Trichophytia

Trichophytosis is a fungal skin disease caused by fungi of the genus Trichophyton. According to the ecological sign of causative agents, anthropophilous (affects only humans), zooanthroponous (strikes human, agricultural and wild animals) and geophytic (strikes human and animals sporadically) trichophytosis.

Anthropophilic (superficial) trichophytosis

The causative agent of this form of trichophytosis is Trichophyton tonsurans, s. Crateriforme, T violaceum. The source of infection is a patient with trichophytosis. Infection occurs by direct contact with the patient or through his things (headgear, nagelnoe and bed-clothes, combs), which the patient used. The patient can become infected in hairdressing salons, kindergartens, schools and other children's institutions. Decreased immunity system, endocrinopathies create good conditions for the development of the disease. By frequency, this mycosis ranks second after microsporia. The causative agents of trichophytosis are divided into groups, depending on the type of damage to the hair. Two main groups are distinguished: endothrix (endotriks) - fungi affecting the inner part of the hair, and estotrix (ectotriks) - vegetative predominantly in the outer layers of the hair. All trichophytons endotrices are anthropophiles, transmitted only from person to person. They cause superficial lesions of the skin, scalp, and nails. Ectotriks are zoophiles, parasitizing mainly on animals, but capable of infecting humans as well. Compared with the fungi of the endotrix group, they cause a more pronounced inflammatory skin reaction in a person.

Symptoms

Distinguish the following forms of anthropophilic trichophytosis: superficial trichophytosis of smooth skin, superficial trichophytosis of the scalp, chronic trichophytosis and trichophytosis of the nails.

[1], [2], [3], [4], [5], [6], [7], [8]

Superficial trichophytosis of smooth skin

Superficial trichophytosis of smooth skin appears on any areas of the skin, but more often on the open face, neck, forearms. Brightly delineated lesions with peeling in the center have a round or oval shape, a pale pink color. The peripheral zone of the outbreaks is surrounded by a more or less pronounced border of spotted or nodular character, on which small bubbles and crusts are often present. The foci can merge, forming bizarre drawings. Itching in the area of the foci is usually small. The disease is acute, with rational treatment, clinical recovery occurs after 2 weeks.

With superficial trichophytosis of the scalp, various foci of round or irregular shape appear, with blurred, diffuse boundaries. Sometimes a mild inflammation is noted. Hair in the lesions partially break off at a height of 1-2 mm or at the skin level. In the outbreaks there is not a continuous damage to the hair, but as it were their rarefaction (thinning). The extracted fragments of hair have the form of commas, hooks, question marks. Briefly broken hair is often called "hemp". The bend of the trichophyton-struck hair extracted by forceps is explained by its softness, so that it can not break through the scales. Sometimes the hair breaks off at the level of smooth skin ("black dots"). For research under a microscope, it is recommended to take just these "hemp" or "black dots". The surface of the foci is covered with whitish scales. There are small- and large-focal variants of the flow of this form of trichophytosis.

Chronic trichophytosis

Chronic trichophytosis is considered a variant of superficial trichophytosis and is also caused by the mentioned anthropophilic fungi of T. Violaceum and T. Crateriforme. Mostly women are ill. The disease begins with childhood with superficial trichophytosis of the scalp or superficial trichophytosis of smooth skin. In the absence of treatment during puberty, the disease spontaneously cures (often in men) or is transformed into chronic trichophytosis, in the development of which endocrine disorders (impaired function of the sexual glands) play an important role, hypovitaminosis, in particular vitamin A deficiency, etc. There is a lesion skin, hair and nails. Foci of lesion are mainly located in the occipital and temporal areas and are manifested only by a slight off-pitted whitish peeling. Pathognomonic sign is that the affected hair break off at the same level with the skin and resemble the gums. These broken in the form of "black dots" hair is sometimes the only symptom of the disease.

Defeat of the skin with anthropophilic trichophytosis is characterized by the formation on the trunk and face of spotted-scaly rashes of pink with a bluish tinge. On the skin of the palms and soles may be observed mild inflammation with lamellar ecdysis. In some patients, against the background of severe concomitant diseases, deep forms of trichophytosis ("trichophytous gums", tubercular trichophytosis, furuncle-like, etc.) occur. Often the nail plates are involved in the pathological process.

Without treatment, trichophytosis in some children can last for years. The disease, as a rule, spontaneously cures only when puberty occurs. In some patients, mostly women, untreated trichophytosis manifests itself differently, turning into chronic trichophytosis. In its pathogenesis, an important role is played by disorders of the autonomic nervous system, endocrinopathy (hypogenitalism, hypercorticism, diabetes, hypovitaminosis A, etc.). It should be borne in mind that chronic trichophytosis can be observed in children. When examining patients with chronic trichophytosis pay attention to the condition of the scalp, smooth skin and nails. The most common manifestations of chronic trichophytosis on the scalp are: single hair broken in the mouth of hair follicles near the surface of the skin, hair in the form of black dots - "black-spotted" trichophytosis), more often in the occipital and temporal areas, small round atrophic scars (1-2 mm in diameter ) and insignificant small-plate scaling.

On smooth skin lesions are usually located in places that are subject to friction (on the extensor surfaces of the elbows and knee joints, on the buttocks, lower legs, on the trunk), where vague erythema-squamous elements with poorly expressed erythema and fine-lamellar scaling of the surface .

At the same time, you can find the third characteristic feature of chronic trichophytosis - the defeat of the nail plates of the hands and feet as an onychomycosis.

[9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20]

Trichophytosis of nails

Trichophytosis of the nails is mainly found in chronic trichophytosis in adults and begins with the free edge of the nail plate, which loses its inherent normal shine.

