Mycosis of the feet (dermatophytosis) is an infectious disease caused by pathogenic or opportunistic fungi. With mycosis, the skin on the legs peels off and becomes very itchy, and in severe cases of the disease, it becomes red and swollen.
Definition of disease
Mycosis of the feet, or dermatophytosis, is an infectious disease caused by dermatophyte molds. In total, 43 species of dermatophytes are known, 30 of them cause mycoses of the feet. In most cases these are the fungi Trichophyton rubrum (90%), Trichophyton mentagrophytes and, less frequently, Epidermophyton. Mycosis of the feet is much less often caused by fungi of the genus Candida and molds Scytalidium dimidiatum, Scytalidium hyalinum.
All dermatophytes have keratinolytic activity: they are capable of dissolving keratin, the fibrous protein that forms the upper part of the skin of humans and animals. The skin is damaged.
Once on the skin, the fungi target the most vulnerable places: the junctions between the cells of the epidermis. There they penetrate inside and begin to actively grow. However, fungi rarely penetrate deeper than the granular layer of the skin. They are usually limited to the upper keratinized tissues only.
Prevalence of mycosis of the feet.
Mycoses of the skin, including those of the feet, are found in all countries of the world. The share of these diseases in the structure of all dermatological diseases reaches 37%-40%.
At the same time, skin mycoses occur more frequently - about 30% of cases.
According to dermatologists, up to 20% of the adult population suffers from foot fungal infections. The pathology is found twice as often in men.
Among people over 70 years of age, foot fungus is found in almost every second patient; This is explained by the fact that older people often have chronic diseases associated with metabolic disorders, as well as vascular pathologies, such as varicose veins.
Foot fungal infection usually occurs in the family, through direct contact with the skin of an infected person. There are also known cases of infection through sharing clothing, shoes and household items.
The infection usually affects both feet at the same time and partially spreads to the nail plates. Without treatment, the disease can also affect the skin of the palm, usually the working hand. This condition is called two feet, one hand syndrome.
Causes of mycosis of the feet.
Most often, mycosis of the feet is caused by dermatophyte fungi: Trichophyton rubrum, Trichophyton mentagrophytes and Epidermophyton floccosum. Much less often, the disease is caused by fungi of the genus Candida (Candida) and mold (Scytalidium dimidiatum, Scytalidium hyalinum).
According to some studies, the proportion of dermatophytes in the structure of the causative agents of mycosis of the feet is gradually decreasing. Candida fungi come to the fore.
Risk factors for developing foot mycosis:
- violation of personal hygiene;
- sharing shoes (for example, at bowling alleys, skate and ski rental shops);
- visit public baths, swimming pools, beaches;
- climatic characteristics: the risk of getting sick is higher in countries with tropical and subtropical climates; This is due to the increase in humidity and ambient temperature;
- constantly wearing closed and tight shoes (this happens among military personnel, miners, workers in the textile and metallurgical industries);
- frequent injuries to the toes from flat feet, calluses, corns;
- non-compliance with sanitary rules during pedicure;
- poor blood supply to the legs;
- immunodeficiency conditions, including HIV;
- chronic dermatoses;
- obesity;
- diabetes;
- chronic venous insufficiency;
- taking certain medications (systemic glucocorticosteroids).
Symptoms of mycosis of the feet.
The symptoms of mycosis of the feet, as well as the features of the treatment of the disease, depend on its clinical form.
Scaly (squamous-hyperkeratotic) form of mycosis of the feet
In most cases, the causative agent of the scaly form of mycosis of the feet is the dermatophyte Trichophyton rubrum.
At the initial stage of the disease, the patient is bothered by moderate peeling of the skin between the fingers: the skin scales are abundant, thin and silvery in color. Then, as the disease spreads to the lateral and dorsal surfaces of the feet, a characteristic inflammatory ridge appears and the skin on the affected areas thickens. Over time, the patient develops onychomycosis, nail fungus.
Intertriginous (interdigital) form of mycosis of the feet.
