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Tinea pedis

  • What is Tinea pedis
  • What triggers / Causes of Athlete's foot
  • Pathogenesis (what is happening) during the Athlete's foot
  • The symptoms of Athlete's foot
  • Diagnosis of Athlete's foot
  • Treatment of Athlete's foot
  • Prevention of Athlete's foot
  • Which doctors should be consulted if You have Athlete's foot

What is the Athlete's foot -

Tinea pedis being the most common ringworm characterized by chronic relapsing course. The term "athlete's foot" understand mycotic infection of the skin and nails of the feet of any nature.

What triggers / Causes of Athlete's foot:

The most frequent causative agent of athlete's foot are Trichophyton rubrum and Trichophyton mentagrophytes var interdigitale. Much less athlete's foot can be caused by Epidermophyton floccosum, as well as yeast and molds. At the same time significantly increased the cases of mixed lesions. Frequency of lesions of the feet, caused by various dermatophytes, varies widely: 70-95 cases occur in Tr. rubrum, from 7 to 34 - Tr. interdigitale and only 0,5-1,5 - E. floccosum.

Pathogenesis (what is happening) during the Athlete's foot:

Infection of athlete's foot usually occurs in showers, swimming pools, saunas, when shared with a sick person household items (towels, sponges, shoes, socks, etc.). Contributing factors are excessive sweating of the feet, flat feet, wearing tight shoes.
The process for a long time may be asymptomatic or manifest mild symptoms in the form of mild peeling, maceration of the epidermis in the interdigital folds, peeling on the arch of the foot, occasional slight itching.
This condition can last for many months and years, without causing particular discomfort in the patient. Chronic haphazard and short-lived, and therefore, unsuccessful attempts of treatment lead to the unjustified conclusion that the disease is impossible to cure. However, the long period of asymptomatic creates the illusion that the disease is not dangerous and does not cause any problems. Both these conclusions are absolutely not true, because the infection continues to spread to the nails and smooth skin. The patient is the source of contamination, especially for family members and for those with who enjoys showers and swimming pool. In addition, the integrity of the skin can become a gateway for bacterial infection. For example, the clinical manifestations observed in intertriginous form of athlete's foot are the result of interactions between fungi and bacteria. Greatly increases Allergy of the body. According to many authors, tinea pedis is one of the main causes of sensitization, the occurrence of contact dermatitis and in atopic dermatitis and eczema. Joined secondary microbial flora weights for fungal infections, further reducing the body's defenses. In contact with the fungi flora such acquires increased resistance to antibacterial agents.
Under the influence of precipitating factors can lead to exacerbation of the disease: there are redness, cracks, maceration of the skin, blisters and bubbles in the arch and side surfaces of the feet, there is soreness, worse when walking. Periods of exacerbation of fungal diseases of the feet are more often seen in the warmer months. A natural result of the development of athlete's foot is a fungal infection of the nails is onychomycosis.
Predisposing factors for development of fungal infection in the feet, especially in case of complications eczematization and/or secondary infection, are also vascular diseases of the extremities, diabetes mellitus, repeated microtrauma, disorders of the nervous, endocrine and immune systems. The disease often develops on the background of prolonged treatment with medicines that suppress the body's defenses (glucocorticoids, cytostatics, broad-spectrum antibiotics), and complicates the course of diseases in which these drugs are administered.

The symptoms of Athlete's foot:

