Rubrophytic skin of the feet, hands, face, nails

Rubrophytia (synonym: rubromycosis) is the most common fungal disease affecting the smooth skin, fingernails, brushes, and fleecy hair.

Causes of the rubrophite

The causative agent of the disease is the   fungus Trichophyton rubrum. The share of this infection accounts for 80-90% of all pathogens pathogens. Infection occurs in the same way as in the epidermophyte of the feet (see epidermophytia of the feet).

Symptoms of the rubrophite

Distinguish the following forms of rubromycosis: pleural fibrosis of the feet, rubromycosis of the feet and brushes, generalized rubromycosis.

Onychomycosis of the feet

Ruberomycosis of the feet is most common. The clinical picture of the disease begins with a lesion of interdigital folds of the feet. Gradually, the process extends to the skin of the soles of the 2nd nail plate (onychomycosis).

The skin of the affected soles is stagnant hyperemic, moderately lichenic, the skin pattern is strengthened, the surface is usually dry; in the furrows there is a rather well expressed mucovidnoe peeling or peeling in the form of small rings and figures of scalloped outlines. Over time, the skin-pathological process passes on the lateral and dorsal surfaces of the feet. Subjectively, itching of the skin, sometimes painful.

In the pathological process, as a rule, the fingernails of the toes are also involved.

There are three types of lesions of the nail plate: normotrophic, hypertrophic and atrophic.

In the normotrophic type, the nail plate is struck from the lateral (or free) edges in the form of bands of white or yellowish color or the same bands that appear through the thickness of the nail plate.

In the hypertrophic type, the nail plate thickens due to subungual hyperkeratosis. It is dull, crumbles from the free edge. In the thickness of it are also visible the mentioned bands.

At an atrophic type, most of the nail plate is destroyed, remaining only partially in the nail roller. Sometimes, the nail plate can be separated from the nail bed by the type of onycholysis.

Ribromycosis of feet and brushes

This form of rubromycosis occurs in patients suffering from mycosis of the feet.

The clinical picture of rubromycosis on the hands is very similar to the manifestation of the foot rhombicosis. The skin-pathological process is much less pronounced due to repeated washing of the hands during the day. Attention is focused on the presence of foci: foci with an intermittent inflammatory ridge on the periphery and on the back surface of the hand, a reddish-cyanotic background of the skin of the palms. Flocculent peeling is observed on the surface of the elements in varying degrees. When involved in the pathological process of the nail plates of the hands, they are also affected by the normotrophic, hypertrophic or atrophic type.

Generalized pulmonary syndromes

The generalization of a fungal infection is observed in patients who suffer from a long-term rubmycosis of the skin of the feet or onychomycosis. The spread of fibromycosis is facilitated by the pathology of the internal organs, the endocrine system, the lack of immunity. The large folds, especially the groin-femoral, buttocks and lower legs, are more often affected, but the foci can also occur in other parts of the skin. In the beginning pink or pink-red spots of rounded outlines appear, with a cyanotic shade, clearly delimited from healthy skin. Later the color of the foci becomes yellowish-red or brown. They are insignificantly infiltrated, their surface is covered with small scales, and on the periphery there is an intermittent scalloped roller, consisting of small papules, vesicles and crusts. As a result of the peripheral growth and merging with each other, the spots occupy vast areas. Deep lesions of the red trichophyton mainly of the shins, buttocks and forearms are considered as a follicular-nodular variety of the disease. The rashes are accompanied by considerable itching, the process is prone to relapse, especially in the warm season. In the generalized form, the hair is damaged. They lose their luster, become dull, break off (sometimes in the form of "black dots").

Importance of the diagnosis of the disease is the detection of the fungus in the microscopic examination of pathological material (scales, gun hair) and planting the material on a nutrient medium to produce a culture of red trichophyton.

The phenomena of generalized rubromycosis develop in most patients after the presence of lesions of the skin and nails of the feet (or feet and brushes) for more or less prolonged periods (from several months to 5-10 years or more) against the background of the pathology of internal organs, the endocrine and nervous system, skin disorders of a trophic nature or due to other changes in the body. For example, the development of generalized manifestations of rubromycosis is often promoted by long-term treatment with antibiotics, cytostatic and steroid drugs.