This form often develops against the background of intense sweating of the feet. The disease affects the spaces between the fingers and is accompanied by redness, swelling and maceration (softening and loosening of the skin). Erosion and cracks often form. Many patients report itching, burning and pain.
Simultaneous infection of the skin of the feet with dermatophyte fungi (usually Trichophyton mentagrophytes var. interdigitale) and the bacteria Staphylococcus aureus often occurs.
Dyshidrotic form of mycosis of the feet.
As a rule, the causative agent of this form of mycosis of the feet is Epidermophyton floccosum (scaly epidermophyton).
The Dyshidrotic form of mycosis of the feet is usually more severe and is accompanied by painful itching and pain. Blisters with a thick layer form on the skin. Merging, they form large multi-chambered blisters, which, after opening, turn into moist pinkish-red erosions, and then into brown scabs.
The disease is difficult to treat and often recurs.
A characteristic feature of the Dyshidrotic form is damage to the arch of the foot, interdigital folds and skin of the fingers. The process can then spread to the heels, the lower lateral surfaces of the feet, and even the skin under the ankles.
If a bacterial infection occurs, the patient may develop fever and the regional lymph nodes will enlarge. Swelling of the foot appears and the skin becomes wet. Severe pain makes it difficult for the patient to walk.
Exudative-dyshidrotic form of mycosis of the feet.
Most often, the exudative-dyshidrotic form of mycosis of the feet is caused by the fungus Trichophyton rubrum (red trichophyton).
The skin between the fingers is affected first. The process then spreads to the sole, dorsal and lateral surfaces of the foot, and to the nail plates. Blisters and erosions appear on the skin, which are then covered with scabs. The skin becomes moist and may rot.
Erased form of mycosis of the feet.
Some researchers identify the erased form. It is believed to occur a few days after infection with the fungus.
The skin in the interdigital folds begins to peel off. There may also be slight peeling on the soles and sides of the feet. Patients may ignore unpleasant symptoms, but still infect others.
Acute form of mycosis of the feet.
The acute form of mycosis of the feet is the result of an exacerbation of the Dyshidrotic or intertriginous (interdigital) form.
The disease begins acutely: a large number of blisters appear on the skin of the feet, and then on the legs. The skin swells. Nodules then form on the hands and the lower third of the forearms.
Once the blisters break open, erosions appear, surrounded by remnants of loose skin. They merge and become extensive suppurating surfaces, often with purulent discharge.
The disease is usually accompanied by fever, deterioration in the patient's general condition and acute pain in the affected hands and feet. The inguinal and femoral lymph nodes enlarge and become painful.
Vesiculobullous (inflammatory) form of mycosis of the feet.
The inflammatory form of mycosis of the feet is usually identified by foreign authors, who often define it as acute. It can develop from a chronic interdigital form of dermatophytosis.
As a rule, the causative agent of the vesicular form is the dermatophyte Trichophyton rubrum.
Main symptoms: intense itching, skin rashes, located mainly on the soles, base and sides of the toes, on the back of the foot. Swollen areas with blisters may appear on the surface. The bubbles can merge or remain unchanged for a long time, if the tire (top) is thick enough.
Often, the nail plates are also involved in the process - onychomycosis develops.
Ulcerative form of mycosis of the feet.
The ulcerative form (in foreign literature it is called deep) is one of the complications of mycosis of the feet, caused by the addition of a bacterial infection.
Extensive deep purulent ulcers form on the soles of the feet. The patient experiences severe pain and, as a result, difficulty walking.
Complications of mycosis of the feet.
Cracks and ulcers on the skin that appear at the site of mycosis are the gateway to bacterial infections. However, it is more difficult to treat these types of infections; This is explained by the fact that fungi produce special substances that increase the resistance of bacteria to drugs.
The most common complications of foot mycosis:
- allergic dermatitis of infectious and pharmacological origin;
- pyoderma - pustular skin diseases (cellulitis, lymphangitis, phlegmon, osteomyelitis of the bones of the foot), which can cause deep and long-lasting skin wounds;
- plantar warts;
- Microbial eczema is a chronic inflammatory disease in which the skin becomes itchy, red, and blistered with fluid;
- a general decrease in immunity and impaired microcirculation in the lower extremities (usually develops in patients with diabetes mellitus and varicose veins);
- spread of the disease to the skin of the hands and nail plates;
- deterioration of the quality of life: in acute forms of mycosis it is difficult to wear shoes, and lymphadenitis causes fever and poor health.
