Mycosis of the feet (dermatophytosis) is an infectious disease caused by pathogenic or opportunistic fungi. With mycosis, the skin of the feet peels off and itches a lot, 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 types of dermatophytes are known, 30 of which cause mycosis of the feet. Most often, these are Trichophyton rubrum (90%), Trichophyton mentagrophytes and, less commonly, Epidermophyton fungi. Mycosis of the feet is less often caused by fungi of the genus Candida and molds Scytalidium dimidiatum, Scytalidium hyalinum.
All dermatophytes have keratinolytic activity: they can dissolve keratin, a fibrous protein that makes up the upper part of the skin of humans and animals. The skin is damaged.
Once on the skin, the fungi are directed to the most sensitive places - the junctions between the cells of the epidermis. There they penetrate inside and begin to grow actively. However, fungi rarely penetrate deeper than the granular layer of the skin. Usually they are limited only to the upper, keratinized tissues.
Spread of mycosis of the feet
Mycoses of the skin, including foot mycoses, 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, mycoses of the skin occur most often - in about 30% of cases.
According to dermatologists, up to 20% of the adult population suffers from mycosis of the feet. Pathology is detected twice as often in men.
Among people over 70 years of age, athlete's foot is found in almost every second patient - this is explained by the fact that older people usually have chronic diseases associated with metabolic disorders, as well as vascular pathologies such as varicose veins.
Infection with mycosis of the feet usually occurs in the family - through direct contact with the skin of an infected person. Cases of infection are also known when sharing clothes, shoes and household items.
The infection usually affects both feet at once and partially spreads to the nail plates. Without treatment, the disease can also affect the skin of the palm - usually on the working hand. This condition is called two-leg-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. Less often, the disease is provoked by fungi of the genus Candida (Candida) and mold (Scytalidium dimidiatum, Scytalidium hyalinum).
According to some studies, the proportion of dermatophytes in the causative structure of foot mycosis gradually decreases. Candida fungi come to the fore.
Risk factors for the development of foot mycosis:
- violation of personal hygiene rules;
- sharing shoes (for example, at bowling alleys, skate and ski rental shops);
- visiting public baths, swimming pools, beaches;
- climatic features: in countries with a subtropical and tropical climate, the risk of disease is higher - this is due to an increase in humidity and environmental temperature;
- constantly wearing closed, narrow shoes (this happens among military personnel, miners, textile and metallurgical industry workers);
- frequent damage to the toes due to flat feet, calluses, corns;
- non-observance of sanitary rules during pedicure;
- violation of blood supply to the legs;
- immunodeficiency conditions, including HIV;
- chronic dermatoses;
- obesity;
- diabetes;
- chronic venous insufficiency;
- taking certain drugs (systemic glucocorticosteroids).
Symptoms of foot mycosis
The symptoms of mycosis of the feet, as well as the treatment features of the disease, depend on its clinical form.
Squamous (squamous-hyperkeratotic) form of mycosis of the feet
In most cases, the causative agent of the squamous form of mycosis of the feet is the dermatophyte Trichophyton rubrum.
At the initial stage of the disease, the patient is disturbed by moderate peeling of the skin between the fingers - the scales on the skin are abundant, thin, silvery. Then, as the disease spreads to the lateral and dorsal surfaces of the legs, a characteristic inflammatory ridge appears and the skin thickens in the affected areas. Over time, the patient develops onychomycosis - nail fungus.
Intertriginous (interdigital) form of foot mycosis
This form often develops against the background of severe 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 are often formed. Many patients complain of itching, burning and pain.
Often, the skin of the feet is infected simultaneously with dermatophyte fungi (usually Trichophyton mentagrophytes var. interdigitale) and Staphylococcus aureus bacteria.
Dyshidrotic form of foot mycosis
As a rule, the causative agent of this form of foot mycosis is Epidermophyton floccosum.
The dyshidrotic form of mycosis of the feet, as a rule, is more severe and is accompanied by painful itching and pain. Blisters with a thick coating on the skin. Combined, they form large multichamber blisters, which, after opening, turn into moist pink-red erosions, and then brown crusts.
The disease is difficult to treat and often recurs.
A characteristic feature of the dyshidrotic form is damage to the skin of the arch of the foot, interdigital folds and fingers. The process can then spread to the heels, lower lateral surfaces of the feet and even the skin under the ankles.
If a bacterial infection occurs, the patient may develop a fever and regional lymph nodes will become enlarged. Swelling of the foot appears and the skin on it becomes wet. Severe pain makes it difficult for the patient to walk.
Exudative-dyshidrotic form of foot mycosis
Often, the exudative-dyshidrotic form of mycosis of the feet is caused by Trichophyton rubrum (red trichophyton) fungi.
The skin between the fingers is affected first. Then the process spreads to the heel, dorsal and lateral surfaces of the foot, nail plates. Blisters and erosions form on the skin, which are then covered with crusts. The skin becomes moist and may fester.
Deleted form of mycosis of the feet
A deleted form is identified by some researchers. It is believed to occur a few days after infection with the fungus.
The skin begins to peel off in the interdigital folds. There may also be slight peeling on the soles and sides of the feet. Patients ignore unpleasant symptoms, but still infect others.