Red trichophyton causes both superficial and deep lesions of smooth skin, which is sometimes observed in the same patient. So, at the same time there may be rashes in the inguinal and intercostal folds and deep (nodular-nodular) foci on the shins or other areas of the skin.

Deep lesions of the red grichophyton mainly of the shins, buttocks and forearms are considered as follicular-nodular variety of the disease. In this form, along with the papular follicular elements, there are also more deeply located elements that are prone to grouping, arranged in the form of arcs, unclosed tracks and garlands. Rashes are accompanied by considerable itching. The process is prone to relapse, especially in the warm season. Foci of this form of rubromycosis can simulate erythema Bazen erythema, erythema nodosum, papulonrotic tuberculosis (often on the site of foci there are cicatrical changes), knotty vasculitis, deep pyoderma, leukemids and manifestations of other dermatoses. So, for example, with the localization of rubromycosis on the skin of the face, the foci may very much resemble lupus erythematosus, tuberculous lupus, manifestations of staphylococcal sycosis and even pigmentary xeroderm in the elderly.

The generalized rubromycosis, certainly, can proceed and without the formation of deeply located foci. In such cases, lesions in clinical manifestations can be very close to eczema, neurodermatitis, parapsoriasis, psoriasis, ring-shaped granuloma, hair deprivation Devergie, etc. Exudative manifestations of rubromycosis - small bubble rashes and crusts on the feet, hands and other areas of the skin can be observed.

It should be avenged that with exudative manifestations of rubromycosis in a number of patients, secondary (allergic) eruptions that do not contain fungal elements may appear on the skin of the trunk and extremities.

Significantly common forms of rubromycosis, when foci rich red (often with a bluish tinge), merging with each other, have more or less pronounced peeling on the surface. Isolate into clinical varieties of the disease mycotic erythroderma and palmar-sole-inguinal and gluteal syndrome. In this syndrome, observed in many patients with generalized rubromycosis, as a rule, the skin of the feet, palms and nail plates are affected.

Lesions of large folds - interannual, inguinal and femoral, buttock skin, under the mammary glands usually occur after more or less prolonged existence of foci of mycosis on the feet and palms. The foci as if proceed from the depth of large folds, extending to the inner quadrants of the buttocks and further to the outer ones. The surface of the foci is yellowish-red or brown. They are slightly infiltrated, slightly flaky. The edges of the foci slightly rise, having an intermittent scalloped cushion, consisting of small papules and crusts. Usually the roller has a more intense reddish-cyanotic shade than the hearth itself.

Diagnostics of the rubrophite

Very important in the diagnosis of the disease are the detection of the fungus in the microscopic examination of pathological material (scales, gun hair) and sowing the material on a nutrient medium to produce a culture of the red trichophytopa.

The diagnosis of stop (or stop and hand) rugmomycosis is based on a rather characteristic clinical picture and the detection of fungal elements in the foci. But often, especially with erased or atypically occurring rubromycosis, decisive for diagnosing is the result of culture studies. These studies are especially important in the dysgrogitic forms of rubromycosis, which are very reminiscent of (if clinically and not identical to) epidermophytic feet caused by Trichophyton interdigitale.

Differential diagnosis

When conducting a differential diagnosis of fibromycosis, one should keep in mind the superficial (anthropophilic) trichophytosis, as well as the limited forms of infiltrative-suppuration (zoophilic) trichophytosis. It should also be remembered that the rarely observed lesions of the scalp with rubromycosis may resemble foci of microsporia.

Differential diagnosis of pleural musculoskeletal (or stop and hand) in the first place should be performed with epidermophytia of the feet (and epidermophytids), trichophytosis caused by the fungi of the anthropophilic group, palmar-plantar hyperkeratosis, psoriasis and eczema of this localization.

It should be borne in mind that lesions of interdigital folds and nail plates can be caused by yeast-like fungi of the genus Candida, mold fungi, and other dermatophytes.