Clinical feet mycosis differ depending on the type of pathogen. T. rubrum affects the skin, the nails of the feet (sometimes hands), as well as any area of the skin, sometimes there is involvement of the downy and long hair. T. interdigitale affects the skin and nail plate only stop.
When athlete's foot, caused by T. rubrum, the disease begins with interdigital folds, then the process involves the skin of the soles, lateral and dorsal surfaces of the feet, palms, and nail plate. The skin becomes dry, thickened, with a distinct pattern of skin furrows and bucovinei plate or peeling. Rubromycosis is characterized by multiple lesions of the feet and hands nails in normotrophic, hypertrophic, atrophic type and by type of onycholysis. Sometimes there is leukonychia – the appearance of spots and stripes of white.
Skin lesions stop if rubromikoz may be in the form of the following clinical forms: squamous, intertriginous, dyshidrotic, this form may be accompanied with single or multiple lesions of the nail or not. The disease in some patients accompanied by itching. Squamous form is characterized by desquamation of the skin of the interdigital folds, soles, palms. When intertriginous form observed slight redness and flaking on lateral surfaces of the fingers, maceration, presence of erosions, superficial or deep cracks in the folds. This form can move in dyshidrotic, in which formed bubbles or bubbles in the vaults, on the outer and inner edge of the feet and interdigital folds. The superficial vesicles are opened with the formation of erosions, which may coalesce, forming lesions with clear boundaries. In case of bacterial infection pustules arise, lymphadenitis and lymphangitis, the development of secondary allergic rash on the lateral and Palmar surfaces of fingers, palms, forearms, legs, rarely on other sites. In some cases the disease becomes chronic with acute exacerbation in spring and summer. While this form may be accompanied shape leather soles (palms) becomes reddish-bluish color skin in the grooves marked pityriasis peeling, which goes on plantar and Palmar surfaces of the fingers. On the palms and soles may be ring-shaped or plate-like flaking. In some patients, it is negligible due to the frequent hand washing. Sometimes along with peeling indicated the areas of thickening of the skin type of callosity.
T. rubrum often strikes the large folds: inguinal-femoral, axillary, buttock, under the Breasts. In the process of generalization rashes can occur on any part of the skin. In rare cases, the affected skin of the scalp and face. Sometimes the disease proceeds as suppurative trichophytosis.
On the smooth skin lesions of irregular shape, with intermittent platen consisting of a small fused nodules pink color, scales and crusts, with a bluish tinge and peeling in the center of the skin bluish-pink. May be nodular or nodular lesions. On legs, these elements are located predominantly on the extensor surfaces, sometimes adjacent to the hair follicles are grouped in an open ring and garlands, quite often affected vellus hair.
Manifestations of rubromycosis on the smooth skin can be various and remind eczema, psoriasis, lupus erythematosus and other skin diseases.
In children the lesions of smooth skin on the feet is characterized by melkoplastinchatym peeling on the inner surface of the terminal phalanges of the fingers, most often in the 3rd and 4th interdigital folds or under the fingers, redness and maceration. Sole skin can not be changed or enhanced skin pattern, sometimes there is a ring-shaped peeling. The disease is accompanied by itching. In children more often than adults, arise of exudative lesions not only on the feet, but also on the hands.
When athlete's foot, is caused by T. interdigitale, often there defeat the 3rd and 4th interdigital folds, the plantar surface, the side surfaces of the foot and toes, the arch of the foot. Clinical forms of destruction are the same as when rubromikoz, but the disease often occurs with more severe inflammatory exudative phenomena, the development of allergic skin rash upper and lower extremities, trunk, face.
For athlete's foot is characterized by loss of nails, and often it happens when multiple rubromikoz and single (I and V fingers feet), if a fungal infection caused by T. interdigitale. Nail involvement may be distal (changing nail starts from the free edge), distal-lateral and proximal. There are several forms of nail infections:
- hypertrophic (in most cases) is a thickening of the nail all over at the expense of subungual hyperkeratosis - nails become dull, dirty gray, friable free edge-
- Mature – saved the normal configuration of the nails, but they become dull, with a yellowish tinge at the free edge, with a thickening in the corners of the plate due to the accumulation of Horny masses-
- atrophic – nails substantially destroyed, as if eaten away on the free edge of the bed is partially bared and covered with layers of loose and dry crumbly mass
- the defeat to the type of onycholysis – nail plate is separated from the bed, sometimes dirty grey colour, at the base retains the normal color of the nail.
Can occur with combined lesions of nails.
Onychomycosis caused by T. interdigitale, nail infections are more superficial than rubromikoz. Clinical manifestations in children are characterized in that the configuration of the nail can not be changed, but the surface is rough or foliated, rare subungual hyperkeratosis, nail color can not be changed, or there are strips of yellow or brownish-yellow, sometimes coalescing into a spot.
For athlete's foot is characterized by a chronic course with frequent exacerbations. The acute and exudative clinical manifestations present in patients of young and Mature age, monotonous over on the "dry type" - patients of elderly and senile age.
The athlete's foot in the elderly - usually many years of mycotic process (disease, acquired back in the early years, continues throughout life). Primarily affecting the soles and interdigital folds - their skin is pinkish-bluish color, dry, covered with small scales, especially in the furrows. Defeat grasps the skin of the fingers, the side (often the back) surface of the foot. In the field of pressure and friction in ill fitting shoes much more frequently than at a young age, occur foci of hyperkeratosis with fissures (deep and sometimes painful, especially in the heel and Achilles tendon). When athlete's foot in the elderly, especially when rubrofitia, there are multiple lesions of the nails, more flowing type of total degeneration. This is due to the fact that 40 patients with onychomycosis were older than 65 years.

