How mycosis of smooth skin manifests itself, and how to deal with it. Mycoses of the skin Mycosis of the smooth skin, ICD code 10

Modern principles of treatment of dermatophytosis should be aimed at the speedy removal of the causative factor - a pathogenic fungus from the affected areas of the skin and nails, as well as, if possible, the elimination of predisposing factors (excessive sweating, trauma, concomitant diseases). Currently, there are a large number of tools and methods for the treatment of fungal diseases. However, only etiotropic therapy is the only effective approach for the treatment of mycoses. It can be carried out externally, when an antifungal drug is applied to the affected area of ​​​​the skin or nail plate, as well as systemically, when the drug is administered orally.
Systemic therapy is prescribed for damage to nails, hair, as well as large areas of skin in conditions close to partial or complete erythroderma. Systemic therapy ensures the penetration and accumulation of antimycotics in horny substances through the blood. Systemic drugs accumulate at the sites of fungal infection in concentrations that are much higher than the minimum inhibitory concentrations of the growth of the fungus and are able to remain there after the end of the drug. In modern medical practice, drugs are widely used: griseofulvin - mainly in children's practice, as the safest; terbinafine (lamisil); ketoconazole (nizoral); itraconazole (orungal). The choice of drug is determined primarily by the type of fungal infection (if the type of pathogen is not established, a broad-spectrum drug is prescribed). Important criteria are localization, prevalence, and severity of the disease. The use of systemic antimycotics is associated with the risk of developing toxic and side effects associated with long-term multi-month intake of the drug. A very significant selection criterion is the safety of treatment, i.e., minimizing the risk of side and toxic effects. Therefore, pregnant and lactating mothers, as well as those with concomitant liver and kidney diseases, manifestations of drug allergies, systemic therapy is not indicated.
Local treatment is an integral part of the treatment of any fungal disease. External antifungal preparations contain very high concentrations of active substances against mycosis pathogens, which are created on the surface of the lesions, where the most viable fungi are located. With local treatment, the development of adverse reactions is rarely observed, even with prolonged use of antimycotics. The appointment of external therapy is not limited by concomitant somatic pathology, the age of the patient, the possible development of interactions while taking other drugs. In most cases, local antimycotics have a wide range of not only antifungal, but also antimicrobial and anti-inflammatory effects, which is very important, since the bacterial flora often accompanies the fungal flora and complicates the course of mycosis. Currently, in the arsenal of practitioners there is a rich selection of topical antifungal drugs in the form of solutions, creams, ointments, powders. The greatest demand is for official drugs used mainly in the form of creams and solutions: clotrimazole, ketoconazole, terbinafine, bifonazole, oxiconazole, miconazole, econazole (Ecodax). Almost each of the listed drugs has a high activity against most types of mycosis pathogens, and the concentration of the antifungal agent created on the surface of the lesion is sufficient to suppress the vital activity of all pathogenic fungi. However, given that the treatment should be carried out for a sufficiently long time (within 3-4 weeks) in the mode of 2-fold use per day, important criterion The choice is the cost and therefore the availability of the drug to the patient. In particular, econazole (Ecodax) has a wide spectrum of antifungal activity, is highly effective in the treatment of skin dermatophytosis and is affordable. According to a study conducted by E. A. Batkaev and I. M. Korsunskaya at the Department of Dermatovenereology of the Russian Medical Academy of Postgraduate Education, in 22 patients with mycosis of the feet and smooth skin, the use of 1% Ecodax cream for three weeks led to a clinical and etiological cure in all patients. Only one patient in this group had a slight increase in itching and hyperemia at the beginning of treatment, which spontaneously regressed during treatment. The use of 1% Ecodax cream in 11 children with microsporia of smooth skin (of which 8 had lesions on the scalp), who, in parallel with local treatment, used griseofulvin in age dosages, after a three-week treatment, it was possible to achieve a clinical and mycological cure in all patients. Adverse reactions were not noted in any case.

• 1 Causes and ways of infection
• 2 The incubation period of microsporia in humans
• • 3.1 Smooth skin
  • 3.2 Scalp
• 4 Features in children
• 5 Microsporia during pregnancy
• 7 Treatment of pathology
  • 7.1 Medicines
  • 7.2 Folk remedies
• 8 Complications and prevention

If laboratory diagnostics has confirmed the diagnosis of microsporia in humans, it is worth immediately starting therapy using antifungal drugs and folk remedies. Once on the skin, the infection spreads, affecting more and more new parts of the body. The initial stage of the disease is quickly cured, but with a neglected form, therapy continues for a long time and always under the supervision of a specialist.

Causes and ways of infection

Microsporia disease is caused by a fungus of the genus Microsporum, which, in addition to the scalp, body and nail plates, also affects the hair follicles, due to which the hair gradually becomes thinner, and if the disease is not treated at the initial stage, you can lose a significant amount of hair. The main routes of transmission of the disease are contact - from person to person or from animal to person, and subject - through objects infected with spores.

According to the international classification of diseases, microsporia has the code B35 "Dematophy".

The fungus often penetrates into the tissues of the skin through damage and injured areas of the epidermis. Microsporia of smooth skin and hairline threatens people with dry skin type, the presence of abrasions and coarsened calloused areas. The disease is not transmitted virulently, and if you wash your hands well after contact with the carrier, you will not be able to become infected, as the mycospores die.

