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 peeling accompanied by itching.In case of severe injuries, against the background of reddening and swelling of the skin, erosion and deep cracks are formed in the legs and in the spaces between the toes, which are accompanied by pain and make it difficult to walk.

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

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

Spread of mycosis of the feet.According to the World Health Organization (WHO), about 1/3 of the world's population suffers from fungal diseases, the most common of which are athlete's foot;the number of cases is increasing every year.

According to dermatologists, 10-20% of the adult population suffers from foot mycoses;in men, the disease occurs twice as often as in women, and in older people more often than in young people.Mycosis of the feet is recorded in every second patient over 70 years of age, which is associated with an increase in accompanying metabolic and vascular changes (diabetes, varicose veins, etc.).Foot mycoses are more and more common in children.

Currently, millions of people are suffering from this disease.Workers in a number 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 mycosis of the feet can be caused by fungi of the genus Candida.

Risk factors for athlete's foot:

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

Infection with athlete's foot can occur directly from a sick person and can also be transmitted by contact and household contact (in a swimming pool, bath, gym, through shoes, towels, rugs, etc.).

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

Symptoms of foot mycosis

The main symptoms of foot mycosis:

• itching;
• small cracks;
• erythema;
• stripping;
• 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, turn red, signs of swelling and inflammation appear.Complications can develop in the form of diaper rash and skin eczema.

Types of foot mycosis:

• removed - manifests itself with moderate itching and hyperemia (redness) of the skin;
• acute - accompanied by skin damage in the form of severe itching and cracks;
• mycosis of the nails (onychomycosis) - is manifested by damage to the nail plates that thicken and change color;

• like a diaper - weeping areas are formed;
• squamous - lamellar scales are visible;
• hyperkeratotic - accompanied by rashes in the form of papules and plaques on the arches of the feet;
• dyshidrotic - occurs with the development of swelling, weeping areas and blisters.

Pathogenesis of foot mycosis

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

The epidermis (outer layer of the skin) is the main barrier for fungi to penetrate the skin.It is a multilayered squamous keratinizing epithelium, which in turn consists of five layers and performs a barrier function.Keratinocytes are the main cells of the epidermis.They contain the protein keratin, which forms the outer layer of the skin and gives it elasticity and strength.Keratinized cells of the epidermis are constantly exfoliated.

Dermatomycetes produce enzymes that destroy keratin - keratinases.Thanks to this, the fungi penetrate the surface layers of the skin and continue to exist there.The cell wall of dermatomycetes contains mannans capable of suppressing local cellular immunity.The fungus T. rubrum prevents the proliferation of keratinocytes under the influence of mannans, as a result of which the desquamation of horny scales from the surface of the skin is delayed and the chronic course of the infection develops.

Classification and development stages of foot mycosis

Classification depending on the pathogen:

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

Classification according to ICD-10:

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

Classification by localization:

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

Classification by clinic:

• Deleted formmanifests itself as peeling in the III-IV interdigital folds of the legs.Small crusts can also occur on the bottoms and sides of the feet.
• Intertriginous formit manifests itself with hyperemia in the interdigital folds of the feet, and the appearance of bubbles that cause the formation of erosion and cracks is also possible.Subjectively, itching and burning are noted.
• With dyshidrotic formClustered blisters appear on the skin of the arches and on the lateral surfaces of the feet.More often, they appear on healthy skin, then increase in size, merge and form larger multi-chamber blisters.Erosions are formed when the blisters open.
• Squamous-hyperkeratotic formcharacterized by local or widespread thickening of the stratum corneum of the lateral and plantar surfaces of the feet.The affected areas of the skin are covered with small pityriasis-like scales.Peeling is especially noticeable in skin folds.Cracks cause pain when walking.

The classification according to the clinic is very convenient from a practical point of view for determining the tactics of further treatment and monitoring the patient.

