Foot mycosis - symptoms and treatment

Foot mycosis(dermatophytosis,Tinea pedis) is a skin disease of the feet caused by pathogenic or opportunistic fungi.Changes in the skin of the feet are characterized by peeling, accompanied by itching.In the case of serious injuries, against 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 code according to the International Classification of Diseases, 10th revision (ICD-10) is B35.3.

The emergence of modern antifungals has improved the epidemiological situation, but foot mycosis still remains one of the most significant problems in dermatovenerology.The use of some medications is limited in the elderly and patients with chronic diseases.

Prevalence of foot mycosis.According to the World Health Organization (WHO), around 1/3 of the world's population suffers from fungal diseases, the most common of which are foot mycoses;the incidence is growing 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 young people.From the age of 70, every second patient has mycosis of the feet, which is associated with an increase in concomitant metabolic and vascular changes (diabetes mellitus, varicose veins, etc.).Increasingly, foot mycoses are being detected in children.

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

Causes of foot mycosis.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 fungi of the genus Candida.

Risk factors for foot mycosis:

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

Foot mycosis infection can occur directly from the patient, and can also be transmitted through contact and household contact (in a swimming pool, spa, gym, through shoes, towels, rugs, etc.).

If you notice similar symptoms, see your doctor.Do not self-medicate - it is dangerous to your health!

Symptoms of foot mycosis

The main symptoms of foot mycosis:

• itch;
• small cracks;
• erythema;
• peeling;
• bubbles;
• keratinization of the skin;
• unpleasant, pungent odor;
• burning sensations and pain.

The first signs of foot mycosis 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 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 skin damage in the form of cracks;
• nail mycosis (onychomycosis) - manifested by damage to the nail plates, which thicken and change color;

• similar to diapers - weeping areas are formed;
• scaly - 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, watery areas and blisters.

Pathogenesis of foot mycosis

The skin is the largest organ in the human body, representing 15% of total body weight.It performs several functions, firstly, 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 is made up of three layers: epidermis, dermis and subcutaneous fat.

The epidermis (outer layer of the skin) is the main barrier for fungi to penetrate the skin.It is a multilayered keratinized squamous epithelium, which, in turn, is composed 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.Because of this, the fungi penetrate the superficial 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 manans, prevents the proliferation of keratinocytes, as a result, the desquamation of horny scales from the surface of the skin becomes slower and a chronic course of infection develops.

Classification and stages of development of foot mycosis

Classification depending on the pathogen:

• Keratomycosis (pityriasis versicolor).
• Dermatophytosis (microsporia, superficial trichophytosis, mycosis of the feet, mycosis of smooth skin, mycosis of the inguinal folds, onychomycosis).
• Candidiasis (candidiasis of the skin, nails).
• Deep mycoses (blastomycosis, sporotrichosis, chromomycosis).

Classification according to ICD-10:

• B35.1 - Nail mycosis.
• B35.2 - Ringworm of the hands.
• B35.3 - Mycosis of the feet.
• B37.2 - Candidiasis of the skin and nails.

Classification by location:

• Skin mycosis.
• Mycosis of the folds.
• Mycosis of the hands.
• Mycosis of the feet (scaly, hyperkeratotic, intertriginous, dyshidrotic form).
• Onychomycosis (distal, superficial, proximal).

Classification by clinic:

• Form deletedmanifests as peeling on the III-IV interdigital folds of the feet.Small peelings may 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 blisters is also possible, which causes the formation of erosions and fissures.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-chambered blisters.When the bubbles open, erosions form.
• Squamous-hyperkeratotic formcharacterized by local or generalized 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.The cracks cause pain when walking.

Classification by clinic is very convenient from a practical point of view for determining new 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 most often associated with T. rubrum, the chronic course and generalized process are characteristic of the opportunistic fungi Candida spp.and Aspergillus.

Complications of foot mycosis

• Fungus allergy.Under the influence of fungi, polyvalent sensitization is formed, that is, the body becomes more sensitive to fungal residues, which are foreign to us and are strong allergens.The body reacts more sharply, which is manifested by various rashes and skin 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 frequently develop occupational allergic complications and drug intolerance.

• Pyoderma- pustular skin diseases (cellulitis, lymphangitis, phlegmon and osteomyelitis of the bones of the foot), which can cause deep, long-lasting skin wounds that do not heal.Pyoderma occurs due to the fact that bacteria easily penetrate through erosions and cracks in the skin (the “gateway to 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 fissures.The reason is a violation of the protective function of the skin, making it more susceptible to any infections, 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, making 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 possible.
• Deterioration in quality of life.Acute forms of foot mycosis are painful, make it difficult to wear shoes and, when lymphadenitis develops, are accompanied by general health problems and fever.

Diagnosis of foot mycosis

The diagnosis of foot mycosis is based on the patient's complaints, medical 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 to confirm 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;less commonly, a sticky tape test is used.

Laboratory diagnosismycoses includes microscopic and cultural examination of material in search of fungi.Microscopic examinationIt is an express method for diagnosing the pathogen, allowing the structure of the fungi to be identified in 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 false positive and false negative results, which depends on many factors: the technique for removing the material, the peculiarities of storage and transportation, etc.

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

When prescribing systemic antifungal therapy, it is recommendedbiochemical blood testdetermine the level of bilirubin, AST and ALT due to the need to monitor the function of the liver and biliary tract, as well as prevent possible complications.

Differential diagnosis of foot mycosis:

• The scaly 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.

Foot mycosis treatment

Treatment must 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 longer and more complex therapy (systemic antifungal therapy).At the same time, it is important to have effective medications that correspond to the modern clinical characteristics of foot mycoses.

Before starting treatment for a disease, the dermatologist chooses between possible treatment options.In most cases, medications are prescribed for topical use.The basis of treatment is the use of antifungal agents that have 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 case of significant hyperkeratosis of the feet, exfoliating therapy is first performed: a medication from the group of azole derivatives, once a day for 3-4 days, which acts as a keratolytic, that is, it removes the rough layer, thus preparing the skin and improving the penetration of antifungals 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 the combined medicines 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 twice 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, oral systemic antimycotic therapy should be prescribed for a period of 3 to 4 months.This therapy requires supervision by a dermatologist, as self-medication can lead to complications of internal organs, especially the liver, bile ducts, stomach, as well as 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 on the skin, without treatment it will not go anywhere, which means that the residues 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 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 family members, therefore 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 dry.To do this, every night 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 of cutaneous mycoses largely depends on the stage of the disease at which treatment was started.Therefore, if you notice changes in your skin, you should not postpone seeing a doctor.With timely and correct treatment of foot mycosisforecastfavorable: complete recovery from the 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 the treatment of public places: baths, saunas, swimming pools, showers.Floors, equipment and household items must be disinfected.Staff and people who frequently visit public baths, saunas, etc.must undergo regular preventive examinations.

2. Primary personal prevention:

   • observe personal hygiene rules when visiting public places;
   • prevent damage and constant moisture to the skin and toenails;
   • wear wide, 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.