Back to index

The incubation period of microsporia in humans

The incubation period of microsporia in humans lasts an average of about a week. During this time, flaky spots appear on the body, which have a clear outline and a tendency to increase. If the foci are localized in the area of ​​​​the hairline, then the hair breaks at the site of formation, the accompanying symptoms are disturbing. By these signs, it can be understood that adults or a child have ringworm.

Back to index

Microsporia is a fungal disease that affects the skin and hair.

The most common pathogen that provokes the development of microsporia in adults and children is considered to be a type of fungus Microsporium, which is called Microsporum canis. It has a zoonotic form of distribution, and the symptoms depend on the location and depth of penetration into the epidermis. There are microsporia of smooth tissues and hairy part.

Back to index

smooth skin

The first signs of microsporia of smooth skin are visible to the naked eye. At the site of the introduction of the fungus, a clear pink spot is formed, which at first looks small, but quickly increases in size, penetrating into the deeper layers of the dermis. The formation peels off, additional spots appear, the number of which does not exceed 2-3 pieces. A skin rash can occur both on the open - face, forearm, neck, and on a closed area of ​​​​the body - torso, arm, leg. Sometimes the patient at the site of the lesion may feel slight discomfort, but most often in the initial stages the disease does not cause physical discomfort.

Back to index

scalp

Microsporia of the scalp most often affects children under 14 years of age, this pathology does not affect adults, since there is a specific organic acid on the skin under the scalp, which prevents the fungus from gaining a foothold on the tissues and prevents its reproduction. The lesions with this type of microsporia are most often localized:

• in the region of the crown;
• on the temporal lobe;
• in the parietal region.

Places of defeat round shape, the number of foci does not exceed 2, while the size of the lesion reaches up to 6 cm in diameter. At the initial stage, the site of the lesion flakes off, but the hair follicle is already infected. After 5-7 days, a significant length of the hair shaft is affected, it becomes thinner and breaks off at the base. The lesion looks like "cut grass".

Anthroponous microsporia is the most common form of infection. The source of transmission of the anthropophilic fungus Microsporum ferrugineum is an infected person. After 6-8 days of the incubation period, small rounded formations with fuzzy outlines and slight peeling appear on the areas affected by the fungus. The hair in this place quickly becomes thinner, becomes faded, and if you do not start treatment in a timely manner, the hair shafts begin to break off at the base, the patient loses a significant amount of hair.

Back to index

Microsporia is the most common fungal infection.

Microsoporosis of rare varieties is also distinguished, these include the forms:

1. Seborrheic, in which the hair becomes thin, dull, covered yellow color scales, which lead to the fact that the hair shaft soon breaks.
2. Trichophytoid, in which the hair shaft breaks off much below the base, so there are no bald spots and signs of baldness in the lesions.
3. Exudative, in which small blistering rashes appear at the site of the lesion of the epidermis, filled with a serous fluid - exudate. If the disease is not treated in the initial stages, the lesions begin to fester and become inflamed. In this case, the patient's condition worsens, body temperature rises, signs of intoxication of the body appear.

Back to index

Features in children

Microsporia in children under 14 is considered one of the most common fungal diseases that every third child has encountered. When treating microsporia in a child, it is important to follow the doctor's recommendations, the disease is treated mostly without complications, but only if the course of therapy was chosen correctly and according to the age criterion of a small patient. The prevalence of fungal disease in children is caused by the following factors:

• Poor personal hygiene, most often unwashed hands.
• Unformed or weakened immunity.
• Contact with infected domestic animals.
• Permanent traumatization of the skin - abrasions, micro-wounds, scratching.

Medicine has an interesting and inexplicable fact. According to observations, young children with red hair almost never experience ringworm.

Back to index

Microsporia during pregnancy

During pregnancy, the protective functions of the body weaken and the expectant mother has an increased chance of contracting an infectious disease, and microsporia is no exception. During this period, it is important to pay attention to the symptoms in time and begin adequate treatment, which will take into account the condition of the woman. Medicines are selected by a dermatologist, and if you follow all the recommendations, the disease disappears in a short time.

Back to index

Before treating this type of lichen, you need to consult a doctor.

Before you start treating microsporosis, it is important to make an accurate diagnosis and make sure that this type of fungus provoked the disease. Fluorescent diagnosis of the lesion site, in which the Wood's lamp is used, as well as microscopy and the cultural method, will help determine the diagnosis.

To accurately determine that microsporosis caused by the fungus Microsporium canis is progressing in the body, the cultural method of diagnosis will help. The infected material or scraping is placed in a special Sabouraud nutrient medium, in which already on the 3-4th day under the microscope, the growth of a colony of fungi will be noticeable. The device for luminescent diagnostics will help determine:

• type of pathogen;
• the degree of damage to the hairline;
• How effective is the therapy?
• whether loved ones who had direct contact with the carrier are infected;
• whether the animal has an infection.

Back to index

Treatment of pathology

It is important to start treating microsporia in humans as early as possible, then it will be possible to avoid complications and serious consequences. In no case should you try to cope with the problem yourself at home and take medications at your own discretion. Tablets, ointments and appropriateness of use folk methods determined by a dermatologist on the basis of a diagnostic study.

Back to index

Medicines

For local therapy, the medicine is selected individually. The most common are presented in the table:

Antimycotic antibiotics will help to cure a child and an adult from lichen on the scalp, one of the most effective is Griseofulvin. The drug is toxic, when it is prescribed, the doctor prescribes maintenance therapy. Treatment of lichen in a person will take an average of 1.5-2 months, a person will be healthy if the scraping analysis is negative.

