- Rubromikoz's symptoms
- Rubromikoz's reasons
- Rubromikoz's treatment
Rubromikoz (tinea) - the widespread fungus disease caused by richophyton rubrum T mushroom (a red trikhofiton), striking soles, palms, smooth skin, vellus hair and nails.
Infection happens in the same ways, as at an epidermophitia. However great epidemiological value of a rubromikoz is connected with the fact that infection is carried out not only in direct contact, but is frequent through objects of household use.
The incubation interval is not established. Perhaps long carriage. The disease is subdivided into several clinical versions: рубромикоз feet, brushes and feet, nails and generalized form. Children suffer rubromikozy brushes and feet aged from 7 up to 15 years.
Rubromikoz of feet
Rubromikoz of feet - the most frequent localization of mycosis. Begins with interdigital folds which unlike an epidermophitia are struck all or almost everything. Then process takes skin of soles which infiltrirutsya, becomes dry, diffuzno hyperemic; clearly skin furrows where the well-marked mukovidny peeling is noted are visible. Process extends also to the back and side surfaces of skin of feet and fingers. At children this form of a rubromikoz quite often is followed by the expressed exudative phenomena that can lead to diagnostic mistakes. Damage of skin of feet, as a rule, leads sooner or later to involvement in the course of nail plates. In other cases process begins with defeat of nail plates, and then takes also skin groan.
Rubromikoz of feet and brushes
The disease begins with skin of feet, and already then brushes and nail plates of fingers of brushes are surprised. Less often the activator is implemented originally into skin of brushes. The clinical picture of a disease is almost similar to damage of skin of feet, but intensity of defeat is less expressed (due to repeated washing of hands). On the periphery of the centers there is a discontinuous roller which quite often is located also on a dorsum of brushes.
Rubromikoz of nail plates
The disease meets often. Sometimes this isolated damage of nails. In other cases it is combined with damages of skin of feet, brushes or with a generalized rubromikoz. Mass character of involvement in process of nail plates is characteristic; all nails on feet and brushes are quite often affected. At normotrofichesky type of a rubromikozny onychia thickness of a nail plate does not change; defeat happens from free edge or from side edges of a nail where are formed white or yellowish color of a strip; the same strips can appear through in the thickness of a nail plate. At hypertrophic type of a rubromikozny onychia the nail plate is thickened, the hyponychial hyperkeratosis crumbles easily, breaks, noted, the strips mentioned above can be observed. At atrophic type of an onychia the nail plate becomes thinner, its most part collapses, remaining only at the nail roller. Sometimes the nail plate separates from a noggevy bed as an onikholizis.
At characteristic (typical) damage of skin of feet, brushes and nail plates establishment of the diagnosis does not cause difficulties, considering also that it easily is confirmed at microscopic examination of pathological material.
Rubromikoz skin of feet and interdigital folds without damage of skin of brushes and nail plates should be differentiated with an intertriginozny and squamous epidermophitia of feet which clinical picture can be almost identical. However at a rubromikoza note more expressed hyperkeratosis and existence of a mukovidny peeling in skin furrows, and at an intertriginozny epidermophitia - more expressed inflammatory phenomena, existence of secondary allergic rashes. For an epidermophitia of nails as it was specified earlier, defeat of nail plates only of I and V fingers a top and an intaktnost of nail plates of brushes is characteristic. At a trichophytosis of nails process begins with smooth skin around a nail plate, and then rather quickly (within several months) takes a nail which changes in color, crumbles, breaks and reminds a rubrofitiyny onychomycosis in the developed stage. For a favus of nails the most pathognomonic is slow involvement in process of a noggevy plate (within several years) in which center the yellow-brownish speck which is gradually increasing and then taking all nail plate is formed in the beginning. The microsporia, as a rule, does not strike nail plates. At psoriasis of nails the naperstkovidny istykannost of a nail gglastinka most often takes place. Eczema and a pyoderma of nails are followed by the characteristic centers of defeat located in a circle of a nail plate. To red flat I deprive of nail plates existence of the pinkish, yellowish and whitish strips going longwise to a nail plate is peculiar. Its combination with a paronychia when the periungual roller swells up a little is characteristic of a barmy onychia, becomes hyperemic and from under it it is possible to squeeze out a pus droplet; disappears эпонихион. Symmetry of defeat, involvement in process of all nail plates are characteristic of dystrophy of nails.
The listed above diseases of nail plates, naturally, are followed by corresponding changes on other sites of an integument that significantly facilitates diagnosis of an onychia.
Finally it is possible to resolve an issue on the basis of cultural diagnosis, i.e. when receiving on a medium (most often on Saburo's circle) cultures of a mushroom - a disease-producing factor.
It is better to make scrapings for microscopic diagnosis from regional rollers where threads of a mycelium are in bigger quantity. It is possible to take on a research mukovidny scales from skin furrows. The horn mass of nail plates take from free edge of a nail (cut off scissors) or from average and deep layers of a nail plate (a drill or a scalpel). Stay in drugs of threads of a mycelium confirms the fungal nature of a disease, but does not allow to judge a type of the activator. The last is possible on the basis of data of a cultural research.
At most of patients generalized рубромикоз develops after more or less long existence of limited damage of skin of feet (sometimes and brushes), and also nail plates. Pathology of internals, endocrine and nervous systems, trophic changes of skin, prolonged use of antibiotics, steroid and cytostatic drugs contribute to dissimination of process. In these cases lymphogenous and hematogenous distribution of process with accumulation of elements of a mushroom in lymph nodes is not excluded.