Diagnosis of Tinea pedis:

Diagnosis of athlete's foot is based on clinical manifestations and detection of the fungus by microscopic examination of pathological material. The type of agent can be identified in the cultural survey.
To differentiate athlete's foot is needed with dyshidrotic eczema, psoriasis, pustular bacteria Andrews, keratodermia - localization of the lesions on the shins with nodular vasculitis, papulonecrotic tuberculosis, limited atopic dermatitis on the skin of the trunk – with psoriasis, superficial and chronic dermatophytosis, and infiltrative infiltrative-suppurative forms zooantroponoznyh ringworm, athlete's groin - face – with lupus erythematosus.

ru/" target="_blank">Treatment of Tinea pedis:

Mycoses of the skin even at the earliest stages of development require mandatory treatment, the leading role belongs antifungal preparations for external use, affecting directly to the lesion.
Antifungal drugs for external actions shall satisfy the following requirements:
- possess sufficient antifungal activity, while taking into account common lesions of mixed infection, and in some cases the impossibility of the in-depth survey to identify the type of pathogen spectrum antifungal activity must be wide (this refers to the activity in relation to the maximum number occurring in the region of the causative agents of fungal infections of the skin and mucous membranes)-
- to ensure a sufficiently high concentration of the antifungal substances in the surface layers of the skin-
- to combine antifungal and antibacterial action
- not to provide local irritative effect-
- not to possess allergenic action
to be easy to use, and no color and smell, not to give the skin a "greasiness", to provide a sufficient effect when applied 1-2 times a day-
to have an affordable price-
- uninterrupted be present in the pharmacy network.
In this regard, an important role in combating fungal infections play mycological, medical-scientific Advisory centres, with trained professionals and appropriate laboratory and clinical bases, have the ability to provide effective care to patients, not only introducing the latest achievements, but also developing new drugs for various clinical forms of fungal infection.
As an active substance in the outer dosage forms are derivatives of azoles, undecylenic acid, allylamines, morpholines, etc.
When squamous manifestations of mycosis antifungal drugs administered topically to the resolution of clinical manifestations. With significant hyperkeratosis in the mycotic lesions on the feet pre-produce the detachment of the stratum corneum of the epidermis with the use of keratolytic agents. In acute inflammatory phenomena (the oozing, the presence of bubbles) and antisense expression of irritation and antihistamines in combination with external means, possessing anti-inflammatory, antiseptic effect (in the form of lotions).
In case of failure of topical therapy for common and frequently relapsing forms prescribed antifungal drugs systemic action:
Terbinafine orally after food 250 mg/day for 3-4 weeks or
Itraconazole orally after meals 200 mg/day daily for 7 days, then 100 mg/day for 1-2 weeks or
Fluconazole orally after meals 150 mg 1 time per week at least 3-4 weeks.
Systemic therapy is carried out taking into account compatibility with other drugs (especially in the appointment of azole) and possible contraindications (especially liver disease).
Describe the various approaches to the treatment of onychomycosis. The most obvious, but not always effective is to remove the affected nail plates with subsequent topical applications of antifungal drugs.
Systemic therapy is the most common method of treatment of onychomycosis – allows the penetration of antifungal drugs into the nail through the blood. Shown in the later stages of the distal-lateral forms of onychomycosis, total defeat of the nail, the proximal forms of onychomycosis, involving more than 50 of the nail plate, the defeat of many nails, nail matrix, the long duration of the disease. Additional arguments in favor of this therapy were the results of recent research which showed that in total onychomycosis can affect not only the nail plate but also the underlying tissues: the epidermis, connective tissue and even the bone structure, particularly the medullary canal. These data, from the point of view of the author, make it necessary in a case of total and proximal onychomycosis enough, prolonged use of systemic anti-fungal drug in the continuous scheme, as modern ceratophyllidae antimycotics accumulate in the stratum corneum, where the mushrooms are subjected to their action, even during breaks in treatment, are not affected in this period by fungi that are in the deeper structures that may contribute to their survival.
Detailing the pathogenesis of onychomycosis, A. Y. Sergeev (2001) concludes that most fully meets the requirements of the habitat of the fungi is in the area of articulation of the nail plate and bed. Here are a softer, ventral layer of the nail plate and the upper layers of the nail bed removed from the vasculature. Moreover, the articulation of the bed plate occurs due to their longitudinal bands, presents the matching grooves and scallops. The space between them – the potential location of a fungal colony. According to the author, exceptional conditions for the growth and activity of fungi in this area due to the high frequency subungual form of the disease.
The duration of systemic therapy with antifungal drugs is determined by the speed of nail growth. The mechanism of action of systemic antifungal agents in accordance with this concept boils down to suppression of invasion of the fungus on the growth of the nail plate. If the nail is growing slowly, it needed large dose and duration of treatment.