Back to index

Folk remedies

At home, it is contraindicated to treat microsporia, as even more serious complications can be provoked. Previously, garlic lotions were used to treat microsporia at home, which were applied to the affected area and kept for at least an hour. Iodine is also effective, but it burns the skin and a scar can remain at the site of the lichen, so if a person has microsporia on his face, this method will definitely not work.

Back to index

Complications and prevention

If you do not start treating the foci of infection spread throughout the patient's body, inflammation may develop. Sometimes, when the scalp is damaged, a complication develops in the form of infiltrates, suppuration and inflammation, which causes severe discomfort in the patient. Since microsporia is transmitted by contact, the prevention of microsporia consists in isolating the carrier and proper treatment, carefully examining others and disinfecting the room in which the patient was located.

Ankle fractures according to ICD-10: classification of injuries and their codes

• Fractures and their classification
• General clinical picture
• External ankle injury
• Trauma to the bones of the medial ankle
• Fracture healing

Ankle fracture is a common injury to the lower extremities, the peaks of injury are recorded in the winter. People at risk are retirement age, children, athletes, as well as women wearing high-heeled shoes. Full recovery after an injury takes at least 2 months, and 10% of cases end in disability.

In medical practice, it is customary to assign a specific code to each disease. These figures are compiled in a document called the International Classification of Diseases (ICD-10). The number 10 indicates the serial number of the revision. An ankle fracture has an ICD 10 code - S82, class Injuries, poisoning and some other consequences of external causes, block Injuries of the knee and lower leg.

Fractures and their classification

Violations of the integrity of the bones are of two types:

• open - with a rupture of soft tissues and skin. Fragments of bones are visible from the wound, blood is flowing;
• closed - there are no skin breaks, bleeding is not observed.

In some cases, bone fragments can be displaced. According to this factor, a fracture is distinguished with and without displacement.

Damage is also classified according to the location of the injury. Allocate fractures:

• outer ankle;
• inner ankle.

There are other classifications as well.

General clinical picture

Experts identify a number of common features:

• numbness of the lower extremities;
• severe pain syndrome, localized not in the area of ​​damage, but slightly above or below;
• attacks of nausea, dizziness and general weakness;
• chills;
• impaired mobility of the joint.

The clinical picture develops quite quickly - within half an hour after the injury.

If the patient has a complex form of fracture, you can additionally observe the following symptoms:

• blanching of the skin due to damage to blood vessels, nerve structures;
• numbness of the foot and ankle in general;
• limb deformity.

External ankle injury

The outer (lateral) side of the lower leg is damaged much more often than the inner, or medial. This is due to the natural weakness of the fibula. Most often, a dislocation of the ankle joint leads to the development of a fracture.

A closed fracture of the lateral malleolus has its own ICD 10 code: S82.6. Trauma has a number of features:

• accompanied by a sharp pain and a crunch emanating from the outside of the ankle;
• damage is formed against the background of direct impact on the ankle;
• the outer part of the joint swells, under the skin there is a noticeable accumulation of a small amount of blood;
• it is difficult or completely impossible to lean on the outer part due to the incorrect position of the foot and, as a result, independent movement is difficult.

Trauma to the bones of the medial ankle

If the lateral part of the ankle is damaged due to dislocation of the ankle, then the trigger mechanism for violating the integrity of the medial section is most often a direct blow. Trauma due to dislocations is less common.

The fracture of the lateral malleolus has the ICD code 10 S82.5. Its features:

• the victim often develops hemarthrosis (accumulation of a large amount of blood in the joint cavity). This makes it difficult to move, can cause the development of secondary arthrosis;
• behind the medial area is a bundle of vessels and nerves extending to the foot, as a result of a violation of the integrity of the bone, they are damaged, profuse bleeding begins.

Otherwise, the clinical picture of fractures of the outer and inner sections of the ankle is similar.

The medial section of the ankle is the area where the large muscles are located. In fractures, they often cause displacement of bone fragments, which creates difficulties in treatment. It is these injuries that often lead to the development of complications.

Fracture healing

The International Classification of Diseases, or ICD, describes the codes for all diagnoses accepted in medicine. For example, in a fused ankle fracture, the ICD 10 code is not one, but several at once:

• M84.0 - poor healing of the fracture;
• M84.1 - fracture nonunion or pseudarthrosis;
• M.84.2 - delayed union of the fracture.

These codes apply not only to traumatic injuries ankle, but also to fractures of other bones.

The body throws all its strength into repairing damaged tissues. For two or three days, the released blood forms clots, over time they are filled with special cells that play an important role in the formation of callus. Also, these cells create a special structure that eliminates the possibility of displacement of bone fragments. In medicine, it is called the granular bridge.

It will take at least ten days for the formed bone callus to strengthen. Complete restoration of the ankle bone of its blood supply lasts about a year.

What can slow down the rate of bone regeneration:

• complexity of the injury, location;
• feature of the tissues of the ankle bone;
• the correctness of first aid;
• patient's age;
• compliance with the doctor's recommendations;
• a history of chronic diseases, inflammatory processes, overweight;
• the psychological state of the patient.

Also, experts identify factors that slow down the formation of corns:

• lack or excess of vitamins;
• disruption of the endocrine glands;
• lack of weight;
• taking certain medications.

In children, the process of bone fusion is much faster than in adults. At the same time, due to their nature, it is difficult for children to strictly observe bed rest. It is also difficult for them not to rely on an injured limb for a long time. Excessive activity negatively affects tissue fusion, slowing it down and provoking complications.

