EPIDERMOFITYYa (epidermophytia; Greek epi-on, atop + derma skin + phyton a plant) — a fungal infection of smooth skin and nails. In a crust, time the term «epidermophitia» designate two mycoses — an inguinal epidermophitia and an epidermophitia of feet, to-rye have a different etiology.
Epidermophitia inguinal. F. Geb a swarm under the term «the bordered eczema» was for the first time described in 1860. In 1907 Saburo allocated and described an infestant, having called it Epidermophyton inguinale; further the activator received the name «Epidermophyton floccosum (Harz) Langeron, Milochevitch (1930)». The fungus belongs to the class Fungi imperfecti, the sort Epidermophyton. In scales of the affected skin and particles of nails fungi find in the form of septirovanny branching short (2 — 4 microns) the mycelium which is well refracting light and located with chains rectangular an artrospor. On Saburo's circle the colony of the activator begins to grow on 6 — the 7th day, has the rounded, dome-shaped shape, a friable and fluffy consistence and yellowish color. At microscopic examination of culture of a fungus the equal septirovanny light mycelium with the blunt-pointed macroconidiums which are located on the ends of a mycelium with groups in the form of clusters of bananas is visible (see Fungi parasitic).
Development of a disease is promoted by disturbances of a carbohydrate lipometabolism, high temperature of the environment and the increased sweating, maceration of skin therefore inguinal E. meets in regions more often with a hot humid climate where common forms of mycosis quite often are registered.
Infection inguinal E. occurs usually through objects of use, to-rymi the patient (basts, bed-pans, kleetsk, thermometers, linen) used, and also at non-compliance with rules of hygiene in baths, shower. More often men are ill.
At inguinal E. in epidermis the parakeratosis (see), an acanthosis (see), quite often intraepidermalny bubbles, focal accumulations of leukocytes and lymphoid cells is noted; in a derma — the small infiltrates consisting of leukocytes and lymphoid cells; around vessels and sweat glands single epithelial cells come to light. At sharply expressed inflammation gistol. the picture can remind eczema (see). The activator is found in a corneous layer of epidermis, it is rare in infiltrates.
The clinical picture is characterized by emergence on skin of pink
Fig. 1. Pas -
Hove - a femoral fold a sick inguinal epidermophitia: the center vos
a palitelny erythema with on-litsiklichesky outlines.
the shelled spots of 0,5 in size — 1 cm in the diameter. They expand on the periphery at simultaneous the razreshenii'vospalitelny phenomena in the center, turning into larger (to 8 — 10 cm in the diameter) ring-shaped inflammatory spots of red or red-brown color. At their merge the centers of polycyclic outlines (fig. 1) with sharp borders and the edematous hyperemic peripheral roller are formed, on Krom there are vesicles and pustules. Most often skin of inguinal folds, scrotums, an inner surface of hips is surprised, is more rare than a mezhjyago-dichny fold, axillary areas, folds under mammary glands. In nek-ry cases the centers of defeat can arise in interdigital folds of feet, skin of a trunk, etc. In rare instances nail plates of fingers of feet are involved in process (spots of yellow color in the thickness of a nail, a hyponychial hyperkeratosis are noted). Patients are disturbed by an itch, burning in the centers of defeat. The course of mycosis in the beginning acute, without treatment passes into chronic.
Diagnosis inguinal E. establish on the basis of characteristic a wedge, pictures and detection of elements of a fungus in scales of skin and particles of nails. Finally allocation of culture E confirms the diagnosis. floccosum.
Differential diagnosis is carried out with a rubrofitpiya * (see), an erythrasma (see), an intertrigo (see), eczema (see), superficial candidiasis of large folds and smooth skin (see Candidiasis).
At treatment in the acute period apply outwardly lotions from 0,25% of solution of silver nitrate, 1% of solution of resorcin; inside appoint 10% solution of calcium chloride and antihistaminic substances (see). In the absence of the phenomena of eczematizations (vesicles, pustules) the centers within 5 — 7 days grease 1 — 2% with spirit solution of iodine, then within 2 — 3 weeks — 3 — 5% serno-degtyar-ache ointment, Mycosolonum and mikosep-tiny.
Primary prevention inguinal E. consists in observance of rules of personal hygiene, fight against perspiration, correction of disturbances of exchange. For prevention of a recurrence of a disease skin on site of the resolved centers of defeat in the absence of contraindications is greased daily within 3 weeks by 2% with spirit solution of iodine, carry out careful disinfection of objects of use, to-rymi the patient used.
An epidermophitia of feet (the mycosis caused by Trichophyton mentag-rophytes var. interdigitale, epider-mofitoz, athletic foot, mycosis of feet). The disease was for the first time described by N. P. Mansurov in 1890, its fungal nature established Kaufmann-Wolf (M. Kaufmann-Wolf) in 1914; the fungus allocated with it was called Epidermophyton Kaufmann-Wolf. Further the fungus received the name «Trichophyton mentagrophytes (Robin) Blanchard (1896) var. interdigitale». An infestant find in scales of skin, scraps of matseri-rovanny epidermis, tires of bubbles and scrapings from the struck nail plates in the form of threads of the branching mycelium which is often breaking up to roundish and square artrospor; sometimes chains and small groups a dispute meet (is more often in material from nail plates).