Due to the fact that the above-described "most convenient" localization removed from the vascular network, the access of systemic antifungal agents is ensured only when their accumulation in the growing nail. At the same time when using animalisticheskih funds and subsequent applied topically antifungal drugs last act synergistically acting on the mass of the fungus in the opposite direction with systemic drugs.
Removal of the affected nail plate, on the one hand, contributes to the destruction of a significant portion of the cells of the fungus, and facilitates access antifungal drugs applied topically to the lesion. The rate of growth of the nail plate, i.e. "crowding out" of her affected part becomes less important. In addition, increasing the chances to provide an antifungal effect on subungual patterns during the period of interruption of systemic medications intermittent use.
The synergy of systemic and topical treatment of onychomycosis due to the fact that the development of new systemic antifungal agents walked in the direction of get high-level components with good bioavailability. The development of topical drugs have focused on mechanisms to improve delivery of the active substance through the nail plate.
Thus, the proposed ways to improve the treatment of onychomycosis, from our point of view, it is legitimate to add and remove animalisticheskiy way affected part of the nail plate.
Especially shown combination therapy in elderly patients, in whom the growth of the nail plate is slower, therefore, to suppress the growth of the fungus systemic drugs need a higher dose and longer duration of treatment, which is associated with increased cost of treatment and the risk of possible side effects. Be aware that this category of patients is more common underlying medical condition, which is a contraindication to the prescription of systemic antifungal drugs, and the violation of peripheral blood circulation, degrade the last delivery to the lesion.
So, we can distinguish the following approaches to the treatment of onychomycosis:
1) local therapy:
a) with removal of the nail plate
- surgical way
- by applying animalisticheskih funds-
b) without removing the nail plate (fungicidal varnish)-
2) systemic therapy:
- standard scheme (average daily intake of therapeutic doses of the drug)-
- short circuit (usually with increasing daily dose)-
- discontinuous scheme (with an interval between courses, comparable to the duration of treatment or longer)-
3) combination therapy:
- some combination of systemic drugs-
- a combination of systemic drugs and topical treatment, including the removal of the nail plate and without it.
Some authors under combination therapy understand the combination of specific systemic treatment and pathogenetic therapies, such as funds, accelerating the growth of the nail plate. If necessary, any specific treatment of onychomycosis should be applied in combination with pathogenetic methods.
Combined method of treatment comprising terbinafine 250 mg/day external application of antifungal drugs after removal animalisticheskiy means the affected part of the nail plate, was the most effective. It exceeded the overall effectiveness of local therapy 36.6, systemic monotherapy – 8 and reduced duration of treatment an average of 8.6 weeks, compared with local therapy and 1.3 weeks in comparison with the system. Combination therapy reduced the duration of the systemic antimycotics, which helped to reduce the likelihood of possible side effects and that is also very important to reduce the cost of treatment. This method of therapy was effective even in patients with the most severe manifestations of onychomycosis, which arose against the background of related pathogenetically significant pathology.
Therefore, combined treatment indicated for moderate extent of injury, although in this case it is possible to use the system alone. In severe extent of the lesion combination therapy has significant advantages over monotherapy. The achievement of clinical remission is possible, usually when you use also pathogenetic methods of treatment.
Combination therapy is particularly effective in severe forms of onychomycosis, the elderly due to the slow growth of the nail plate - the deterioration of the peripheral circulation - the presence of comorbidities that make it necessary to reduce course dose and duration of intake system of the drug in the presence of subungual hyperkeratosis or partial detachment of the nail plate, which hinders getting into her system of the drug - with the defeat of the nail plate only the first finger, as it makes possible a significant reduction in this case, the duration of application of system of the drug.
Thus, today in the Arsenal of dermatologists, there are new methods and means of treatment and prevention of fungal diseases. They are affordable, safe, effective, ie correspond to all modern requirements. At the same time, timely access to a doctor, correct diagnosis and adequate form and stage of the disease the treatment will help to relieve the patient from such serious diseases as fungal infection of the skin, or to prevent its occurrence.
Tinea pedis

Prevention of Athlete's foot:

Prevention of athlete's foot boils down to personal events (wrestling with sweating stop, etc.) and public (the contents of the sanitary condition of the baths, showers) hygiene, sanitary-educational work.

Which doctors should be consulted if You have Athlete's foot:

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