Women who carry a child or breastfeed him recover from an ankle fracture for a very long time. Splicing slows down due to the fact that the level of calcium, other important minerals, decreases during this period.

The rate of healing of displaced ankle fractures is influenced by the following factors:

• how accurately and correctly the surgeon combined the fragments;
• compliance bed rest after operation;
• whether all particles of muscle and connective tissue have been removed from the fissure.

Closed and open fractures are fused differently, but in both cases a lot depends on the patient. Following the recommendations of the doctor, not loading the leg and eating right, you can significantly speed up recovery.

Tags: Treatment of joints

Mycoses of the hands, feet and torso are diseases caused by pathogenic fungi that affect the skin and its appendages.

Etiology and epidemiology of mycoses

The most common causative agents of dermatophytosis are pathogenic fungi Trichophyton rubrum (90%) and Trichophyton mentagrophytes, var. interdigitale. Less commonly, these diseases are caused by Epidermophyton floccosum and fungi of the genus Candida.

Infection with pathogenic fungi can occur through direct contact with the patient, as well as through shoes, clothes, household items (bath rugs, washcloths, manicure accessories, etc.), when visiting gyms, baths, saunas, swimming pools.
The penetration of fungi into the skin is facilitated by abrasions, cracks in the interdigital folds due to abrasion, excessive sweating or dry skin, poor drying after water procedures, narrowness of interdigital folds, flat feet, circulatory disorders in vascular diseases of the extremities, etc. Mycoses can become widespread in the presence of concomitant diseases - endocrine, more often diabetes mellitus, immune disorders, genodermatosis, blood diseases, as well as when using antibacterial, corticosteroid and cytostatic drugs .

At present, athlete's foot caused by Trichophyton rubrum is the most common fungal disease in adults.

Classification of mycoses

• B35.1 Mycosis of nails
• B35.2 Mycosis of the hands
• B35.3 Foot mycosis
• B35.4 Trunk mycosis
• B35.6 Athlete's groin
• B37.2 Skin and nail candidiasis

Clinical picture (symptoms) of mycoses

Rubrophytia

In the clinical picture of rubrophytosis of the feet, five main forms are distinguished: squamous, squamous-hyperkeratotic, intertriginous, dyshidrotic and onychomycosis of the feet.
The squamous form is characterized by the presence of peeling on the skin of the interdigital folds, soles, palms, sometimes with the presence of small surface cracks. In the region of the lateral surfaces of the soles, phenomena of epidermal desquamation can also be observed.

Squamous-hyperkeratotic form is manifested by diffuse or focal thickening of the stratum corneum (hyperkeratosis) of the lateral and plantar surfaces of the feet, which bear the greatest load. Usually, the affected areas of the skin have a mild inflammatory color and are covered with small pityriasis or flour-like scales. The modified foot may look like a "footprint" or "Indian stocking" - "moccasin type". Peeling in the skin furrows creates an exaggerated pattern, which gives the skin a "powdered" appearance. Subjectively, dry skin, moderate itching, and sometimes pain in the affected areas are noted.

Intertriginous (interdigital, diaper rash) form is clinically similar to diaper rash. Interdigital folds are affected, more often between III and IV, IV and V toes. The process is characterized by hyperemia, swelling, weeping and maceration, in some cases - blisters. Erosion and deep painful cracks are often formed. Subjectively, itching, burning, pain in the lesions are noted.

The dyshidrotic form is manifested by numerous vesicles with a thick tire. The predominant localization of the rashes is the arch of the foot, as well as the interdigital folds and the skin of the fingers. Merging, the bubbles form large multi-chamber bubbles, upon opening of which wet erosions of a pink-red color appear. Rashes are located on unchanged skin. With the development of the process, hyperemia, swelling and itching of the skin join, which makes this variety similar to acute dyshidrotic eczema.

In children, lesions of smooth skin on the feet are characterized by small-lamellar peeling on the inner surface of the terminal phalanges of the fingers, more often in the 3rd and 4th interdigital folds or under the fingers, hyperemia and maceration. On the soles, the skin may not be changed or the skin pattern may be enhanced, sometimes ring-shaped peeling is observed. The disease is accompanied by itching. In children, more often than in adults, exudative forms of lesions occur not only on the feet, but also on the hands.

Onychomycosis of the feet with rubrophytosis is mainly manifested by the defeat of all nails.

Allocate normotrophic, hypertrophic and atrophic types of onychomycosis.

The normotrophic type is characterized by the appearance of yellowish and yellowish stripes in the thickness of the nail. white color, while the nail plate does not change its shape, subungual hyperkeratosis is not pronounced.

In the hypertrophic type, the nail plate thickens due to subungual hyperkeratosis, acquires a yellowish color, crumbles, and the edges become jagged.

The atrophic type of onychomycosis is characterized by significant thinning, detachment of the nail plate from the nail bed with the formation of voids or its partial destruction.

rubrophytosis of nails (atrophic type)

There are also distal, distal-lateral, white superficial, proximal subungual, total dystrophic onychomycosis.

Rubrophytosis of the hands at the beginning of the disease is characterized by damage to the skin of the palms and is unilateral in nature, it can be combined with onychomycosis of the hands. Dry skin, thickening of the stratum corneum, mucosal peeling and exaggeration of the skin furrows are clinically observed. The emerging foci on the back of the hands have intermittent edges and consist of nodules, vesicles, and crusts. Infection of the hands, smooth skin and folds, as a rule, occurs from foci of rubrophytosis of the feet as a result of lymphohematogenic spread of fungi and during autoinoculation; in rare cases, it occurs primarily with the exogenous introduction of fungi.

