Mycosis of the feet - symptoms and treatment

Mycosis of the feet(dermatophytosis,Tinea pedis) is a skin disease of the feet caused by pathogenic or opportunistic fungi.Skin changes on the feet are characterized by peeling, which is accompanied by itching.In the case of severe lesions, on the background of red and swollen skin, erosions and deep cracks appear on the soles of 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 mycoses still remain one of the most significant problems in dermatovenerology.The use of some drugs is limited in the elderly and patients with chronic diseases.

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

According to dermatologists, 10-20% of the adult population suffers from foot mycosis;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, foot mycosis 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 feet are being detected more and more often in children.

Millions of people are currently affected by this disease.Workers in numerous professions are at risk: miners, athletes and military personnel.

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

Risk factors for foot mycosis:

• Exogenous (external): microtraumas of the skin of the feet (calluses, corns), cracks, increased sweating, wearing tight shoes, shoes made of artificial materials, non-observance of personal hygiene rules, irregular foot washing and poor drying with a towel.
• Endogenous (internal): varicose veins and vegetovascular dystonia, which lead to insufficient blood supply to the skin of the feet;hypovitaminosis;taking glucocorticosteroids, cytostatics, antibacterial and estrogen-progestin drugs, which reduce the body's overall immunity.

Infection with mycosis of the foot can occur directly from a sick person, and it can also be transmitted through contact and household contact (in the swimming pool, bathroom, gym, through shoes, towels, mats, etc.).

If you notice similar symptoms, contact 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 sharp 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, redden, signs of swelling and inflammation appear.Complications in the form of diaper rash and skin eczema may develop.

Types of foot mycosis:

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

• nappy-like - weeping spots are formed;
• squamous - lamellar scales appear;
• hyperkeratotic - accompanied by a rash in the form of papules and plaques on the arches of the feet;
• dyshidrotic - occurs with the development of swelling, weepy areas and blisters.

Pathogenesis of foot mycosis

The skin is the largest organ in the human body and makes up 15% of the total body weight.It performs many functions, first of all, it protects the body from the action 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 the skin) is the main barrier to fungi penetrating the skin.It is a multi-layered squamous keratinizing epithelium, which, in turn, consists of five layers and acts 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, which destroy keratin.Because of this, the fungi penetrate into the surface layers of the skin, where they continue to exist.The cell wall of dermatomycetes contains mannans, substances that can suppress local cellular immunity.The fungus T. rubrum, through the action of mannan, prevents the proliferation of keratinocytes, which slows down the desquamation of horny scales from the surface of the skin and develops a chronic course of infection.

Classification and stages of development of foot mycosis

Classification depending on the pathogen:

• Keratomicosis (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 - Nail mycosis.
• B35.2 - Mycosis of hands.
• B35.3 - Mycosis of the feet.
• B37.2 - Candidiasis of skin and nails.

Classification according to localization:

• Mycosis of the skin.
• Mycosis 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 foot.Minor scaling can also occur on the soles and sides of the feet.
• Intertriginous formit is manifested by hyperemia in the interdigital folds of the feet, and the appearance of bubbles that cause the formation of erosions and cracks is also possible.Itching and burning are subjectively noticed.
• With a dyshidrotic formClustered blisters appear on the skin of the arches and lateral surfaces of the feet.They appear more often on healthy skin, then enlarge, merge and form larger multichamber blisters.When the blisters open, erosions occur.
• 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 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 treatment tactics and monitoring the patient.

The causative agent of the disease can be judged on the basis of the clinical picture of the disease.For example, the dyshidrotic form often occurs in foot mycoses 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 fungi, polyvalent sensitization occurs, that is, the organism becomes more sensitive to waste products of fungi, which are foreign to us and are strong allergens.The organism reacts more sharply, 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 develop occupational allergic complications and drug intolerance more often.

