating foci with vesicles, there are exudative symptoms.

Fungi of the genusT.rubrum ,T.mentagrophytes var. Interdigitale . These can occur in athletes, hence the name "athlete's foot". This is due to frequent training, during which the feet are in an environment with increased temperature and humidity. Infection occurs in swimming pools, through shoes, especially rubber socks.

There are 3 types of foot dermatophytosis:

  • interdigital dermatophytosis

Applies mainly to the 3rd and 4th interdigital spaces, the foci are burned, with maceration (damage) of the epidermis.

  • sweat dermatophytosis

There are many bubbles, there may be exudative spots.

  • exfoliating dermatophytosis

You can see hypercarotic foci, numerous cracks; excessively exfoliating lesions can spread to the side surfaces of the feet, then this form is called moccasin mycosis. This form of dermatophytosis may be accompanied by onychomycosis.

The course is usually many years, with exacerbations of the disease. Mycological examination determines the diagnosis of mycosis. When diagnosing hand dermatophytosis, attention should be paid to tinea pedis. Existsbecause the syndrome of "one hand and both feet", where mycosis on the dominant hand is the result of an infection from the feet. Treatment may be local:

  • imidazole derivatives, usually it is recommended to use it twice a day for 4 weeks
  • terbinafine - twice a day for 2 weeks. Terbinafine exhibits anti-inflammatory activity, in order to obtain an anti-inflammatory effect in treatment with imidazole derivatives, they should be combined with mildly acting glucocorticosteroids

or general:

  • terbinafine - 250mg / 24h for 2 weeks
  • intraconazole - 100mg / 24h for 2 weeks or 400mg / 24h (200mg twice a day) for 1 week

In the case of treatment of severe changes, it is recommended to extend the therapy.

Dermatophytosis of smooth skin

In this dermatophytosis, the lesions are erythematous-exfoliating, with the presence of vesicles and pustules, mainly on the periphery. They are characterized by a relatively quick course and disappearance without the presence of scars.

Smooth skin dermatophytosis can be caused by human and animal dermatophytes. Adults and children are sick. Changes caused by zoophilic dermatophytes can be covered with vesicles and pustules all over the surface, while human fungi cause less inflammatory forms.

The location is non-specific, but most often occurs on the bare skin of the hands, face or neck. The onset of the disease is sudden, acute or subacute. The patient may be pruritic, and in some cases it is significant and troublesome.

Mainly external preparations are used, general treatment only in long-term and extensive lesions. Therapeutic regimens such as for athlete's foot, however, there is no need for an additional prolongation of intraconazole use.

Nail dermatophytosis

Symptoms include thickening of the nails, the appearance of furrows, hyperkeratosis, discoloration and brittleness. Nail dermatophytosis is caused by a variety of nail clippers. The risk of developing the disease increases in people with immune disorders and hormonal problems.

The vast majority require general treatment:

  • terbinafine - 250 mg / 24 h for 6 weeks for onychomycosis and 12 weeks for feet, it is well tolerated, shows little interaction with other drugs, there may be transient taste disturbances
  • intraconazole - an alternative to continuous terbinafine therapy is the so-called pulse therapy 400mg / 24h (2x 200mg) for a week (1 week=1 pulse)

Pulses are separated by a 3-week break. Two are required for onychomycosis of the toenailspulses, in the case of feet - three. The substance is well tolerated, but shows many interactions with other drugs. Local treatment is also recommended:

  • nail polishes - amorolfine and ciclopirox

5% amorolfine - once a week for 5-12 months 8% ciclopirox - daily for 5-12 months

  • bifonazole with 40% urea

usually for the treatment of single and altered nail plates.

In situations of advanced dermatophytosis, a combination therapy may prove effective - amorolfine lacquer therapy in combination with oral antifungal drugs - terbinafine and itraconazole. The treatment is recommended in the case of severe mycosis affecting the nail matrix.

In the treatment of onychomycosis, it is very important to disinfect shoes and socks (after treatment) As mycological tests are not always negative then, items should be disinfected again three weeks after treatment.

General principles of the treatment of dermatophytosis

Indications for general treatment:

  • multifocal fungus superficial hairy skin
  • extensive changes on smooth skin, regardless of the type of fungus causing
  • long-term hyperkeratotic mycosis of the feet and hands
  • onychomycosis involving at least a few fingers

Indications for topical treatment only:

  • single outbreaks of zoonotic mycosis, regardless of location, and of superficial smooth skin mycosis
  • tinea pedis, mainly the displacement and potnicia varieties, requires long-term treatment and the use of antifungal powders

Diagnostics of dermatophytoses should be based not only on clinical symptoms, but also on mycological examinations, including direct microscopic examination and breeding.

Mycosis of the nails, due to the introduction of general and local treatment, does not currently require surgical removal of the nail plates.

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Category:

Dermatology