At crops on Saburo's circle on 4 — the 5th day the colony of the activator begins to grow in a type of a white fluffy lump, for the 10th day the colony has a diameter of 20 — 40 mm. Gradually it becomes dome-shaped, powdery, creeping, gains cream color. At microscopic examination the thin, long, branchy, septirovanny mycelium comes to light; on each side it odinochno and clusters roundish, oval or pear-shaped microconidiums of 2 in size — 3 microns are located. Blunt-pointed, multichamber (5 — 6-cellular) macroconidiums have the form of cigarettes, the size 5 — 7 microns of X 20 — 30 microns; many curls and spirals are noted; intercalary and terminal chlamydospores meet.
The disease is eurysynusic almost worldwide. Especially often occurs among athletes, in particular at swimmers («stop of the athlete», «stop of the athlete»), and also bathhouse attendants, metallurgists, miners and other persons whose profession is connected with long wearing footwear in the conditions of the elevated temperature and humidity of the environment that results in the increased perspiration of feet.
A number of researchers carries T. interdigitale to pathogenic fungi, nek-ry — to opportunistic,
gaining pathogenic properties only at the increased humidity of the respective sites of skin of feet and their macerations. The last explains preferential localization of process in interdigital folds of feet and an exacerbation of a disease in hot season at the increased perspiration. However, considering measures of prevention and a way of transfer of the activator, before the final decision of a question of pathogenicity of a fungus, it is reasonable to carry it to pathogenic.
To development E. disturbance of an integrity of skin on feet (an intertrigo, an injury, an attrition), flat-footedness, narrowness of interdigital intervals, long wearing rubber footwear, disturbance of a tone of vessels of the lower extremities, dysfunctions of nervous and endocrine systems, immunological insufficiency promotes. Pathogenic T. interdigitale has the expressed allergenic properties; existence causes them emergence of an allergic enanthesis, facilitates accession of consecutive infection and development of complications. Immunity after the postponed mycosis does not develop.
Patients E are a source of an infection. stop, and also objects contaminated by fungi which were in their use. Infection occurs at direct contact with the patient, is more often in places of general use (e.g., a bath, a shower, the swimming pool, the gym). The warm wet environment promotes infection, especially at non-compliance a dignity. - a gigabyte. mode (unsatisfactory and untimely cleaning of the room, bad drain of water, use of wooden floorings, benches). Fungi it is long remain in wet doormats, mats, basts, insoles of footwear, on objects of care of skin.
At an epidermophitia of feet in an acanthceous layer of epidermis are noted spongiosas with formation of multichamber bubbles and an acanthosis; in a papillary layer of a derma — infiltrates around vessels. Elements of a fungus find in horn, granular, is more rare acanthceous layers of epidermis. At an onychomycosis (see) the parakeratosis, smoothness of nipples, hypostasis in a mesh (reticular) layer of a derma, the infiltrates around vessels of a bed of a nail consisting of lymphoid cells and histiocytes is observed; in horn masses the mycelium of a fungus which is breaking up to artrospor comes to light.
Clinically distinguish squamous, intertriginozny, disgidro-tichesky, acute forms E. stop and epidermophitia of nails. Squamous E. stop is shown by a melkoplastinchaty peeling of skin of side, flexion surfaces of fingers
Sh interdigital folds of feet. Sometimes this form is combined with the centers of a diffusion hyperkeratosis of skin in the form of callosities (skvamozno-gi-
Fig. 2. Foot of the patient with an intertrigi-nozny epidermophitia of feet: to
zha interdigital folds of a matseriro-van, defeat reminds an intertrigo.
perkeratotiche-Skye version). In some cases the peeling is hardly noticeable, and small surface cracks in the middle of interdigital folds do not cause subjective feelings (the erased version).
Intertriginozny E. stop reminds an interdigital intertrigo (fig. 2); most often it develops pleated between IV and V, is more rare between III and IV fingers of feet where there is a crack surrounded with the exfoliating whitish corneous layer of epidermis. The narrowness of intervals in interdigital folds promotes development of the increased humidity of skin, alkalization of sweat, favors to development of a fungus. Wearing close footwear and long walking are the reason of transformation of surface cracks into an erosion with the becoming wet surface, accessions of secondary piokok-kovo-barmy flora that leads to strengthening of the inflammatory phenomena, emergence of a hyperemia, puffiness, an itch, a dermatalgia in the center of defeat.
Disgidroticheskaya E. of feet develops on the arches, side surfaces and fingers of feet where bubbles with a thick horn tire appear. Usually they are grouped, can merge, forming multichamber large bubbles with nap-
Threshing barns. 3. Feet of the patient with a disgidrotiche-sky epidermophitia of feet: 1 — multiple erosion; 2 — the exfoliating corneous layer of skin.
a masked tire and serous, muddy or purulent (at the expense of the joining piokokkovy flora) to contents. During the opening of bubbles and bubbles the erosion (see) surrounded with the exfoliating corneous layer of skin (fig. 3) are bared. Patients can have limfangiita (see), lymphadenites (see), fervescence and disturbance of the general state is noted.