Rubrophytosis of smooth skin is more often observed on the buttocks, thighs and legs, but can be localized on any part of the body, including the skin of the face. There are erythematous-squamous, follicular-nodular and infiltrative-suppurative forms.

The erythematous-squamous form of rubrophytia is characterized by the presence of pink or reddish-pink spots with a bluish tinge, rounded outlines with clear boundaries. Small scales are usually present on the surface of the spots; an intermittent roller consisting of juicy papules passes along their periphery. Often papules are covered with small vesicles and crusts. The spots are initially small, tend to centrifugal growth and merge with each other, while they form extensive foci with scalloped outlines, occupying vast areas of the skin.

The follicular-nodular form of rubrophytia is distinguished by the defeat of vellus hair within the erythematous-squamous foci. Hair loses its natural shine, becomes dull and brittle.

The infiltrative-suppurative form of rubrophytia is quite rare, mainly in children on the scalp. According to clinical manifestations, it resembles infiltrative-suppurative trichophytosis caused by zoophilic trichophytons. Separate atrophic scars may remain at the site of the foci after the resolution of the infectious-inflammatory process.

Epidermophytosis

Athlete's foot is a foot lesion caused by Trichophyton mentagrophytes, var. interdigitale (interdigital trichophyton). This fungal process is much less common and clinically slightly different from rubrophytosis.

The causative agent of epidermophytosis of the feet has a pronounced allergenic effect, therefore, patients more often develop intertriginous and dyshidrotic forms of the disease, accompanied by secondary rashes (mikids). Perhaps the development of erythema, swelling, abundant desquamation of the epidermis with the formation of erosions and ulcers, the addition of a secondary infection caused by gram-negative bacteria. Such a process is accompanied by regional (inguinal-femoral) lymphadenitis, lymphangitis and general infectious symptoms: fever, malaise.

At the beginning of the disease, there is a lesion of the fold between the 3rd and 4th toes, with a transition to the upper third of the sole, arch, lateral surfaces of the foot and fingers.

Onychomycosis of the feet due to Trichophyton mentagrophytes, var. interdigitale is characterized by damage to the nail plates of the I and V toes, while distal, distal-lateral and proximal types of altered nails can be observed. Superficial forms of onychomycosis are more often detected, however, combined forms of onychodystrophy can occur in one patient (similar to those with rubrophytosis).

Epidermophytosis inguinal is characterized by the appearance on the skin of the inguinal regions, inner thighs, scrotum, less often in the intergluteal fold, as well as in the axillary and submammary areas of scaly pink spots. At the beginning of the disease, the size of the elements is up to 1 cm in diameter, then they increase in size, while inflammation in the center can be resolved. Large (up to 10 cm in diameter) annular red spots are formed, which form "scalloped" foci when merged. The boundaries of the foci are clear, edematous bright hyperemic inflammatory roller with bubbles and small pustules on its surface. Subjectively, rashes are characterized by itching.

The clinical picture of candidal onychomycosis is usually represented by the proximal form, less often by the distal one.

In the proximal form, a yellowish-brown or brownish color of the nail plate is observed with an area of ​​pronounced fragility, which leads to the formation of a side-cut edge of the nail (proximal-lateral variant). The process is combined with the phenomena of paronychia, when fluctuation and purulent discharge can be observed during palpation of the inflamed nail fold.

The distal form of candidal onychomycosis is manifested by a change in color, hyperkeratosis and subsequent lysis of the nail plate from the free (distal) edge.

The clinical picture of mold onychomycosis is more often represented by a distal form and is observed in older people already suffering from onychopathy of the feet of various origins, both fungal and non-fungal in nature (secondary onychomycosis). The nail plate acquires a different color (black, greenish-yellow or gray) depending on the mold pathogen that caused this pathology. These changes depend on the pigment-forming activity of fungi and their frequent association with bacteria and yeast-like fungi. In the future, the lower part of the nail loosens, the upper one thickens. Pronounced onychomycosis develops, the nail is deformed, often changes according to the type of onychogryphosis, the nail plates are most often affected thumbs stop.

The proximal form of onychomycosis with or without paronychia, caused by molds, is much less common.

Diagnosis of mycoses

Diagnosis of dermatophytosis is based on the data of the clinical picture and the results of laboratory tests - microscopic examination of the affected nail plates, scraping of scales from lesions on smooth skin.
To determine the type of pathogen, a cultural study and a study by molecular biological methods are carried out.

When prescribing systemic antimycotic drugs, it is recommended to conduct a biochemical study of blood serum to determine the level of bilirubin, AST, ALT, GGT, alkaline phosphatase, glucose.

In treatment-resistant forms of onychomycosis, it is recommended to perform ultrasound superficial and deep vessels.

Differential diagnosis of mycoses

The differential diagnosis of rubrophytosis is carried out with psoriasis, seborrheic dermatitis, eczema, lichen planus, Dühring's herpetiform dermatitis, lupus erythematosus, skin lymphoma.

Differential diagnosis of inguinal epidermophytosis is carried out with erythrasma, rubromycosis, psoriasis, candidiasis.

Differential diagnosis of candidal lesions of the nails is carried out with onychia and paronychia of a bacterial nature, psoriasis.

Treatment of mycoses

Treatment Goals

• clinical cure;

Indications for hospitalization

Long-term ineffective outpatient treatment for common forms of the disease.

Treatment regimens for mycosis of the feet and hands:

Treatment of mycosis of the smooth skin of the feet, hands and other localizations.