• Pyoderma- pustular skin diseases (cellulitis, lymphangitis, phlegmon and osteomyelitis of the bones of the foot), which can lead to deep, long-term non-healing wounds on the skin.Pyoderma occurs due to the fact that bacteria easily penetrate through erosions and cracks in the skin ("gateway of infection").At the same time, the temperature increases, weakness and malaise appear, which requires urgent surgical correction.
• An increase in the number of viral complicationsin the form of warts due to the presence of hyperkeratosis and cracks.The reason is the violation of the protective function of the skin, due to which it becomes more sensitive to any infection, including viral.
• General reduction of immunityand impaired microcirculation in the lower extremities in patients with accompanying somatic diseases, such as diabetes mellitus and varicose veins.
• The spread of the disease to the nails and skin of the hands.With the appearance of nail fungus, deformation occurs, an ingrown nail, panaritium (purulent inflammation of the finger tissue), paronychia (inflammation of the periungual fold) and complete separation of the nail plates are possible.
• Deterioration of the quality of life.Acute forms of foot mycosis 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 foot mycosis is made based on the patient's complaints, history, clinical picture and laboratory results.Foot mycoses are among those diseases that necessarily require laboratory tests to confirm the clinical diagnosis.

The main method of confirming the diagnosis of foot mycosis is microscopic examination and culture.The material is skin flakes, which are scraped from the skin lesion with a scalpel or glass;the adhesive tape test is used less often.

Laboratory diagnosticsmycosis includes microscopic and cultural examination of material for fungi.Microscopic examinationis an express method for diagnosing pathogens, which enables the identification of the structure of fungi within a few hours.Microscopic examination can 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 transport, etc.

Culture methodis the most accurate diagnostic method, which enables identification of the type of fungus for prescribing pathogenetic therapy.In order to prepare for the analysis, the patient is not recommended to use any antifungal agents independently for 1 month.

When prescribing systemic antifungal therapy, it is recommended thatbiochemical blood testto determine the level of bilirubin, AST and ALT in connection with the need to monitor the function of the liver and bile ducts, as well as to prevent possible complications.

Differential diagnosis of foot mycosis:

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

Treatment of foot mycosis

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

The primary task in the fight against foot mycosis 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 match the modern clinical characteristics of foot mycosis.

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

• Antifungal agents for external therapy: applied externally 1-2 times a day for 4 weeks.
• In the case of significant hyperkeratosis of the feet, peeling therapy is first carried out: a drug from the group of azole derivatives, once a day for 3-4 days, which has a keratolytic effect, that is, removes the rough layer, 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.
• 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 they are completely healed;you can use a spray whose active component is undecylenamidopropyltrimonium methosulfate.
• If the nail plates are affected, systemic antimycotic therapy must be prescribed orally for 3 to 4 months.This therapy requires the supervision of a dermatologist, because self-medication can lead to complications on the internal organs, primarily the liver, bile ducts, stomach, as well as to the ineffectiveness of therapy and the formation of resistance to treatment.

It is necessary to treat mycosis of the feet, because if the fungus is located 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 skin damaged by mycosis practically does not perform a protective function.Thus, all conditions are created for the addition of accompanying bacterial infection.

A patient with foot mycosis is an active source of infection for people around him, especially for family members, so treatment in this case is an effective means of preventing fungal infection in 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 must try to keep the skin of the feet dry.To do this, every night you need to wash your feet with soap and dry the skin with a disposable paper towel, paying special attention to the space between the toes.

Forecast.Prevention

The prognosis for cutaneous mycosis largely depends on the stage of the disease in which the treatment was started.Therefore, if you notice changes on the skin, do not delay the visit to the doctor.With timely and proper treatment of foot mycosisforecastfavorable: there is a complete recovery from the fungal infection, 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.

Preventionyeast infection:

1. Public prevention means treating public places: bathrooms, saunas, swimming pools, showers.Floors, equipment and household items must be disinfected.Staff and people who frequently visit public baths, saunas, etc.they should undergo regular preventive examinations.

2. Primary personal prevention:

   • observe the rules of personal hygiene when visiting public places;
   • avoid damage and constant moisture of 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.