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 legs are characterized by scaling, which is accompanied by itching.In severe lesions, on the background of red and swollen skin, erosions and deep cracks appear on the feet and in the spaces between the toes, which are accompanied by pain and make walking difficult.

The International Classification of Diseases, 10th Revision (ICD-10) code is B35.3.

The advent 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 in the elderly and patients with chronic diseases.

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

According to dermatologists, 10-20% of the adult population suffers 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.Over the age of 70, mycosis of the feet is registered in every second patient, which is associated with an increase in accompanying metabolic and vascular changes (diabetes mellitus, varicose veins, etc.).Mycoses of the legs are more and more often found in children.

Millions of people are currently affected by this disease.Those working in a number of professions are at risk: miners, athletes and the military.

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

Risk factors for athlete's foot:

• Exogenous (external): microtraumas on the skin of the feet (calluses, calluses), cracks, increased sweating, wearing tight shoes, shoes made of artificial materials, non-compliance with the rules of personal hygiene, irregular 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 that reduce the body's general immunity.

Infection with mycosis of the feet can occur directly from a sick person and can be transmitted through contact and household contacts (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 foot mycosis

The main symptoms of foot mycosis:

• 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, turn red, 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 damage to the skin in the form of cracks;
• mycosis of the nails (onychomycosis) - manifested by damage to the nail plates, which become dense and change color;

• diaper rash - weeping areas are formed;
• squamous - lamellar scales appear;
• hyperkeratosis - accompanied by rashes in the form of papules and plaques on the arches of the feet;
• dyshidrotic - proceeds with the development of swelling, wet 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 impact 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 fungi penetrating the skin.It is a multilayered flat 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 exfoliated.

Dermatomycetes produce enzymes - keratinases that destroy keratin.Thanks to this, the fungus penetrates the surface layers of the skin, where it continues 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 of which the desquamation of horny scales from the surface of the skin is delayed and a chronic course of the 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 the feet.
• B37.2 - Candidiasis of the skin and nails.

Classification by location:

• 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:

• Deleted formmanifests itself as peeling in the III-IV interdigital folds of the legs.Minor peeling may also occur on the soles of the feet and sides of the legs.
• Intertriginous formit is manifested by hyperemia in the interdigital folds of the legs, the appearance of bubbles is also possible, which causes the formation of erosions and cracks.Itching and burning are subjectively noted.
• With a dyshidrotic formClustered 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 multichamber blisters.When the bubbles break open, erosions form.
• Squamous-hyperkeratotic formcharacterized by local or widespread thickening of the stratum corneum on the lateral and plantar surfaces of the feet.Affected areas of the skin are covered with small scales similar to pityriasis.Peeling is especially noticeable in skin folds.Cracks cause pain when walking.

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

Based on the clinical picture of the disease, the causative agent of the disease can be assessed.For example, the dyshidrotic form is often found in athlete's foot 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 foot mycosis

• Allergy to fungi.Under the influence of the fungus, polyvalent sensitization is formed, i.e.the body becomes more sensitive to the waste products of fungi, which are foreign to us and are strong allergens.The body reacts more acutely, 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 more often develop occupational allergic complications and drug intolerance.

• Pyoderma- purulent skin diseases (cellulitis, lymphangitis, phlegmon and osteomyelitis of the bones of the foot), which can lead to deep, long-lasting 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 infections, including viral ones.
• General reduction 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 on the nails and skin of the hands.When fungus appears on the nails, they are deformed, ingrowth of the 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 wear 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 picture and laboratory results.Mycoses of the feet are among those diseases that necessarily require laboratory tests to confirm the clinical diagnosis.

The main method for confirming the diagnosis of foot mycosis is microscopic examination and culture.The material is skin flakes that are scraped from the lesion on the skin with a scalpel or glass;a band-aid test is less commonly used.

Laboratory diagnosticsmycoses involves microscopic and cultural examination of material for fungi.Microscopic examinationis an express method for the diagnosis of the pathogen, which allows to identify the structure of the fungus within a few hours.Microscopic examination can reveal fungal elements in the form of mycelial filaments 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: the technique of taking the material, the peculiarities of storage and transportation, etc.

Cultural methodis the most accurate diagnostic method that allows identifying the type of fungus for prescribing pathogenetic therapy.To prepare for the analysis, the patient is not recommended to use any antifungal agents for 1 month.

When prescribing systemic antifungal therapy, it is recommendedbiochemical 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 foot mycosis:

• 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 foot mycosis

The 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 complex therapy (systemic antifungal therapy).At the same time, it is important to have effective drugs that meet the modern clinical characteristics of foot mycoses.

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

• Antifungal agents for external therapy: apply externally 1-2 times a day for 4 weeks.
• In case of significant hyperkeratosis of the feet, exfoliation therapy is first carried out: a drug from the group of azole derivatives 1 time a 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.After that, combined drugs are prescribed 2 times a day externally for 7-10 days.
• Antihistamines are prescribed for severe itching: 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 complete healing;you can use a spray whose active component is undecylenmidopropyltrimonium methosulfate.
• If the nail plates are affected, systemic antifungal therapy should be prescribed orally for a period of 3 to 4 months.This therapy requires supervision by a dermatologist, as self-medication can lead to complications from internal organs, primarily the liver, bile ducts, stomach, as well as ineffectiveness of therapy and 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 fungi indicates a decrease in immunity, and the skin damaged by mycosis practically does not perform a protective function.Thus, all the conditions are created for the addition of a concomitant bacterial infection.

A patient with foot mycosis is an active source of infection for people around him and especially for 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 night you should wash your feet with soap and dry your skin with a disposable paper towel, paying special attention to the space between the 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 on the skin, you should not delay your visit to the doctor.With timely and correct treatment of mycosis of the feetforecastfavorable: a complete recovery from a 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 includes treatment of public places: bathrooms, saunas, pools, showers.Floors, equipment and household items must be disinfected.Staff and persons who frequently visit public baths, saunas, etc., must 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 toenails;
   • wear loose, comfortable shoes;
   • Avoid contact with infected people.

3. Secondary personal prevention:

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