External Therapy

Antimycotic preparations for external use:

• isoconazole cream 1-2 times a day topically for 4 weeks
• ketoconazole, cream, ointment
• clotrimazole, ointment, cream,
• terbinafine, spray, dermgel
• terbinafine solution
• miconazole cream
• naftifine, cream, solution
• oxiconazole cream
• sertaconazole cream 2%
• ciclopirox, cream
• undecylenic acid + zinc undecylenate, ointment
• econazole cream
• bifonazole, cream

With significant hyperkeratosis in the foci of mycosis on the feet, a detachment of the stratum corneum of the epidermis is preliminarily performed using:

• bifonazole

At the first stage of therapy, in the presence of acute inflammatory phenomena, lotions are used:

• Ichthyol, solution 5-10%
• brilliant green, aqueous solution 1%
• fukortsin, solution

With the subsequent appointment of pastes and ointments containing antifungal and glucocorticosteroid drugs:

• miconazole + mazipredone
• isoconazole nitrate + diflucortolone valerate
• clotrimazole + betamethasone cream

With severe weeping (in the acute phase) and the addition of a secondary infection, anti-inflammatory solutions are prescribed as a “lotion” and combined antibacterial drugs:

• Ichthyol, solution 5–10%
• natamycin + neomycin + hydrocortisone cream
• betamethasone dipropionate + gentamicin sulfate + clotrimazole, ointment, cream

Systemic therapy

With the ineffectiveness of external therapy, antimycotic drugs of systemic action are prescribed:

• itraconazole 200 mg
• terbinafine 250 mg
• fluconazole 150 mg

In acute inflammation (weeping, blisters) and severe itching, antihistamines are used:

• chloropyramine hydrochloride 0.025 g
• clemastine 0.001 g
• mebhydrolin (D) 0.1 g

Treatment of onychomycosis of the feet and hands

External Therapy

If single nail plates are damaged from the distal or lateral edges to 1/3–1/2 of the plate, only external antifungal drugs and nail cleanings (using keratolytic agents or a scaler) can be used.

Keratolic agents:

• bifonazole, ointment

After removing the fungus-affected areas of the nails, one of the preparations is used on the cleaned nail bed:

• ketoconazole cream
• clotrimazole, cream, solution
• naftifine, cream, solution
• oxiconazole cream
• ciclopirox, cream, solution
• bifonazole, solution, cream 1%
• amorolfine, nail polish 5%
• ciclopiroxolamine, nail polish 8%

Systemic therapy

With total damage to the nails, systemic antimycotic drugs are prescribed:

• itraconazole 200 mg
• ketoconazole 400 mg
• terbinafine 250 mg
• fluconazole 150 mg

Special situations

Treatment of children with athlete's foot and hands:

• terbinafine for children weighing more than 40 kg - 250 mg once a day orally after meals; children weighing 20 to 40 kg - 125 mg per day orally after meals, children weighing less than 20 kg - 62.5 mg

Requirements for treatment outcomes

• absence of pathological changes on the skin;
• negative microscopic examination results for fungi.

First control laboratory research in the process of treatment of onychomycosis of the hands, it is carried out after 6 weeks and with onychomycosis of the feet - 12 weeks after the end of therapy.

Tactics in the absence of the effect of treatment

In the absence of positive dynamics in the clinical picture of onychomycosis with systemic or combined therapy carried out for 16 weeks, as well as in the detection of a slow regrowth of a healthy nail plate, it is recommended to change drugs to antimycotic medicine another pharmacological group with the addition of angioprotectors.

Prevention of mycoses

Primary prevention: foot skin care to prevent microtrauma, abrasions, eliminate hyperhidrosis (aluminum hydrochloride 15% + decylene glycol 1%) or dry skin (tetranyl U 1.5% + urea 10%), flat feet, etc.

Secondary prevention: disinfection of shoes, gloves 1 time per month until complete cure:

• undecylenamidopropyltrimonium methosulfate, spray
• chlorhexidine bigluconate, solution 1%.

IF YOU HAVE ANY QUESTIONS REGARDING THIS DISEASE, PLEASE CONTACT DERMATOVENEROLOGIST ADAEV KH.M:

WHATSAPP 8 989 933 87 34

Email: [email protected]

INSTAGRAM @DERMATOLOG_95

In contact with

Classmates

According to scientists, mycosis of the feet, which affects the skin of the sole and the folds between the fingers, is diagnosed in 70% of the population of the entire Earth.

The cause of the development of such a pathology is a fungus. Initially, the disease affected the inhabitants of limited areas of Asia and Africa, but the migration of the population and the significant deterioration in living conditions during the First World War led to the spread of pathology throughout the world.

What is a fungus and what are its causes?

(mycosis pedis) - a pathological lesion of the skin of the foot and nails, caused by the appearance and development of yeast or dermatophyte fungi. More often defeat caused by red fungi of the genus Trichophyton rubrum, less often - Candida and very rarely - mold microorganisms.

These infections cause the appearance of fairly similar symptoms of the development of the pathology, therefore, it is possible to distinguish the root cause only under a microscope, examining microscopic particles of the affected skin or nails.

Fungus - code according to the International Classification of Diseases 10

ICD-10 - International Classification of Diseases was adopted in 2007 as a single document for recording and classifying diseases, reasons for the population to seek help in all medical institutions and factors leading to mortality.

This classifier was developed World Organization Health and has been revised 10 times (hence the ICD-10).