Almost the weight of the nail plates is involved in the pathological process. In the thickness of the nail a patch of grayish-dirty color is formed. Over time, the affected nail plates become tuberous, easily crumbled, the free edge of the nail plate is raised due to its splitting into several layers. Then the nail plate becomes black.

Zoanthroponotic (infiltrative-suppuration) trichophytosis

The disease is caused by Trichophyton gypscum and Trichophyton verrucosum, belonging to zoophilic fungi. The incubation period for trichophytosis caused by Trichophyton verrucosum is 1-2 months, and with Trichophyton gypseum - 1-2 weeks. The above pathogens parasitize on rodents (mice, including laboratory ones, rats, etc.), cows, calves, less often - on horses, sheep and other animals. The source of infection are sick animals, less often - a sick person.

Symptoms

Clinically distinguish 3 forms of zoonotic trichophytosis: superficial, infiltrative and suppuration.

With a superficial form, large foci of lesion with scalloped contours appear on the affected skin due to their fusion with each other. Foci of lesions are rounded, pink, their surface is covered with scales, and along the periphery there is a continuous cushion, consisting of vesicles and crusts. Infiltrative form is characterized by the development of infiltration in the lesion and painful regional lymphadenitis.

In the future, inflammatory phenomena increase, and against the background of infiltration on the surface and in the outbreaks there are numerous folliculitis and yellow-brown crusts. After peeling, it can be found that pus is released from each follicle separately, although the first impression is that the patient has one large and deep abscess. These pockets are very similar to honey, which stands out from honey combs (kerion Celsi - honeycombs of Celsius). Infiltrative and suppuration forms of trichophytosis when localized on smooth skin flow less sharply - foci of the kerion Celsi type on it are almost not formed. With the location of the foci on the upper lip, cheeks and chin, the clinic resembles sycosis ("parasitic sycosis"). Pus, present in the lesion, is able to lyse (dissolve) fungi, in connection with which cases of self-healing are noted. After the process is resolved, scars remain.

With infiltrative-suppuration trichophytosis on the scalp, and in men, also in the area of growth of the beard and mustache, there are one or two sharply limited inflammatory nodes protruding above the surface of the skin and painful on palpation. At first they have a dense consistency, and then soften. Their surface is covered with thick purulent-bloody crusts. Hair, piercing the crusts, seem unchanged, but when pulled, they are easily removed. In places, more on the periphery of the foci, follicular pustules are visible. After the removal of the crusts along with the hair, a hemispherical inflamed surface is exposed with a number of dilated mouths of the hair follicles, from which, when squeezing the focus, pus drops out. This form, known since ancient times by the name of the Roman physician Celsus, honeycomb).

At the height of development mycosis is accompanied by an increase in regional subcutaneous lymph nodes and a violation of the general condition - malaise, fever. Often there are mycids - secondary allergic nodular and spotted rashes on the trunk and extremities. After 2-3 months without treatment, the mycotic process subsides, and the filtrate resolves, scar alopecia remains and specific immunity forms. Similar changes develop when the region of the beard and mustache are affected. This disease is called parasitic sycosis.

Zooanthroponotic trichophytosis of pubic localization

Zooanthroponotic trichophytosis of pubic localization in the scientific literature was first described by SS Arifov, 3. M. Abidova and AS Lukyanova (2003). The authors examined 356 patients with zooanthroponotic trichophytosis (men - 237, women - 119). Of these, children under 14 years old - 141. In 215 of 356 patients, the pathological process was located in the pubic region. 148 (68.8%) of 215 patients linked their illness to sexual intercourse. Of these, 149 (69.7%) patients had different STIs: ureoplasm - in 38.2% of the Gardeningella - in 21.2%; candidate albikans - in 14.8%; chlamydia - 12.7%; syphilitic infection - in 4.2%; gonococci - 2,1%; trichomonas - in 2.1% and in 4.2% of patients, the ELISA was postponed for HIV infection.

The authors suggest, from the epidemiological and preventive point of view, to include the trichophytosis of pubic localization in the STI group.

Differential diagnosis

The disease should be distinguished from pyoderma, microsporia, psoriasis, etc.

[21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31]

Treatment of trichophytosis

With superficial trichophytosis with a lesion of only the skin, the presence of single foci (without involvement in the process of hair), it is sufficient to use external means. At local treatment it is necessary to take into account the stage of inflammation (wetness, swelling, etc.), using lotions, pastes. After removal of acute inflammatory phenomena, 3-5% solution of iodine, Castellani paint, travogen, lamizil, clotrimazole, mycospores, mycoseptin etc. Are prescribed as antifungal agents. The most effective in external therapy is lamilicol in the form of a cream or gel. Experience with this drug showed that lamizil, as a fungicidal drug, allows for a short time to achieve a high percentage of clinical and mycological recovery compared with other antimycotics. It is applied once a day for a week. In case of damage to the scalp, multiple damage to smooth skin involving gun hair, systemic antimycotics are used. Assign inside griseofulvin (in a daily dose of 18 mg / kg - for children or 12.5 mg / kg - for adults) or lamizil (up to 20 kg - 62.5 mg, 20 to 40 kg - 125 mg and more than 40 kg and adults - 250 mg) once a day for 28 days.

When the scalp is affected, 2-5% iodine solution, antimycotic ointments (lamizil, travogen, etc.) are applied externally. When treating patients with chronic trichophytosis, it is advisable to use the means of pathogenetic therapy and immunomodulators.

Prevention is carried out jointly with the veterinary service for the identification of sick animals and their deratization. It is necessary to conduct an examination of family members of the patient and children's groups.