Based on the clinical picture of the disease, the causative agent of the disease can be judged.For example, dyshidrotic form often occurs with foot mycosis caused by Trichophyton mentagrophytes var.interdigitale, the squamous-hyperkeratotic form is more often associated with T. rubrum, the chronic course and widespread process are characteristic of the opportunistic fungus Candida spp.and Aspergillus.

Complications of foot mycosis

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

• Pyoderma- pustular skin diseases (cellulitis, lymphangitis, phlegmon and osteomyelitis of the leg bones) that can cause deep, long-term non-healing skin wounds.Pyoderma occurs due to the fact that bacteria easily penetrate through erosions and cracks in the skin ("doorway of infection").At the same time, the temperature rises, weakness and malaise appear, which requires immediate surgical correction.
• Increase in viral complicationsin the form of warts due to the presence of hyperkeratosis and cracks.The reason is the violation of the protective function of the skin, as a result of which it becomes more sensitive to any infection, including viral infections.
• A general decrease in immunityand impaired microcirculation in the lower limbs 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 fungus occurs, they are deformed, ingrown toenails, panaritium (purulent inflammation of the tissues of the fingers), paronychia (inflammation of the periungual layer) and complete detachment of the nail plates are possible.
• Deterioration of quality of life.Acute forms of mycosis of the foot are painful, make it difficult to put on shoes, and when lymphadenitis develops, it is accompanied by general health and fever.

Diagnosis of foot mycosis

The diagnosis of foot mycosis is based on the patient's complaints, history, clinical picture and laboratory results.Mycosis of the feet is one of the diseases that definitely requires laboratory examination to confirm the clinical diagnosis.

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

Laboratory diagnosticsmycoses include microscopic and cultural examination of the material for fungi.Microscopic examinationis an express method of diagnosing the pathogen, which allows determining the structure of fungi in a few hours.During microscopic examination, fungal elements can be detected in the form of mycelial threads and spores.The disadvantage of the method is that it is possible to get both false-positive and false-negative results, which depends on many factors: material collection technique, storage and transportation characteristics, etc.

Culture methodis the most accurate diagnostic method that allows to determine the type of fungus to prescribe pathogenetic therapy.To prepare for the analysis, the patient is not recommended to use any antifungal agent for 1 month.

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

Differential diagnosis of foot mycosis:

• The squamous form differs from psoriasis, eczema and keratoderma.
• The interdigital form differs from impetigo, diaper rash, and candidiasis.
• Dyshidrotic form differs from palmoplantar pustulosis.

Treatment of foot mycosis

Treatment should be carried out under the supervision of a dermatologist.

The main task in the fight against mycosis of the feet is its timely detection, recognition and treatment before the development of nail fungus, which requires a longer and more complex therapy (systemic antifungal therapy).At the same time, it is important to have effective drugs that match the modern clinical features of foot mycoses.

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

• Antifungal agents for external therapy: applied externally 1-2 times a day for 4 weeks.
• In the case of significant hyperkeratosis of the feet, exfoliative therapy is performed first: a drug from the group of azole derivatives, once a day for 3-4 days, plays a keratolytic role, that is, it removes the rough layer, thereby 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 combined drugs are prescribed externally 2 times a day for 7-10 days.
• Antihistamines are prescribed for severe itching: histamine H blocker₁-receptors – ethanolamine derivative 0.001 g 2 times a day for 10-15 days.
• Disinfect the shoes once a month until they are completely cured;you can use a spray whose active component is undecylamidopropyltrimonium methosulfate.
• If the nail plates are affected, systemic antimycotic therapy should be prescribed orally for 3-4 months.This therapy requires the supervision of a dermatologist, because self-treatment can cause complications from internal organs, primarily 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, it will not go anywhere without treatment, that is, the waste products of the fungus 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 the fungus 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 accompanying bacterial infection.

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

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

Forecast.Prevention

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

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

Preventionfungal infection:

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

2. Primary personal prevention:

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

3. Secondary personal prevention:

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