It contains 21 sections, each of which contains headings with codes for absolutely all diseases and conditions. Mycosis of the foot belongs to class 12 and has a code - B35.3. In the ICD, you can not only determine the disease code, but also find medications and medicines for its treatment, used throughout the world, sorted alphabetically.

How can you get infected?

Fungi that affect the feet and cause mycosis, in in large numbers disperse their spores, which are significantly adapted to environmental conditions and are able to remain viable for quite a long time on any surface.

Mycosis of the skin of the feet is transmitted by household. Infection can occur when wearing someone else's shoes and socks, using shared towels, visiting public places with poor sanitary and hygienic conditions. The causative agents of mycosis are extremely resistant to external environment- they can “live” for a long time on wood, in shoe insoles, on fabric fibers and other objects.

Activation of the fungus is most often observed in spring or autumn.. But, even getting on a healthy surface, the fungus cannot always penetrate the thick layer of the epithelium, provided that it is not damaged.

The main condition for the penetration of the fungus into the pores of the skin is the moisture accumulated by the epidermis. In the presence of such a sufficiently favorable environment, the fungus begins to actively multiply. For the emergence and development of the pathological process, several more conditions are necessary: ​​sufficiently high humidity; wearing tight and uncomfortable shoes; visiting swimming pools, baths or saunas; contact with an infected person.

In addition to the influence of external factors, the development of pathology can be provoked by internal states human: the course of diabetes mellitus; diseases associated with a decrease in immunity and AIDS; flat feet and varicose veins of the lower extremities, as well as atherosclerosis.

External manifestations

The first symptoms of the disease are burning and itching in the affected area, redness and peeling of the skin, dry feet.

Quite painful cracks and bubbles with a colorless liquid appear between the fingers.

Rashes eventually burst, forming erosion. But often mycosis is manifested simply by peeling of the skin, resembling erased flour, especially in the folds between the fingers. This course of the disease is called a latent form. Depending on the reaction of the human body to the defeat of a fungal infection and the localization of the foci of the disease, 4 more forms of pathology are distinguished:

• Intertriginous- manifests itself in the form of diaper rash in the interdigital folds, often combined with small bubbles, leading to weeping erosions. A swollen epidermis hangs over the edges of the plaques. Pathology is accompanied by painful unbearable itching and is complicated by the possibility of developing an infection that leads to streptoderma or erysipelas of the feet.
• - often develops on the lateral surfaces of the foot in the form of grouped bubbles that merge with each other and, in the presence of infection, are filled with purulent contents. The rash is accompanied by itching, burning and pain.
• Acute- usually develops as an exacerbation of the course of one of the above forms of mycosis and manifests itself in the form of multiple vesicles against the background of foot edema. Pathology has an allergenic effect and spreads to the skin of the hands and forearms, located absolutely symmetrically. There is no fungus in these rashes - these are manifestations of an allergic reaction caused by pathology. Rashes quickly form weeping erosions, often with purulent discharge. With the development of the process, there is an increase in lymph nodes in the inguinal and femoral regions, a deterioration in the general condition of the patient: headache and fever.
• Squamous-hyperkeratic- this form of pathology is characterized by a thickening of the stratum corneum of the surface of the feet (on the side and on the sole), covered with small scales. Peeling is most noticeable in the skin grooves and is accompanied by quite severe itching. In addition, rashes cause pain when walking. It is this form of pathology that most often cannot be recognized.

When the feet are affected by a fungal infection, the nails also undergo changes. The process applies to all nail plates - first covered yellow spots free edges of the nail, which then begin to exfoliate and crumble.

Which doctor should I contact with a fungus?

Determine the presence of the disease and recognize the form of the pathology, can doctor - dermatologist when examining a patient.

But to confirm the final diagnosis, a microscopic examination of scales taken from the lesion is necessary.

This method is called direct microscopy and allows you to determine the disease itself, but not the type of fungus that caused it. To determine the culture of the pathogen, bakposev is carried out, which is based on the germination of the fungus in a special nutrient medium, followed by its study.

Treatment

The most commonly used for treatment is external therapy, carried out in Stage 2 A. First remove the acute inflammatory process(if the disease proceeds in an acute form) and remove the stratum corneum on the feet.

Removal of the affected epithelium occurs radically - surgically or gradually, using lotions or baths with a solution of boric acid. Then use special ointments and creams that have a detrimental effect on the fungus.

Medicines and medical devices used to treat fungal infections should contain anti-inflammatory hormones and antibiotics. Most often, the drug "Clotrimazole" is used to treat mycosis of the feet. It is available as a cream and lotion.

The advantage of the lotion is that the substance penetrates perfectly into the affected nail plate and kill the fungus. The drug is well tolerated and has high activity against fungus, safety and hypoallergenicity.

The agent is applied clean, previously washed with soap and dried skin, several times a day, rubbing it into the affected areas. The course of treatment continues for several weeks after the complete disappearance of the symptoms of the disease. The only contraindication to the use of the drug is the first trimester of pregnancy, since the substances that make up its composition can cause complications.

In addition to topical preparations, patients with athlete's foot are prescribed antifungal drugs inside.

Simultaneously with these drugs, medical varnishes are also used, which are applied to nail platinum during the entire course of treatment.

Traditional medicine also has big amount recipes that can relieve the symptoms of athlete's foot. Most often, decoctions of medicinal herbs are used, which have an astringent and antimicrobial effect. Baths with such infusions help to get rid of the layering of keratinized scales, in which the fungus multiplies, and prepare the skin of the foot for further processing.

