Foot fungus - symptoms and treatment

Foot fungus(dermatophytosis,Tinea pedis) is a skin disease of the feet caused by pathogenic or opportunistic fungi.Skin changes on the feet are characterized by peeling accompanied by itching.In case of severe lesions, against the background of red and swollen skin, deep erosions and cracks appear on the soles of the feet and in the spaces between the toes, which are accompanied by pain and make walking difficult.

The International Classification of Diseases, 10th Revision (ICD-10) code is B35.3.

The emergence of modern antifungal drugs has improved the epidemiological situation, but foot mycosis still remains one of the most important problems in dermatovenerology.The use of certain medications is limited in older adults and patients with chronic illnesses.

Prevalence of foot fungus.According to the World Health Organization (WHO), about a third of the world's population suffers from fungal diseases, the most common of which are foot fungus;the incidence increases every year.

According to dermatologists, 10 to 20% of the adult population suffers from foot fungus;in men, the disease occurs 2 times more often than in women and more often in older people than in young people.At the age of over 70 years, mycosis of the feet is recorded in every second patient, associated with an increase in concomitant metabolic and vascular changes (diabetes mellitus, varicose veins, etc.).More and more foot fungus infections are being detected in children.

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

Causes of foot fungus.The most common causes of foot fungus are dermatomycete fungi: Trichophyton rubrum (90%), Trichophyton mentagrophytes and more rarely Epidermophyton.Sometimes foot fungus can be caused by fungi of the Candida genus.

Risk factors for foot fungus:

• Exogenous (external): microtrauma of the skin of the feet (calluses, corns), cracks, increased sweating, wearing tight shoes, shoes made of artificial materials, non-compliance with the rules of personal hygiene, irregular washing of the feet and improper drying with a towel.
• 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-progestogen drugs, which reduce the overall immunity of the body.

Infection with foot fungus can come directly from a sick person, and it can also be transmitted through contact and household contact (in a swimming pool, bathhouse, gym, through shoes, towels, carpets, etc.).

If you notice similar symptoms, consult your doctor.Do not treat yourself, it is dangerous for your health!

Symptoms of foot fungus

The main symptoms of foot fungus:

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

The first signs of foot fungus 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 may develop in the form of diaper rash and skin eczema.

Types of foot fungus:

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

• diaper-like – crying areas form;
• scaly - lamellar scales appear;
• hyperkeratotic - accompanied by rashes in the form of papules and plaques on the arch of the foot;
• dyshidrotic - occurs with the development of swelling, oozing areas and blisters.

Pathogenesis of foot fungus

The skin is the largest organ in the human body, accounting for 15% of the total body weight.It performs many functions, first of all, 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: the epidermis, the dermis and subcutaneous fat.

The epidermis (outer layer of skin) provides the main barrier against fungi penetrating the skin.It is a multi-layered keratinizing squamous epithelium, which, in turn, consists 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.As a result, fungi penetrate the superficial layers of the skin, where they continue to exist.The cell wall of dermatomycetes contains manans, substances capable of suppressing local cellular immunity.The fungus T. rubrum, thanks to the action of manans, prevents the proliferation of keratinocytes, which slows down the peeling of horny scales from the surface of the skin and a chronic course of infection develops.

Classification and stages of development of foot fungus

Classification according to pathogen:

• Keratomycosis (tinea 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 fungus.
• B35.2 - Mycosis of the hands.
• B35.3 - Mycosis of the feet.
• B37.2 - Candidiasis of the skin and nails.

Ranking by location:

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

Ranking by clinic:

• Form deletedmanifests itself by desquamation of the interdigital folds III-IV of the feet.Minor peeling may also occur on the soles and sides of the feet.
• Intertriginous formmanifests itself as hyperemia in the interdigital folds of the feet, and the appearance of bubbles is also possible, causing the formation of erosions and cracks.Subjectively, itching and burning are noted.
• With dyshidrotic formClustered blisters appear on the skin of the arch and lateral surfaces of the feet.Most often, they appear on healthy skin, then enlarge, merge and form larger, multi-chambered blisters.When the blisters open, erosions form.
• Scaly-hyperkeratotic formcharacterized by local or extensive 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 resembling pityriasis.Peeling is particularly visible in skin folds.Cracks cause pain when walking.

Classification by clinic is very convenient from a practical point of view for determining further treatment tactics and monitoring the patient.

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 foot fungus caused by Trichophyton mentagrophytes var.interdigital, the scaly-hyperkeratotic form is more often associated with T. rubrum, the chronic course and generalized process are characteristic of opportunistic fungi Candida spp.and Aspergillus.