Acute form of foot mycosis
The acute form of mycosis of the feet is the result of 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. Then there are nodules on the hands and the lower third of the forearms.
After the blisters open, erosions appear surrounded by loose skin scraps. They often merge into large weeping surfaces with purulent discharge.
The disease is often accompanied by fever, worsening of the patient's general condition, and sharp pain in the affected hands and feet. Inguinal and femoral lymph nodes are enlarged and painful.
Vesiculobullous (inflammatory) form of foot mycosis
The inflammatory form of mycosis of the foot is usually defined by foreign authors, who often define it acutely. It can develop from the chronic interdigital form of dermatophytosis.
As a rule, the causative agent of the vesiculobullous form is the dermatophyte Trichophyton rubrum.
Main symptoms: severe itching, skin rashes, localized mainly on the heels, soles and sides of the fingers, back of the foot. Areas of swelling with blisters on the surface may be seen. Bubbles can coalesce or remain unchanged for a long time - if the tire (upper part) is thick enough.
Often, nail plates are also involved in the process - onychomycosis develops.
Ulcerative form of foot mycosis
The ulcerative form (called deep in foreign literature) is one of the complications of mycosis of the feet caused by the addition of bacterial infection.
Large deep purulent ulcers form on the heels. The patient experiences severe pain and as a result has difficulty walking.
Complications of foot mycosis
Cracks and ulcers in the skin that appear at the site of mycosis are gateways for bacterial infections. However, it is more difficult to treat such 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:
- infectious and medicinal allergic dermatitis;
- pyoderma - pustular skin diseases that can cause deep, long-lasting skin wounds (cellulitis, lymphangitis, phlegmon, osteomyelitis of the leg bones);
- plantar warts;
- microbial eczema is a chronic inflammatory disease in which the skin becomes itchy and red, and liquid blisters appear on it;
- a general decrease in immunity and a violation of 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 deterioration of health.
Diagnosis of foot mycosis
A dermatologist-mycologist deals with the diagnosis and treatment of foot mycosis.
During the reception, the doctor will assess the condition of the patient's nails, skin, mucous membrane and hair. He will conduct a dermatoscopy - examine the skin under magnification. In parallel with the examination, the specialist will collect anamnesis and ask the patient about lifestyle, nutritional quality, household habits and care procedures.
If you suspect a leg tumor, your doctor will order laboratory tests.
Examination of skin scrapings will rule out or confirm a fungal infection.
The doctor may also send the patient for microscopic examination and culture.
The cultivation or cultural method allows to obtain more accurate information about the causative agent of the disease, although it takes more time - usually a month.
Diabetes mellitus can significantly worsen the course of mycosis of the feet and cause serious complications. Comprehensive studies can exclude or confirm this diagnosis.
A complete blood count helps to assess the general condition of the patient.
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 diagnose anemia, diseases of the hematopoietic organs, allergic reactions and autoimmune diseases.
Also, before recommending antifungal therapy, the doctor may prescribe a biochemical blood test for the patient - this study will determine the level of bilirubin and liver enzymes ALT and AST. Such information will help the doctor to choose the dose of the drug and minimize the risk of side effects.
Treatment of foot mycosis
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 ammonium bituminous sulfonate, agents with antiseptic properties (Castellani liquid, 1% aqueous solution of brilliant green). Then pastes and ointments containing antifungal and glucocorticosteroid drugs are prescribed.
When severe crying (in the acute stage) and secondary infection are added, anti-inflammatory solutions such as lotions, as well as combined antibacterial preparations in the form of creams and solutions are used.
The basis of therapy is the use of antimycotic - antifungal agents.
At the main stagetreatment uses antifungal drugs designed to destroy pathogenic fungi. Most often, such drugs are produced in the form of ointments, creams or solutions.
If the patient is bothered by severe itching, the dermatologist can prescribe antihistamines. They are usually taken for 10-15 days, until the unpleasant symptom disappears completely.
When the nails are damaged, antifungal substances are used - they 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 blood, eliminating the risk of side effects.
If external drugs do not work, systemic antimycotics are prescribed.
The treatment regimen and the dosage of drugs are determined by the doctor. During treatment, it is necessary to visit a podiatrist at least once a month.
Prognosis and prevention
If you consult a doctor in time, the prognosis for mycosis of the feet is favorable: most patients treated with antifungal drugs get rid of the disease forever.
To prevent mycosis, you need to protect your feet and hands from irritating and traumatic factors and strengthen your immune system.
Measures to prevent onychomycosis:
- change socks daily or more often if your feet are sweaty or wet;
- air or dry shoes after wearing;
- use an antifungal UV shoe dryer;
- do not wear shared slippers when visiting;
- do not wear shoes on bare feet in the store;
- use a personal towel for your feet;
- use personal tools for nail care (tweezers, files);
- wear shoes in the pool or sauna;
- control the variety of your diet;
- avoid stressful situations.
Frequently asked questions
How to treat athlete's foot?
Antimycotic drugs, which are usually available in the form of creams, ointments, and solutions, are used to treat foot fungus. A dermatologist should choose the most effective drug and determine its dosage.
Why do my feet itch?
One of the causes of itchy feet is mycosis of the feet, an infectious disease caused by dermatophyte molds.