Mycosis of the feet - symptoms and treatment

Mycosis of the feet(dermatophytosis,Tinea pedis) is a skin disease of the feet that is caused by pathogenic or opportunistic fungi.Skin changes on the feet are characterized by peeling, which is accompanied by itching.In case of severe lesions, against 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 walking difficult.

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 mycosis of the feet still remains one of the most significant problems in dermatovenerology.The use of some drugs is limited in older people and patients with chronic diseases.

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

According to dermatologists, 10-20% of the adult population suffer from mycoses of the feet; in men the disease occurs 2 times more often than in women, and in older people more often than in young people.At the age of over 70 years, mycosis of the feet is registered in every second patient, which is associated with an increase in concomitant metabolic and vascular changes (diabetes mellitus, varicose veins, etc.).Increasingly, mycoses of the feet are being detected in children.

Millions of people are currently affected by this disease.Workers in a number of professions 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 mycosis of the feet:

• Exogenous (external): microtrauma of the skin of the feet (calluses, corns), cracks, increased sweating, wearing tight shoes, shoes made of artificial materials, failure to comply with personal hygiene rules, irregular foot washing 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 feet;hypovitaminosis;taking glucocorticosteroids, cytostatic, antibacterial and estrogen-progestin drugs, which reduce the overall immunity of the body.

Infection with mycosis of the feet can occur directly from a sick person, and it can also be transmitted through contact and household contact (in a swimming pool, bathhouse, 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 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 odor;
• 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, and signs of swelling and inflammation appear.Complications may develop in the form of diaper rash and skin eczema.

Types of mycosis of the feet:

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

• diaper-like - weeping areas are formed;
• squamous - lamellar scales appear;
• 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 mycosis of the feet

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 (outer layer of skin) is the main barrier to fungi penetrating the skin.It is a multilayered 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.The keratinized cells of the epidermis are constantly exfoliated.

Dermatomycetes produce enzymes - keratinases, which destroy keratin.Due to this, the fungi penetrate into the surface layers of the skin, where they continue to exist.The cell wall of dermatomycetes contains manans, substances that can suppress local cellular immunity.The fungus T. rubrum, due to the action of manans, 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 mycosis of the feet

Classification depending on the pathogen:

• Keratomycosis (pityriasis versicolor).
• Dermatophytosis (microsporia, superficial trichophytosis, mycosis of the feet, mycosis of smooth skin, mycosis of 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 the hands.
• B35.3 - Mycosis of the feet.
• B37.2 - Candidiasis of the skin and nails.

Classification by localization:

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

Classification by clinic:

• Erased formmanifests itself as peeling in the III–IV interdigital folds of the feet.Minor peeling may also occur on the soles and sides of the feet.
• Intertriginous formmanifested by hyperemia in the interdigital folds of the feet, and the appearance of bubbles is also possible, which cause the formation of erosions and cracks.Subjectively, itching and burning are noted.
• With dyshidrotic formGrouped blisters appear on the skin of the arches and lateral surfaces of the feet.More often they appear on healthy skin, then increase in size, merge and form larger multi-chamber blisters.When the blisters open, erosions form.
• 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.The cracks cause pain when walking.

Classification by clinic is very convenient from a practical point of view for determining further treatment tactics and monitoring the patient.

Based on the clinical picture of the disease, one can judge the causative agent of the disease.For example, the dyshidrotic form often occurs with mycosis of the feet 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 opportunistic fungi Candida spp.and Aspergillus.

Complications of mycosis of the feet

• Allergy to fungus.Under the influence of fungi, polyvalent sensitization is formed, i.e. the body becomes more sensitive to the waste products of the fungus, 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.The development or worsening of pathologies such as bronchial asthma, allergic dermatitis, seborrheic dermatitis and psoriasis is possible.In addition, a person may more often develop occupational allergic complications and drug intolerance.

• Pyoderma- pustular skin diseases (cellulitis, lymphangitis, phlegmon and osteomyelitis of the bones of the foot), which can lead to deep, long-term non-healing skin wounds.Pyoderma occurs due to the fact that bacteria easily penetrate through erosions and cracks in the skin (the “gate 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 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 in immunityand impaired microcirculation in the lower extremities in patients with concomitant somatic diseases, such as diabetes mellitus and varicose veins.
• Spread of the disease to the nails and skin of the hands.When nail fungus occurs, they become 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 in quality of life.Acute forms of mycosis of the feet are painful, make it difficult to wear shoes, and when lymphadenitis develops, they are accompanied by poor general health and fever.

Diagnosis of mycosis of the feet

Diagnosis of mycosis of the feet is based on the patient’s complaints, medical history, clinical picture and laboratory results.Mycoses of the feet are among those diseases that necessarily require laboratory testing 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, which are scraped off from the lesion on the skin with a scalpel or glass; less commonly, an adhesive tape test is used.

Laboratory diagnosticsmycoses includes microscopic and cultural examination of material for fungi.Microscopic examinationis an express method for diagnosing the pathogen, allowing one to identify the structure of fungi within a few hours.Microscopic examination may reveal fungal elements in the form of mycelial threads and spores.The disadvantage of the method is that it is possible to obtain both false-positive and false-negative results, which depends on many factors: the technique of taking the material, the peculiarities of storage and transportation, etc.

Culture methodis the most accurate diagnostic method, allowing one to identify the type of fungus for prescribing pathogenetic therapy.To prepare for the analysis, the patient is not recommended to use any antifungal agents on his own for 1 month.

When prescribing systemic antifungal therapy, it is recommended tobiochemical blood testto 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 mycosis of the feet:

• The squamous form is differentiated from psoriasis, eczema, and keratoderma.
• The interdigital form is differentiated from impetigo, diaper rash and candidiasis.
• The dyshidrotic form is differentiated from palmoplantar pustulosis.

Treatment of mycosis of the feet

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

The primary task in the fight against mycosis of the feet is its timely detection, recognition and treatment 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 mycoses of the feet.

Before starting treatment for a disease, the dermatologist chooses between possible treatment options.In most cases, drugs are prescribed for topical use.The basis of treatment is the use of antifungal agents that have diverse 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 significant hyperkeratosis of the feet, exfoliating therapy is first carried out: 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, 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 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 shoes once a month until completely cured; you can use a spray whose active component is undecylenamidopropyltrimonium methosulfate.
• If the nail plates are affected, systemic antimycotic therapy orally must be prescribed for a duration of 3 to 4 months.This therapy requires supervision by a dermatologist, since self-medication can lead to complications from internal organs, primarily the liver, biliary tract, stomach, as well as to the ineffectiveness of the therapy and the formation of resistance to treatment.

It is necessary to treat mycosis of the feet, because if the fungus has settled in 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 fungus indicates a decrease in immunity, and 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 mycosis of the feet 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 humid environment, so you need to try to keep the skin of your feet always dry.To do this, every evening you need to wash your feet with soap and dry your skin with a disposable paper towel, paying special attention to the space between your toes.

Forecast.Prevention

The prognosis for cutaneous mycoses largely depends on the stage of the disease at which treatment was started.Therefore, if you notice changes in the skin, you should not postpone 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 left untreated, 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.

Preventionfungal infection:

1. Public prevention involves treating 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. should undergo regular preventive examinations.

2. Primary personal prevention:

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

3. Secondary personal prevention:

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