Diagnosis of mycosis of the feet.
A dermatologist-mycologist deals with the diagnosis and treatment of mycosis of the feet.
At the appointment, the doctor will evaluate the condition of the patient's nails, skin, mucous membranes and hair. He will perform a dermoscopy: he will examine the skin under magnification. In parallel with the examination, the specialist will collect a history and ask the patient about his lifestyle, quality of nutrition, household habits and care procedures.
If you suspect you have athlete's foot, your doctor will order lab tests.
Examination of the skin scrapings will rule out or confirm a fungal infection.
The doctor may also refer the patient for microscopic examination and culture.
Sowing, or cultural method, allows more precise information to be obtained about the causative agent of the disease, although it takes longer, usually a month.
Diabetes mellitus can significantly worsen the course of mycosis of the feet and lead to serious complications. Complex studies can exclude or confirm this diagnosis.
A complete blood count helps evaluate the patient's general condition.
A clinical blood test is a blood test that allows you to assess your general health, identify inflammation, bacterial, viral and fungal infections, and can also help in the diagnosis of anemia, diseases of the hematopoietic organs, allergic reactions and autoimmune diseases.
Also, before recommending antifungal therapy, the doctor may prescribe the patient a biochemical blood test; This study will determine the level of bilirubin and the liver enzymes ALT and AST. Such information will help the doctor choose the dosage of the drug and minimize the risk of side effects.
Treatment of mycosis of the feet.
Treatment of mycosis of the feet is carried out in two stages.
In the first stageIf there is acute inflammation, lotions are used: aqueous solutions of bituminous ammonium sulfonate, agents with antiseptic properties (Castellani liquid, 1% brilliant green aqueous solution). Pastes and ointments containing antifungal medications and glucocorticosteroids are then prescribed.
In case of intense crying (in the acute phase) and the addition of a secondary infection, anti-inflammatory solutions in the form of lotions are used, as well as combined antibacterial drugs in the form of creams and solutions.
The basis of therapy is the use of antifungal (antifungal) agents.
On the main stageTreatment uses antifungal medications designed to destroy pathogenic fungi. Most often, these drugs are produced in the form of ointments, creams or solutions.
If the patient is bothered by severe itching, the dermatologist may prescribe antihistamines. They are usually taken for 10-15 days, until the unpleasant symptom disappears completely.
When the nails are damaged, antifungal agents are used that are applied directly to the nail plate and nail folds. In this case, the drug is concentrated on the surface of the nail and does not penetrate into the bloodstream, eliminating the risk of side effects.
If external medications have no effect, systemic antifungal agents are prescribed.
The treatment regimen and dosage of medications are determined by the doctor. During treatment it is necessary to visit the podiatrist at least once a month.
Prognosis and prevention
If you consult a doctor in a timely manner, the prognosis for mycosis of the feet is favorable: most patients treated with antifungal drugs are rid of the disease forever.
To prevent mycosis, it is necessary to protect the feet and hands from irritating and traumatic factors and strengthen the immune system.
Measures to prevent onychomycosis:
- change your socks every day or more often if your feet are sweaty or wet;
- air or dry shoes after wearing them;
- use an antifungal UV shoe dryer;
- do not wear shared slippers when visiting;
- do not try on shoes in a store barefoot;
- use a personal towel for your feet;
- use individual nail care tools (tweezers, files);
- wear shoes in the pool or sauna;
- monitor the diversity of your diet;
- avoid stressful situations.
Frequently asked questions
How to cure foot fungus?
Antifungal drugs are often used to treat leg fungus, which come in the form of creams, ointments and solutions. A dermatologist must choose the most effective drug and determine its dosage.
Why do my feet itch?
One of the causes of itchy feet is foot mycosis, an infectious disease caused by dermatophyte molds.