Clinic and current. Clinically the picture of a disease is very various and it can conditionally be subdivided into several versions: erythematic and squamous (superficial), follicular and knotty (deep), exudative forms and defeat like erythrosis.
The erythematic and squamous centers of a rubromikoz can be located on any sites of an integument, are followed by the expressed itch and remind atopic dermatitis, a parapsoriasis, a ring-shaped granuloma, some forms of eczemas, scaly deprive, etc. On clinical diagnosis tendency of the centers to group, to formation of rings, arches, semi-arches and garlands, a hyperpegmentation and an easy peeling help to suspect mycosis of the center. Special significance in diagnosis is attached by festonchatost in an outline of the centers and to existence of the edematous, discontinuous roller on the periphery. The course of process chronic with a tendency to an aggravation in warm season. In diagnosis the microscopy of scales and vellus hair has crucial importance (the last, being clinically invariable, may contain mushroom elements inside). Cultural diagnosis distinguishes from a surface and an infiltrative purulent trichophytosis of smooth skin erythematic and squamous рубромикоз.
The follicular and knotty (deep) form of a rubromikoz most often affects shins, buttocks and forearms. Its elements are inclined to form figures and can clinically remind a knotty erythema, an indurative erythema of Bazen, a knotty vasculitis, papulonecrotic tuberculosis (on site the centers often there are scars). At localization of this form on face skin it is necessary to carry out differential diagnosis from an eritematozoma by a tubercular lupus.
Inguinal, mezhjyagodichny folds, skin under mammary glands are struck quite often. Surface of the centers of yellowish-red or brown color. They are unsharply infiltrirovana, are shelled. Edges tower, have the discontinuous scalloped roller on which small papules and crusts are located. Such centers of a rubromikoz differentiate with candidiasis of large folds and microbic eczema at which on a kr of holes of the main center there is a large number of so-called affiliated elements (eliminations).
At candidiasis the center more мацерирован, becomes wet, and at microbic eczema are observed polymorphism of primary elements with dominance of microvesicles, pustules, and also "serous wells", places of stratification of yellowish color of purulent crusts.
At a rubromikozny erythrosis the centers of defeat of saturated red color with a cyanotic shade, merge among themselves, taking the big surfaces of skin. Exudative displays of mycosis are rather rare and there can be pleated skin and on extremities.
The damages of smooth skin described above at a rubromikoza can be combined at one patient and it to facilitate clinical diagnosis, in particular at simultaneous damages of skin of feet, palms and nail plates.
Infestant is the anthropophilous mushroom of Trichoph. purpureum, or Trichoph. rubrum. In recent years prevalence of a rubromikoz increased as among adults, and children. On cultural features the activator of a rubromikoz is subdivided on gipsovidny, fluffy and velvety. The most virulent and aggressive - gipsovidny option in this connection it became the leading causative agent of mycoses of feet.
At damage of nails, hair, common forms of a disease purpose of an orungal is obligatory or lamizit inside. At acute inflammatory process with moknutiy and hypostasis at first it is necessary to calm the inflammatory phenomena. For this purpose appoint rest, the cooling lotions, alternating them to the warming compresses, for example, from Gulyardovy water, Burov's liquid (1-2 tablespoons on a glass of water), 1-2% aqueous solution of nitrate silver (lyapis) and 1-2% solution of Rivanolum, etc. Large bubbles after preliminary disinfection by alcohol puncture. It is necessary to delete carefully and daily with scissors the hanging corneous layer. In process of subsiding of inflammatory process appoint boron-tar, sulfur-tar or boron-нафталановые pastes, then fungicidal solutions and ointments (Undecinum, Mycosolonum, микосептин, Zincundanum). The corneous layer is otslaivat ointments or varnishes with keratolytic substances, greasing by 2% spirit solution of iodine with the subsequent use of ointments (микозол, sulfuric, sulfur-salicylic and tar).
Palms and soles are processed serially. After a hot soap and soda bathtub (at the rate of 2-3 teaspoons of soda and 20-30 g of soap on water liter) 20-30% salicylic ointment or ointment containing 6% of lactic acid and 12% of salicylic is imposed under a compresseal bandage. In 48 hours 5-10% salicylic ointment is imposed for days. When processing a sole patients have to use crutches, otherwise when walking ointment will be to mix up from the affected skin. In out-patient conditions it is better to use a milk and salicylic collodion: within 3 days daily to grease skin of soles with three times uniform layer. After use of keratolytic means do a soap and soda bathtub again, and a scalpel or scissors horn masses is removed. If it was not succeeded to clear skin completely, for 2-3 days 5% salicylic ointment is imposed. After amotio rub fungicidal ointments and solutions, it is reasonable to alternate them each 3-4 days or ointments to apply for the night, and solutions - in the afternoon, once a week are obligatory foot (manual) baths.
Treatment of the centers of a rubromikoz out of palms and soles is carried out from the very beginning by fungicidal means. The affected nails soften and delete, a bed of a nail treat antifungal plasters, ointments and liquids. At the same time appoint it is long (before half a year) inside griseofulvin or nizorat (in the absence of contraindications). Treatment - process very difficult and labor-consuming. Efficiency of therapy depends generally on care of performance of necessary manipulations.