Complications of foot fungus

• Mushroom allergy.Under the influence of mushrooms, versatile sensitization is formed, that is, the body becomes more sensitive to the waste products of the fungus, which are foreign to us and are strong allergens.The body reacts more sharply, which manifests itself in 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 often develop occupational allergic complications and intolerance to medications.

• Pyoderma- pustular skin diseases (cellulitis, lymphangitis, phlegmon and osteomyelitis of the bones of the foot), which can lead to deep, non-healing skin wounds in the long term.Pyoderma is caused by bacteria easily entering 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.
• Increased viral complicationsin the form of warts due to the presence of hyperkeratosis and cracks.The reason is a violation of the protective function of the skin, which makes 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 appears, they become deformed, 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 are possible.
• Deterioration of quality of life.Acute forms of foot fungus are painful, make it difficult to wear shoes, and when lymphadenitis develops, they are accompanied by poor general health and fever.

Diagnosis of foot fungus

The diagnosis of foot fungus is based on the patient's complaints, medical history, clinical picture and laboratory results.Foot fungus is one of those diseases that necessarily requires laboratory tests to confirm the clinical diagnosis.

The main method of confirming the diagnosis of foot fungus is microscopic examination and culture.The material consists of skin scales, which are scraped from the skin lesion with a scalpel or glass;more rarely, a tape test is used.

Laboratory diagnosisMycoses include microscopic and cultural examination of material for fungi.Microscopic examinationis an express method of diagnosing the pathogen, allowing the structure of fungi to be identified within a few hours.Microscopic examination may reveal fungal elements in the form of mycelial filaments and spores.The disadvantage of the method is that it is possible to obtain both false positive and false negative results, which depend on many factors: the technique of sampling the material, the peculiarities of storage and transportation, etc.

Cultivation methodis the most accurate diagnostic method, allowing the type of fungus to be identified to prescribe pathogenetic treatment.To prepare for the analysis, the patient is not recommended to use antifungal agents on his own for 1 month.

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

Differential diagnosis of foot fungus:

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

Treatment of foot fungus

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

The main task in the fight against foot fungus is its timely detection, recognition and treatment before the development of nail fungus, which requires longer and more complex therapy (systemic antifungal therapy).At the same time, it is important to have effective drugs that correspond to modern clinical characteristics of foot mycoses.

Before starting treatment for a disease, the dermatologist chooses between possible therapeutic options.In most cases, medications are prescribed for topical use.The basis of treatment is the use of antifungal agents that have various effects.Medicines that stimulate blood circulation and medications 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 carried out: a drug from the group of azole derivatives, 1 time a day for 3 to 4 days, which acts as a keratolytic, that is, removes the rough layer, thus preparing the skin and improving the penetration of antifungal agents into the dermis.
• If there are bubbles, use Castellani liquid;the solution is applied externally 1-2 times a day for 2-3 days.Then combined drugs are prescribed 2 times a day externally for 7-10 days.
• In case of severe itching, antihistamines are prescribed: histamine H blocker₁-receptors – ethanolamine derivative 0.001 g 2 times a day orally for 10 to 15 days.
• Disinfect shoes once a month until completely cured;you can use a spray, the active component of which is undecylenamidopropyltrimonium methosulfate.
• If the nail plates are affected, systemic oral antimycotic treatment must be prescribed for a period of 3 to 4 months.This therapy requires the control of a dermatologist, since self-medication can lead to complications in internal organs, primarily the liver, bile ducts, stomach, as well as ineffectiveness of therapy and the formation of resistance to treatment.

It is necessary to treat mycosis of the feet, because if the fungus has settled in the skin, it will not go anywhere without treatment, which means that the waste products of the fungus will always penetrate into 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 fungus is an active source of infection for those around him and in particular for members of his family.Treatment in this case is therefore an effective way to prevent fungal infection in healthy relatives and those around them.

A favorable environment for the development of fungal infections on the skin of the feet is a humid environment, so you should try to keep the skin of your feet always dry.To do this, every evening 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 for skin fungal infections largely depends on the stage of the disease at which treatment was initiated.Therefore, if you notice any changes on the skin, you should not postpone your visit to the doctor.With prompt and correct treatment of foot fungusforecastfavorable: complete cure of the fungal infection occurs, the patient recovers.

If left untreated, the fungus can lead to complications that not only distort the shape of the nails, but also affect the condition of the body as a whole.

Preventionfungal infection:

1. Public prevention consists of treating public places: baths, saunas, swimming pools, showers.Floors, equipment and household items should 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;
   • avoid damage and constant moisture to the skin and toenails;
   • wear loose, comfortable shoes;
   • Avoid contact with infected people.

3. Secondary personal prevention:

   • maintain a hygienic regime for the skin of the feet;
   • disinfect shoes, showers and bathrooms;
   • increase immunity.