Epidermophytia of the feet

Epidermofitiya stop is a chronic infectious disease. It often begins in adolescents or young people. Men are sick more often. The disease is found in almost all countries of the world.

[1], [2], [3], [4]

Causes of epidermophytosis of the feet

The causative agent of the disease is mainly Tr. Rubrum (80-85%). The share of Trichophyton interdigitale accounts for 10-20% of all pathogens From athlete's foot. Infection occurs with direct contact with a sick person (common bed), but more often indirectly: when wearing shoes, socks, stockings of a patient suffering from epidermophytic stops, as well as in baths, showers, swimming pools, gyms, where exfoliated epidermis and fallen particles of nail fungus destroyed patients can get to the wet skin of a healthy person's feet. Risk factors are hyperhidrosis, flat feet, insufficient hygienic care, wearing tight shoes.

In scales of human skin, arthrospores retain their vital functions for more than 12 months.

Penetration of fungal infection in the skin contributes to the violation of the integrity of the epidermis (microtrauma, rubbing, diaper rash), microcirculation of the lower extremities, endocrine (diabetes mellitus), the immune system, prolonged use of cytostatics, glucocorticosteroids and antibiotics.

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Histopathology

With squamous form of epidermophytia, acanthosis, hyperkeratosis are noted. The stratum corneum 2-3 times thicker than the rest of the epidermis; a shiny layer is usually absent.

With a dyshidrotic form, there are significant acanthosis, hyperkeratosis, focal parakeratosis; in the malpighian layer - intercellular edema with a large number of vesicles - exocytosis, in the upper layers of the dermis - edema, perivascular inflammatory infiltration from lymphocytes, histiocytes, fibroblasts and neutrophilic granulocytes. Threads and chains of mushroom spores are found in the horny and prickly layers of the epidermis.

With onychomycosis in the nail bed, parakeratosis, smoothening of the papilla of the dermis, edema in the reticular layer, infiltrates from lymphoid cells and histiocytes around the vessels are observed. In the horny and parakeratotic masses of the nail bed, the fungal elements are found.

Symptoms of epidermophytosis of the feet

The incubation period is not exactly established. There are several forms of mycosis: squamous, intertriginous, dishydrotic, acute and onychomycosis (nail damage). Possible secondary rashes on the skin - eiidermofitidy (mycids), associated with allergenic properties of the fungus.

With squamous form, scaling of the skin of the arch of the feet is noted. The process can spread to the lateral and flexural surfaces of the toes. Sometimes sites of diffuse thickening of the skin are formed by the type of omozolality, with lamellar ecdysis. Usually patients do not complain about subjective sensations.

Intertriginoznaya form begins with a barely noticeable peeling of the skin in the III and IV interdigital folds of the feet. Then there is an intertrigo with a crack in the depth of the fold, surrounded by exfoliating, whitish color, horny layer of the epidermis, accompanied by itching, sometimes burning. With prolonged walking, cracks can transform into erosion with a wetting surface. In the case of joining the pyococci flora, hyperemia, swelling of the skin develop, itching becomes worse, and soreness appears. The course is chronic, exacerbations are observed in the summer.

With a dyshidrotic form, bubbles appear with a thick horny tire, transparent or opalescent contents ("sago grains"). Bubbles are usually arranged in groups, are prone to fusion, the formation of multi-chambered, sometimes large bubbles with a strained tire. They are usually localized on the vaults, the lower lateral surface and on the contacting surfaces of the toes. After their opening, erosions are formed, surrounded by a peripheral roller of exfoliating epidermis. In case of secondary infection, the contents of the vesicles (blisters) become purulent and lymphangitis and lymphadenitis can occur, accompanied by pain, general malaise, fever.

Acute epidermophytia occurs as a result of a sharp exacerbation of the dyshidrotic and intertriginous forms. It is characterized by the precipitation of a significant number of vesicular-bullous elements on the swollen, inflamed skin of the soles and toes. There are lymphangitis, lymphadenitis, severe local soreness, obstructing walking, high body temperature. On the skin of the body may appear generalized allergic rashes. In clinical practice there is a combination or transition of the above described forms in the same patient.

When the nails are damaged, the nail plates (often the V toes of the feet) become dull, yellowish, uneven, but they retain their configuration for a long time. In the thickness there are spots of yellow color or bands of ocher-yellow color. Over time, most patients develop subungual hyperkeratosis and the nail plate is destroyed, accompanied by the "erosion" of its free edge. Nails on the hands are almost not affected.

Differential diagnosis

The decisive role belongs to the results of microscopic and cultural studies. Clinically, the disease should be distinguished from rubrophytic, superficial pyoderma, contact dermatitis; intertriginoznuyu form - from candidiasis and intertrigo small folds.

[7], [8]