It is advisable, after water procedures, to use a pumice stone or a special scrub with crystals, for example: salt. This will help to more effectively remove the stratum corneum from the surface of the feet.

No drug applied to the affected areas of the skin will give the desired therapeutic effect if the surface is not pre-treated: washed and dried.

For baths, you can use: infusion of burdock leaves, St. John's wort or wormwood; strong decoction of ground coffee; salt solution with addition apple cider vinegar and baths with laundry soap.

Disease prevention

Important to remember: athlete's foot is a fungal infection, and fungi actively multiply and feel great only in a humid environment. Therefore, the main rule for the treatment of mycosis is the complete exclusion of moisture. To do this, it is necessary to change socks daily, after thoroughly washing and drying the feet and the spaces between the fingers.

With severe sweating of the feet, the soles must be treated with special sprays or powder. You should also carefully care for everyday shoes - ventilate them and treat them with substances containing an antiseptic. Do not walk barefoot in in public places– saunas, baths or pools.

When visiting, it is also advisable to wear your own slippers, which you need to take with you. General strengthening of immunity and timely treatment of certain diseases will help to avoid the occurrence of fungal infections.

Useful video

The video below is a very interesting and inexpensive way to get rid of foot and nail fungus at home:

Conclusion

healthy, beautiful nails and the skin of the feet at any age is a sign not only of careful personal care, but also of health. In addition to aesthetic discomfort, foot mycosis also leads to a significant deterioration in well-being. Any diseases, especially fungal ones, are easier to prevent than to treat, so it is always necessary to follow the rules of hygiene and take care of your health.

In contact with

Click to enlarge

There are several signs by which it is possible to divide the fungal infection of the toenails into types. To begin with, it is worth considering the key feature of the classification - the pathogen. Varieties of pathogenic fungi in this case are combined into three groups:

1. Dermatophytes (molds). The most common causative agents of onychomycosis on the feet. These include the genera Alternaria (Alternaria) and Aspergillus (Aspergillus).
2. Nondermatophytes. Second in frequency of occurrence. They are represented by fungi of the genera Epidermophyton (Epidcrmophyton), Microsporum (Microsporum) and Trichophyton (Trichophyton).
3. Yeast fungi of the well-known genus Candida. The most rare representatives of pathogens.

Onychomycosis is also classified according to the pathological changes that occurred with the nail plate during its development:

1. Normotrophic variant, that is, the thickness of the nail does not change during the life of the pathogen.
2. Hypotrophic variant (it can also be called atrophic or onycholytic). The thickness of the nail is reduced, in some cases the nail completely exfoliates from its bed.
3. hypertrophic variant. Thickness, on the contrary, tends to thicken.

Well, without a doubt, onychomycosis can be characterized by the localization of pathological changes:

1. Proximal (upper) - the upper part of the nail plate is affected.
2. Distal (lower) - pathological changes are localized mainly along the free edge of the plate.
3. Lateral (lateral) - the sides of the nail change.
4. Total - the entire nail suffers.

Along with all the listed classifications, there is the most important - international (ICD 10). It is she who helps doctors navigate in filling out medical documentation and encrypting onychomycosis as an independent nosological unit.

How can you get infected?

The main mechanism of transmission of fungi is contact with a surface contaminated by them. Moreover, this contact may not be noticed in Everyday life. Or you can create certain conditions that will contribute to the reproduction of fungi on the nails and periungual tissues.

The list of the main causes of infection with one or another type of fungus includes:

• Neglect of wearing individual shoes in public places such as swimming pools, baths, saunas, locker rooms, showers, etc.
• Buying and wearing shoes made of artificial materials, closed, not in size (especially summer period year when the foot sweats more).
• Lack of daily and regular foot hygiene.
• Using other people's pedicure tools, as well as visiting pedicure masters in unverified and dubious establishments of the corresponding profile.
• Wearing someone else's shoes, especially the shoes of a person with obvious signs of a fungal infection on the nails.

Nail fungus in ICD 10

To look for onychomycosis, you need to pay attention to subsection B35-B49 called "Mycoses". This group combines all fungal infections of the human body, including nails. More specifically, the B35 code is “Dermatophytosis” (the origin of this name can be guessed from the classification of onychomycosis by the type of pathogen). The nail fungus itself is hidden under the code B35.1.

External manifestations

Click to enlarge

Symptoms as such develop gradually, so for a long period they may not be recognized at all by a person as signs of pathology. In addition, they vary in their severity in each of the patients. But still, you can give a single list of the main changes in onychomycosis:

• Changing the color of the nail plate from transparent to whitish, yellow, greenish, brown (shades of the listed colors are possible).
• Change in the thickness of the nail plate in three types according to the classification.
• Tarnishing, the disappearance of gloss on the surface of the nail.
• The appearance of a more pronounced striation.
• An increase in the fragility of the nail, the possibility that it will crumble.
• The edge of the nail may become uneven, corroded.
• With a psoriatic origin of onychomycosis, the nails can be subjected to onycholysis (destruction) with a symptom of a "fat spot".
• On close to the nail soft tissues you can find burrs, peeling of the skin.

Onychomycosis, like any other independent disease, is included in the accepted Russian Federation classification "ICD 10". When making this diagnosis, doctors must enter the nail fungus code into the medical records of each patient. The patients themselves may not be aware of the existence of this cipher (this is not essential information for them), but if you are aware of the matter, this only increases erudition and awareness of your pathology. But it is precisely awareness that the population sometimes lacks in order to prevent infection and further development of the fungus on the toenails.