Acute E. stop results from accession of piokokkovy flora and an aggravation disgidrotiches-which, is more rare intertriginozny E. stop. At acute E. stop appears a significant amount of vezikuleznobullezny elements on soles and fingers of both feet that is followed by their puffiness, inguinal lymphadenitis, generalized allergic rashes (miki-da), substantial increase of body temperature, a headache, a febricula.
At an epidermophitia of nails nails of big (fig. 4) and
Fig. 4 in most cases are surprised. Damage of a nail of the I finger of the left foot at the patient with an epidermophitia of feet: color of edge of a nail plate is changed, transparency of a nail plate is lost.
The V fingers of feet that is connected with their greatest traumatization footwear. Nails of fingers of hands are not surprised. Process proceeds slowly. In the beginning the free edge of a nail is surprised, the outer surface to-rogo a long time does not change the configuration. In the thickness of a nail spots or strips of yellow, ocherous-yellow or canary-yellow color are illuminated. At the expressed hyponychial hyperkeratosis the reinforced nail crumbles; a lysis of a nail plate is noted seldom. Damage of nails can be isolated or (is more often) be combined with damage of skin.
Approximately at 60% of patients disgid-rotichesky less often at patients with an intertriginozny form E. stop at an aggravation of process there are mi-kida — toksiko-allergic rashes. In their emergence the essential role belongs to neuroreflex mechanisms of limfogematogenny dissimination of a fungus in sensibilized skin. Rashes can be spotty (scarlatiniform), papular, Ur-tikarnymi, vesicular. Mikey-dy can have regional (e.g., news agency to skin of extremities) or generalized (on all skin) an arrangement. Elements of a fungus in mikida, as a rule, are not found.
The diagnosis establish on the basis a wedge, the picture confirmed with results a lab. researches (detection of a fungus in patol. material — tires of bubbles, scales of skin, pieces of the affected nails, and then allocation of culture of T. interdigitale at crops on Saburo's circle).
Differential diagnosis is carried out with a tinea (see), candidiasis (see), eczema (see), a pyoderma (see), an intertrigo (see), contact dermatitis (see).
Treatment at all forms of an epidermophitia of feet consists in use of fungicidal and anti-inflammatory drugs. At the expressed inflammatory phenomena appoint desensibilizing and sedatives, vitamins of group B, Rutinum, ascorbic to - that, at accession of consecutive infection — short-term courses of antibiotics of a broad spectrum of activity. Locally apply cold lotions from 1 — 2% of solution of resorcin to removal of the acute inflammatory phenomena, 0,1% of solution of Aethacridinum of a lactate. (Rivanolum), solution of potassium permanganate (1: 6000 — 1: 8000), 0,25% of solution
of silver nitrate, then wet you - sykhayushchiye the bandages impregnated with these solutions. Tires of bubbles (bubbles) cut with observance of rules of an asepsis. During the subsiding of the inflammatory phenomena use fungicidal drugs — Castellani's liquid (fukortsin), 2% spirit solution of iodine, 1 — 2% spirit solutions of aniline dyes (e.g., methylene blue), Undecinum, miko-septin, Mycosolonum, ointments containing sulfur, tar (2 — 5%), salicylic to - that (2 — 3%). In the absence of acute inflammatory process treatment is carried out only by fungicidal means.
At defeat of nail plates (an epidermophitia of nails) an indispensable condition of successful treatment is removal of the struck nail plate after a softening keratolytic means (20% ureaplast) and careful treatment of a nail bed fungicidal drugs.
Primary prevention consists in observance of rules of personal hygiene, use of individual footwear, fight against a hyperhidrosis. Observance dignity. - a gigabyte. the mode in baths, pools, shower, hairdresser's. For prevention of a recurrence of mycosis skin of feet after disappearance a wedge, displays of a disease grease within 2 — 3 weeks 2% with the spirit solution of iodine, ointments containing 2 — 3% of sulfur and tar, Nitrofunginum, Zincundanum, mikoseptiny and other antifungal drugs.
Patients E. stop after the end of treatment stay on the dispensary registry during 1 year.
Bibliography: Ariyevich A. M. and III e-tsiruli JI. T. Patologiya of nails, page 78, Tbilisi, 1976; To and sh to and N P. N. and Lisin V. V. Practical guidance on a medical mycology, L., 1983; Kashkin P. N. and Shekla-k about in N. D. Guide to a medical mycology, page 63, M., 1978; Leshchenko V. M. Laboratory diagnosis of fungus diseases, page 81, M., 1982; Hebra F. Das umschriebene Eczem, Eczema marginatum, Handb. spec. Path, u. Ther., hrsg. v. R. Virchow, Bd 3, Abt. 1, S. 361, 1860; R a mesh V. o. Cli-nico-mycological study of onychomycosis, Indian J. Derm. Venereol., v. 48, p.
145, 1982, bibliogr. V. M. Leshchenko.