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Treatment of the rubrophite

Treatment of the epidermophyte of the feet and rubrofitia should be etiotropic, pathogenetic and symptomatic. Begin the treatment with external therapy. In acute inflammatory processes with the phenomena of mocculation appoint lotions from a 2% solution resorcinol, boric acid, 0.25% solution of silver nitrate. Cover the bubbles (bubbles) pierce with a needle or cut with scissors in compliance with the rules of asepsis. Then, solutions of aniline dyes (Kostellani's paint, methylene blue, brilliant greens, etc.) are used. Creams and ointments containing antimycotics (1% cream or derm-gel lamilazil, travogen, zalain, etc.) are prescribed for etiotropic treatment. In the presence of severe inflammation and secondary infection, ointments or creams containing corticosteroids and antibiotics together with aphygicotics ( travocort, gentryderm, triderm, etc.). With the aim of drying out the foci of mocclusion, an antifungal drug is widely used, nitrosfungin-neo in the form of a solution and a spray. Apply lamiril in the form of a derm-gel or 1% cream once a day for 7 days. When using mix forms of lamizil, at the end of therapy in patients with foot mycosis, clinical recovery came in 82%, mycological - in 90% of patients. By the end of the second week, all patients had clinical and mycological recovery. According to many scientists, this pronounced effect is due to lipophilic and keratophile properties of the preparation, rapid penetration and prolonged maintenance of a high concentration of terbinafine in keratinized skin. Lamisil can be used in mycosis of feet complicated by secondary infection, as it is proved that the drug has anti-inflammatory activity as cycloripoxolamine and antibacterial effect as 0.1% gentamycin cream.

With the erythematous squamous form of foot mycosis accompanied by cracks, the use of lamizil in the form of 1% cream for 28 days contributes not only to clinical and mycological cure, but also healing of superficial and deep cracks. Consequently, lamizil in addition to antifungal, antibacterial and anti-inflammatory properties has the ability to stimulate regenerative processes in the skin.

Systematic symptomatic treatment includes the use of desensitizing, antihistamines, sedatives and vitamins, since the causative agents of this fungal infection have pronounced antigenic properties.

If there is no effect from external agents, you should proceed to receive systemic antimycotics.

At present, the following systemic antimycotics are used as etiotropic agents: terbinofin (lamizil), itraconazole (teknazol, orungal), griseofullovin and others.

Lamisil in the epidermophytosis of the feet without lesions of the nail plates is prescribed in a daily dose of 250 mg for 14 days. With mycosis, the stop of itraconazole (tecnazol, orungal) is administered 100 mg once a day for 15 days.

With onychomycosis, stop lamizil appoint 250 mg per day for 3 months, and with onychomycosis of brushes - for 1.5 months. Itracozal (teknazol, orungal) is used 200 mg twice a day for a week (one course), then take a break in 3 weeks. With onychomycosis, stop prescribed 3 courses of treatment, and with onychomycosis of brushes - 2 courses.

Considering the expressed allergenic properties of the pathogen, desensitizing agents and antihistamines, sedatives, B vitamins, rutin, ascorbic acid should be prescribed (especially in the presence of mycids). In the case of secondary pyococcal infection, short-term courses of broad-spectrum antibiotics are indicated.

It is necessary to eliminate concomitant diseases (diabetes mellitus, endocrine, immune disorders, violation of microcirculation of the lower extremities, etc.).

For general prophylaxis, hygienic maintenance and regular disinfection of baths (floors, rugs, wooden bars and pastes, benches, basins), shower rooms and swimming pools, medical examinations of their personnel, timely treatment and medical examination of patients are necessary. Personal prophylaxis consists in using only their shoes, observing the rules of personal hygiene of the skin of feet, disinfecting shoes. Cotton swab moistened with a 25% solution of formalin or a 0.5% solution of chlorhexidine bigluconate, wipe the insole and shoe lining. Then the shoes are placed in a polyethylene bag for 2 hours and then air-dried until dry. Socks, stockings are disinfected by boiling for 10 minutes. In order to prevent relapses of epidermophytosis, the skin of the feet after the disappearance of the manifestations of the disease is lubricated for 2-3 weeks with antimycotics. For the purpose of prevention, nitro fungin-neo is widely used as a solution or spray.